menstrual disorders Flashcards
LH peaks in what phase
end of follicular, before ovulation and goes down in ovulation
FSH peaks in what phase
end of follicular, before ovulation and goes down in ovulation
progesterone peaks in what phase
even and low throughout menstruation, follicular phase and ovulation, slowly rises and falls in luteal phase (for negative feedback on HPG axis)
oestrogen peaks in what phase
rises before ovulation and dips again, slow rise and fall in luteal as well (for negative feedback on HPG axis)
what hormone triggers ovulation
LH
what occurs in luteal phase
corpus luteum is the tissue in the ovary that forms at the site of a ruptured follicle following ovulation. It produces oestrogens, progesterone and inhibin to maintain conditions for fertilisation and implantation.
At the end of the cycle, in the absence of fertilisation, the corpus luteum spontaneously regresses after 14 days. There is a significant fall in hormones, relieving negative feedback, and resetting the HPG axis ready to begin the cycle again.
If fertilisation occurs, the syncytiotrophoblast of the embryo produces human chorionic gonadotropin (HCG), exerting a luteinising effect, and maintaining the corpus luteum.
causes of heavy menstrual bleeding
PALM COEIN
polyp
adenomyosis
leiomyoma and fibroid
malignancy
coagulopathy
ovulation dysfunction
endometrium/hyperplasia
iatrogrenic
not yet classified
presentation uterine fibroids
HMB
dysmenorrhea
pelvic pain
presentation endometrial polyps
HMB
intermenstrual bleeding
need endometrial polyps
presentation endometriosis and adenomyosis
HMB
dysmenorrhea
dyspareunia
severe pelvis pain
difficulty conceiving
need diagnostic laparoscopy
endometrial hyperplasia or carcinoma presentation
postcoital bleeding
intermenstrual bleeding
pelvic pain
PCOS presentation
anovulatory menorrhagia
irregular bleeding
dysfucntionl bleeding causes and what is
common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic disease
exclude PALM COEIN and usually caused by ovarian hormone dysfucntion
manage with GnRH analogues up to 6 months for patients who are nearly menopausal and have not responded to other treatment options
management of menstrual disorders (hormonal)
mirena IUS
COCP
POP
depo provera
management of menstrual disorders (non hormonal medical)
mefenamic acid- prostaglanidn inhibitor that reduces blood loss and pain
tranexamic acid- antifibrinolytic reduces blood loss
GnRH anaologue
