Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YEAR 4 REPRO > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

abnormal menstruation, including PCOS, fibroids, endometriosis, polyps, endometrial hyperplasia and infections

1
Q

What is Oligomenorrhoea?

A

Infrequent periods (less than 6-8 periods a year)

Cycle > 35 days but less than 6 months in length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Oligomenorrhoea Causes?

A

Annovulation:
PCOS
Thyroid disease
Prolactinoma
CAH

Constitutional: not pathological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is PCOS?

A

Heterogenrous endocrine disorder with unknown aetiology

Familial clustering
90% of cases of amenorrhoea
Usually emerges in adolesence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Features of PCOS?

A

Hyperandrogenism:
Acne
Hirsuitism
Obsesity
Anovulation:
Oligo/amenorrhoea
Multiple ovarian follicles on USS (string of pearls)
and/or ovarian volume >10cm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnostic criteria for PCOS

A

Rotterdam Criteria: 2 of the following 3 are present:

Infrequent or no ovulation

Clinical and/or biochemical signs of hyperandrogenism (hirsuitism, acne, or elevated levels of total or free testosterone)

Needs to have 12 or more follicles on one or both ovaries on USS and/or increased ovarian volume > 10cm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DDx of PCOS?

A

Simple obsesity
Premature ovarian failure
Thryoid diease
Hyperprolactinaemia
CAH
Androgen secreting tumours
Cushing’s Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations for PCOS?

A

In follicular phase:
Sex Hormone Binding Globulin (normal to low)
Total testosterone (normal to raised)
*these two can be used to calculate Free Androgen Index- RAISED is a typical biochemical feature of PCOS

FSH,LH, TFTs and Prolactin- exclude other causes
FSH and LH should be taken at fixed point at cycle

Pelvic USS- multiple ovarian cysts

Check BM for impaired glucose tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PCOS Mangement?

A
  • Weight loss is the primary intervention tool esp in women who are trying to get prgenant and symptoms decrease (EBM)
  • Screening for imparied glucose tolerance
  • Psych and mental wellbeing and refer appropriately
  • Specific management of what the woman wants/ life stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Specific PCOS management for woman who wants periods?

A
  • COCP- helps with hyperandrogenic effects of PCOS
  • OR cyclical progesterone ( POP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCOS managment for someone who wants to conceive?

A

Reduce BMI to <30
Start Folic acid
Baseline fertility assessment incl semen analysis on partner
Refer to fertility services
May need to undergo ovulation induction using clomifene
Metformin is controversial- used often though in conjungtion with clomifene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment for PCOS for someone who wants to control acne and hirsuitism?

A

COCP
Acne: retinoids, abx etc. as per derm
Hirsuitism: waxing and laser hair removal

IF doesn’t respond to this may try topical eflornithine
spironolactone, flutamide and finasteride may be used under specialist supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Long-term implications of PCOS?

A
  • Metabolic disorders e.g. impaired glucose tolerance and T2DM
  • CVS disease
  • OSA
  • Infertility
  • Recurrent miscarriage
  • Pregnancy complications such as pre-eclampsia and gestational diabetes
  • Endometrial cancer
  • psychological disorders e.g. anxiety and depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are fibroids?

A

Benign uterine tumour primarily composed of smooth muscle and fibrous connective tissue (leiomyomata)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for uterine fibroids?

A

Increasing age (40s)
Afro-carribean ethnicity
Overweight
Vit D deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of fibroids?

A

Mostly asymptomatic
Heavy menstrual bleeding- may result in iron deficiency anaemia
Irregular firm central pelvic mass
Pelvic pain- esp during periods
Dysmenorrhoea
Bloating
fatigue
Subfertility
Urinary complaints

Rare:
polycythaemia secondary to autonomous prodcution of EPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for uterine fibroids?

A

Transvaginal and transabdominal USS
Endometrial biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DDx of fibroids?

A

Adenomyosis
Endometrial polyp
Endometrial hyperplasia
Endometrial Ca
Uterine sarcoma
Pregnancy
Ovaran Ca
GI Ca

18
Q

Managment of asymptomatic fibroids?

A

No treatment needed, other than periodic review to monitor size and growth

19
Q

Treatment of menorrhagia secondary to fibroids?

A

Levonorgestrel intrauterine system (LNG-IUS)
useful if the woman also requires contraception
cannot be used if there is distortion of the uterine cavity
NSAIDs e.g. mefenamic acid
tranexamic acid
combined oral contraceptive pill
oral progestogen
injectable progestogen

20
Q

Treatment to shrink/remove fibroids?

