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Reproduction and Sexual Health > menstrual disorders > Flashcards

menstrual disorders Flashcards

1
Q

GnRH is secreted by the hypothalamus and stimulates the release of what two hormones from the ant pituitary

A
  • FSH
  • LH
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2
Q

FSH initiates what growth?

A
  • follicular growth
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3
Q

LH stimulates what?

A
  • further development of follicles
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4
Q

FSH and LH stimulate ovarian follicles to secrete what?

A
  • oestrogen
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5
Q

progesterone is secreted mainly by what?

A
  • corpus luteum
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6
Q

progesterone and oestrogen work together to do what?

A
  • maintain endometrium ready for implantation
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7
Q

what hormone allows primary follicles to develop into secondary follicles?

A
  • FSH
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8
Q

a fall in what hormones stimulates the release of prostaglandins causing uterine spiral arterioles to constrict?

A

oestrogen and progesterone

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9
Q

what part of the endometrium sloughs off after the cells supplying the spiral arterioles die off?

A
  • stratum functionalis
    -> leaving thin stratum basalis (2-5mm)
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10
Q

what is the normal amount of blood loss from the vagina?

A

5-80ml

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11
Q

what phase of the menstrual cycle varies in time?

A
  • preovulatory phase
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12
Q

which type of follicles secrete oestrogen?

A
  • secondary follicles
  • one secondary follicle outgrows the rest to become dominant and develops into the graafian follicle
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13
Q

what happens in the uterus in response to oestrogens being released into the circulation?

A
  • oestrogen released by the secondary follicles and graafian follicle stimulates the growth of the endometrium
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14
Q

what part of the endometrium undergoes mitosis during the preovulatory phase?

A
  • stratum basalis and produces a new stratum functionalis
  • endometrial thickness doubles to 4-10mm
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15
Q

what day does ovulatory phase occur?

A
  • day 14 (14 days before menstruation)
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16
Q

what occurs in the ovaries during the ovulatory phase?

A
  • oestrogen stimulates more GnRH release
  • leading to an increase in LH and FSH
  • LH causes the rupture of the graafian follicle and expulsion of a secondary oocyte (approx 9 hrs after the LH surge)
  • the oocyte is taken into the fallopian tube
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17
Q

what occurs in the uterus during the ovulatory phase?

A
  • progesterone and oestrogen continue to stimulate proliferation of the endometrium
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18
Q

what occurs in the ovaries during the preovulatory phase?

A
  • secondary follicles secrete oestrogen
  • one secondary follicle outgrows the rest to become the dominant and develops into the graafian follicle
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19
Q

what occurs in the uterus during the preovulatory phase?

A
  • oestrogens released into the circulation by the growing secondary follicles and graafian follicle stimulate growth of the endometrium
  • cells of stratum basalis undergo mitosis and produce new stratum functionalis
  • endometrial thickness doubles - 4-10mm
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20
Q

how long does postovulatory phase occur for?

A
  • routinely lasts for 14 days w little variation
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21
Q

what occurs in the ovary during the postovulatory phase?

A
  • the collapsed follicle becomes the corpus luteum under the influence of LH
  • the corpus luteum secretes progesterone, oestrogen, relaxin, and inhibin
  • if fertilisation does not occur, this secretory activity declines after 2 weeks and a new cycle begins
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22
Q

what occurs in the uterus in the postovulatory phase?

A
  • progesterone and oestrogen promote growth and coiling of the endometrial glands, vasculisation and further thickening of the endometrium - 12-18mm
  • endometrial glands begin to secrete glycogen
23
Q

how long does a normal cycle last for and how long should bleeding occur for?

A
  • 24-38 days
  • bleeding should last 8 days or less each cycle
24
Q

how many women are affected by pre-menstrual disorders?

A
  • 5% of women
  • seen as a disorder when premenstrual symptoms impact on daily living
25
Q

name 3 physical symptoms in PMD?

A
  • breast tenderness
  • bloating
  • headache
26
Q

name 3 psychological symptoms in PMD?

A
  • mood swings
  • anger
  • depression
27
Q

name 3 behavioural symptoms in PMD?

A
  • sleep disturbance
  • change in appetite
  • restlessness/poor concentration
28
Q

what helps make a diagnosis of PMD?

A
  • keeping a symptom diary - paper, online, apps
  • needs to occur for a minimum of 2 cycles
29
Q

what kind of management is used for PMD?

A
  • ovulation suppression through a variety of different medications
30
Q

what is the 1st line tx for PMD?

A
  • Yasmin and Eloine COC (combined oral contraception pill)

-> can be used continuously
-> those containing drospirenone COC have proven impact

31
Q

name some other treatments for PMD?

A
  • GnRH agonists
  • danazol
  • oestrogen
  • bilateral oophorectomy and hysterectomy w add back oestrogen only
32
Q

side effect of GnRH agonists

A
  • menopausal symptoms i.e. hot flushes and osteoporosis
  • trial of tx 3-6 months
33
Q

what is GnRH indicated for?

A
  • PMD and approaching menopause
  • severe endometriosis in younger women to see if they would benefit from an oophorectomy or hysterectomy (i.e. if symptoms improve opt for surgery)
34
Q

side effects of Danazol?

A
  • teratogenic effect so must be used alongside contraceptive
35
Q

side effect of oestrogen

A
  • unopposed oestrogen increases chances of endometrial hyperplasia or cancer
  • counteracted by giving progesterone but can bring on PMD symptoms again…
36
Q

other pharmacological and lifestyle mx for ovulation suppression?

A

SSRIs
- used continuously or during luteal phase only

Diuretics
- reduce bloating

Herbal supplements

CBT

Exercise

vit B6 and calcium

37
Q

what is heavy menstrual bleeding?

A
  • blood loss is perceived by the patient as interfering w physical, social, emotional or material aspect of a woman’s life.
38
Q

assessment for heavy menstrual bleeding?

A
  • exclude pregnancy
  • history and examination
  • bloods (anaemic), cervical smear, swab for infection, USS and if clinically indicated coag screen
  • if no abnormality or fibroids <3cm causing no distortion of uterine cavity start medical mx
39
Q

1st line mx for heavy menstrual bleeding

A

mirena coil
- slowly releases localised progesterone and prevents proliferation of endometrium

40
Q

2nd line heavy menstrual bleeding?

A
  • tranexamic acid
    anti-fibrolytic

or
- COC
suppresses ovulation and endometrial proliferation, regulates cycle

41
Q

3rd line for heavy menstrual bleeding?

A

norethisterone
- prevents proliferation of the endometrium

DMPA
- long acting progesterone, suppresses ovulation and prevents proliferation of the endometrium

42
Q

4th line for heavy menstrual bleeding?

A
  • surgical management/referral to secondary care
43
Q

main cause of menstrual bleeding?

A
  • fibroids (20-30%)
    benign SM tumours of uterus, v common, harmless unless they have a pressure affect
44
Q

other causes of menstrual bleeding?

A
  • polyps 5-10%
    may be diagnosed on spec exam, USS or hysteroscopy
    may be endometrial or endocervical
  • adenomyosis 5%
    presence of non-neoplastic endometrial glands and stroma in myometrium instead of endometrium
45
Q

what is adenomyosis?

A

presence of non-neoplastic endometrial glands and stroma in myometrium

assoc w hyperplasia and hypertrophy of surorunding myometrium

46
Q

risk factors for adenomyosis?

A
  • associated with a history of c/section, uterine curettage, surgical termination of pregnancy, inc age, oestrogen exposure and tamoxifen use (blocks action of oestrogen - given as a prevention in breast cancer)
47
Q

most common coagulative pathology causing heavy menstrual bleeding?

A
  • von willebrand disease
48
Q

von willebrand typical presentation?

A
  • younger patient presenting not long after menarche - w heavy menstrual bleeding
49
Q

how else is coagulopathy caused?

A
  • medication
  • PPH, inc bleeding during surgery or inc bleeding during dental work
  • referral to haem required
50
Q

red flag concern for heavy menstrual bleeding?

A
  • malignancy
51
Q

surgical mx for polyp?

A
  • hysteroscopy then polypectomy
52
Q

surgical mx for minimising monthly blood flow or stopping it?

A
  • endometrial ablation
  • less effective in younger patients and it is not contraceptive
53
Q

surgical mx for fibroids?

A
  • uterine artery embolization
    cut off blood supply and thus shrink fibroid
    can be a painful procedure

or

  • myomectomy - fibroids removed surgically from uterus and preserving the uterus (for fertility reasons)
54
Q

indications for hysterectomy?

A
  • older patient
  • had a family, do not wish to have any more children

Reproduction and Sexual Health (29 decks)

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