Menstrual disorders Flashcards

1
Q

Define dysfunctional uterine bleeding

A

any symptomatic variation from normal menstruation (regularity, frequency, duration, volume) when not pregnant. Includes IMB
normal - 24-38 day cycle, variation of no more than 9 days, duration up to 8 days, volume - subjectively intervening with life

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2
Q

What are the physiological/endocrine factors that can impact on bleeding?

A

Thyroid - hypothyroidism can cause HMB (mainly causes Oligo- or amenorrhoea)
HPA - responsible for normal menstrual cycle
coagulation cascade/clotting factors

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3
Q

What are the risk factors for DUB?

A
  • obesity
  • PCOS
  • Tamoxifen
  • Hypothyroidism
  • Nulliparity
  • unopposed estrogen
  • Lynch syndrome
  • diabetes
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4
Q

What are two non hormonal treatments for DUB and what are their MOA?

A
  • TXA - inhibits fibrinolysis and slows clot break down

- NSAIDs - inhibit prostaglandin production in the endometrium –> vasoconstriction and reduced bleeding

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5
Q

What is the incidence of PMS?

A

40%

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6
Q

What is the pathogenesis of PMS?

A
  • sensitivity to progesterone (elevated in luteal phase)

- serotonin and GABA receptors being activated by progesterone and estrogen

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7
Q

What is the definition of PMS?

A

cyclical emotional or physical symptoms that are worse in the luteal phase and improve with menstruation
symptom free week during menses
interfere with daily activities

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8
Q

How should PMS be managed?

A
  • exclude other pathology
  • confirm diagnosis with symptom diary
  • treat with COCP/SSRI/CBT/VIt B6/Topical estrogen/GnRH agonist/TAH + BSO (???)
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9
Q

Why is normal menstruation self limiting?

A
  • shedding of functional layer of endometrium
  • vasoconstriction within basal layer
  • coagulation cascade
  • muscle contraction of myometrium compressing uterus and vessels
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10
Q

How effective is the mirena for menorrhagia?

A

90% of cases but may take up to 6 months to work

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11
Q

How effective is ablation for treatment of menorrhagia?

A

97% effective

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12
Q

list 4 disadvantages of ablation for treatment of menorrhagia

A

still require contraception (if fall pregnant risk of placentation issue)
may require repeat procedure
risks of procedure itself
cannot easily sample endometrium in future (risk of endometrial cancer)

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13
Q

What regimen of SSRI would you use as first line treatment for someone with PMS?

A

10mg citalopram in luteal phase e.g day 15 -28

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14
Q

List 5 advantages of uterine artery embolisation of treatment of fibroids

A
  • avoid surgery/anaesthesia
  • shorter hospital stay
  • potentially fertility sparing
  • potentially cheaper than surgical management
  • shorter recovery time
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15
Q

list 5 disadvantages of uterine artery embolisation (when cf myomectomy)

A
  • unproven for fertility sparing
  • more post procedure pain than surgical management
  • higher re-operation rate
  • requires arterial anatomy compatible with embolisation
  • exposure to radiation
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16
Q

give 2 examples of 1st generation endometrial ablation methods

A

diathermy loop

roller ball ablation

17
Q

Give 2 examples of 2nd generation endometrial ablation methods

A

microwave ablation

impedance control ablation

18
Q

List 5 absolute contraindications to endometrial ablation

A
  • pregnancy
  • endometrial hyperplasia/cancer
  • active genital tract infection
  • previous myomectomy or classical c/s (as may weaken myometrium)
  • small uterus (<4cm)
19
Q

List 3 relative contraindication to endometrial ablation

A
  • uterine pathology such as septum
  • uterus >10cm
  • condition predisposing to malignancy e.g. LYNCH syndrome