A

MEDICAL:
* GnRH agonists may reduce size of the fibroid but are typically used more short term due to their menopausal like side effects
* Ulipristal acetate has been in the past but not currently due to concerns about rare but serious liver toxcity
SURGICAL
* myomectomy- abdominally, laparoscopically or hysteroscopically
* hysteroscopic endometrial ablation
* hysterextomy

  • uterine artery embolization
21
Q

Prognosis of fibroids?

A

Usually regress after menopause

22
Q

Complications of fibroids?

A

Subfertility
Recurrence
Iron-deficiency anaemia
Red degeneration- haemorrhage into tumour- commonly occurs during pregnancy

23
Q

What is endometriosis?

A

Chronic inflammatory condition defined by endometrial stroma and glands found outside of the uteine cavity.

Most common sites affected: pelvic peritoneum and ovaries

24
Q

RF for endometriosis?

A

Reproductive age
Positive fhx
non-parous women
mullerian anomalies

25
Q

Features of endometriosis?

A

Dysmenorrhoea
Chronic or cyclic pelvic pain
Dyspareunia
Sub-fertility
non-gynaecological e.g. dysuria, urgency, haematuria, dyschezia

26
Q

Examination findings in endometriosis?

A

Pelvic examination:
* reduced organ mobility - fixed retroverted uterus is classical sign
* tender nodularity in the posterior vaginal fornix
* visible vaginal endometriotic lesions may be seen

27
Q

Investigations for endometriosis?

A

Laproscopy is the gold-standard investigation

Poor correlation between laparscopic findings and severity of symptoms

28
Q

Management of endometriosis (before secondary care referral)?

A

NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief

if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried

If analgesia/hormonal treatment does not improve symptoms or if fertility is a priority the patient should be referred to secondary care

29
Q

Management of endometriosis in secondary care

A

GnRH analogues - said to induce a ‘pseudomenopause’ due to the low oestrogen levels

drug therapy- not seem to have a significant impact on fertility rates

surgery: some treatments such as laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility

30
Q

How to treat endometriosis for a pt who wants to get immediate fertility?

A

Controlled ovarian hyper-stimulation
2nd line: IVF

31
Q

Complications of endometriosis?

A
  • Endometriomas (ovarian cysts containing blood and endometriosis-like tissue) — if the ovaries are affected, endometriomas may develop. These may rupture and can affect fertility by causing distortion of pelvic anatomy.
  • Fertility problems — endometriosis is commonly associated with infertility, with a prevalence of 25–40% in infertile women compared with 0.5–5% in fertile women [NICE, 2017]
  • Adhesion formation — may occur due to the endometriosis or secondary to surgery or infection, and may cause chronic pelvic pain.
  • Bowel obstruction — partial or complete bowel obstruction can occur due to adhesion formation or a circumferential endometriotic deposit.
  • Chronic pain
  • Reduced quality of life — symptomatic endometriosis can have a significant and sometimes severe impact on the woman’s quality of life and activities of daily living, including relationships and sexuality, work productivity, fitness, and mental health
32
Q

What is Peutz-Jeghers syndrome?

A

Rare
Autosomal dominant disorder characterised by hamartomatous polyposis caused by germline mutation sin the STK11 gene

Increases risk of GI and exra-GI cancers

33
Q

What is endometrial hyperplasia?

A

Defined as abnormal proliferation of the endometrium in excess of normal proliferation that occurs during the menstrual cycle.

Minority of pts with this may develop endometrial cancer

34
Q

Types of endometrial hyperplasia?

A

Simple
Complex
Simple atypical
Complex atypical

35
Q

Features of endometrial hyperplasia?

A

abnormal vaginal bleeding e.g. intermenstrual

36
Q

Managment of endometrial hyperplasia?

A

Simple with atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgesterel intra-uterine system may be used
Atypia: hysterectomy is usually advised

37
Q

Uterine polyps features?

A

bleeding in between periods
bleeding post menopause
irregular bleeding
heavy periods

38
Q

Investigations for endometrial polyps?

A

Hysteroscopy- then biopsied

39
Q

Treatment of endometrial polyps?

A

Removed surgically through a hysteroscope
May recur

40
Q

Polyps vs fibroids?

A

Fibroids- bengin and non-cancerous
Polyps: occur when that part of the lining doesn’t shed- they may become cancerous of precancerous

YEAR 4 REPRO (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions