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Obs and gynae > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

Menstrual cycle:

  • Describe the follicular phase (ovarian cycle) + proliferative phase (uterine cycle)
  • Describe the luteal phase + secretory phase
  • What is the normal frequency, duration and volume of a cycle
A
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2
Q

Primary amenorrhoea:

  • Definition
  • Causes (6)
  • Investigations
  • Management

Secondary amenorrhoea:

  • Definition
  • Causes
A

Primary amenorrhoea:

  • Definition: by age 15 with secondary characteristics or 13 with none
  • Causes (6): ovarian degenesis (turners) hypergonadotrophic hypogonadism, imperforate hymen, CAH/androgen insens syndrome, hypogonadotrophic hypogonadism (pit tumours, ibd, surg/radio)
  • Investigations: lh/fsh, oest/test, preg test, prolactin, tfts, xray wrist, uss
  • Management

Secondary amenorrhoea:

  • Definition : none for 3-6 months after previous normal for 6-12 months
  • Causes: preg, menop, prim ovarian insuff, ashermans, hyperprolactinoma, hyperthyroid, contracep, pcos
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3
Q

Oligomenorrhoea:

  • Definition
  • Causes
A
  • causes: pcos, anorexia, perimeno, contracep, prolactinoma, antipsych/epileptics
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4
Q

Dysmenorrhoea:

  • Definition
  • Symptoms + signs
  • risk factors
  • Causes (4)
  • Management
A

Dysmenorrhoea:

  • Definition: primary and secondary
  • Symptoms + signs
  • risk factors
  • Causes secondary (4): endometriosis, adenomyosis, pid, fibroids, iud
  • Management: if primary just nsaids like mefenamic acid or cocp. if secondary refer all patients to gynae
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5
Q

Menorrhagia:

  • Definition
  • What is metrorrhagia
  • Risk factors
  • Symptoms + signs
  • Causes
  • Investigations
  • Management
A

Menorrhagia:

  • Definition
  • What is metrorrhagia
  • Risk factors
  • Symptoms + signs
  • Causes : Polyps, Adenomyosis, Leiomya (fibroid), Malignant, Coag (warfarin/vwf), Ovulatory disorder (pcos, hypothyroidism), Endometriosis, Iatrogenic IUD
  • Investigations: fbc/coag, transvag uss if maybe structural cause
  • Management: mefenamic/tranexmic acid if want children. If not mirena, cocp, injection/implant
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6
Q

PCOS:

  • Definition + pathophysiology
  • Risk factors (4)
  • Symptoms + signs
  • DD (4)
  • Complications (5)
  • Investigations + rotterdam criteria
  • Management
A

PCOS:

  • Definition + pathophysiology: endocrine condition assoc with insulin resistance and hyperandrogenism due to increased gnrh. inc androgens suppresses SHBG haltering follicle development leading to infertility + oligomenorrhoea
  • Risk factors (4): fx, obese, diabetes
  • Symptoms + signs: hirsutism, acne, acanthosis nigricans, infertility, oligomen
  • DD (4)
  • Complications (5): infertility, gest diab, endometrial cancer, cvs disease
  • Investigations: ogtt/cbg, lh (v high!!)/fsh/oest/test, transvag uss
    Rotterdam criteria: 2/3: oligomen, acne/hirsut, 10cm vol or >11 follicles
  • Management:
    Cons: smoking, weight, diab control
    Hirsutism: cocp, topical eflornitine
    Infert: weight, clomifene, metformin
    oligo: cocp, mirena
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7
Q

Fibroids:

  • Definition
  • Types (4)
  • Risk factors
  • Symptoms + signs
  • DD (4)
  • Investigations
  • Management
  • Complications
A

Fibroids:

  • Definition : benign sm tumour of myometrium growing in response to oest
  • Types (4): pedunculated, submucosal, subserosal, intramural
  • Risk factors : fx, black, obese, menopause
  • Symptoms + signs: menorrhagia, bloating, abdo pain, urin/constipation, infert, dysparinea, enlarged non tender uterus
  • DD (4)
  • Investigations : transvag uss
  • Management: if assymp just monitor growth
    If <3cm + menorr mirena, mefenamic acid, cocp
    If >3cm refer to gynae. Can give gnrh agonists to reduce size. Then surgery myomectomy, endometrial ablation or hysterectomy or uterine artery embolisation. Should regress after menopause
  • Complications : iron deficiency, subfertility, red degeneration (esp during preg as inc oest, when growth outstrips blood supply, fever/pain/vomiting and needs rest/analgesia)
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8
Q

Cervical polyps:

  • Definition
  • Symptoms + signs
  • DD
  • Investigations
  • Management
  • Complications

Endometrial polyps:

  • Definition
  • Risk factors
  • Symptoms
A

Cervical polyps:

  • Definition
  • Symptoms + signs: bleed, discharge, infertility
  • DD
  • Investigations
  • Management : remove bc malig transformation so twist + cauterise and if bigger diathermy loop excision colposcopy
  • Complications

Endometrial polyps:

  • Definition : grows in response to oest
  • Risk factors : post meno, obesity, tamoxifen
  • Symptoms
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9
Q

Endometriosis:

  • Definition
  • Common locations
  • Risk factors (6)
  • Symptoms and signs
  • DD
  • Investigations
  • Management
  • Complications
A

Endometriosis:

  • Definition: endometrial tissue outside uterus
  • Common locations : pelvis, ovaries, pouch douglas, peritoneum
  • Risk factors (6): late menopausal/early menarche, smoking, fx
  • Symptoms and signs: cyclical pelvic pain, dysparinea deep, haematochezia/uria, dyschezia, diarrhoea, subfertility, fixed retroverted cervix
  • DD
  • Investigations : preg test, fbc/crp, transvag uss, lapro surgery + biopsy
  • Management: nsaids/paracetamol, cocp/imp/inj, gnrh agonists, laproscopy - excision + ablation + adhesiolysis (inc conception chances), hysterectomy
  • Complications
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10
Q

Adenomyosis:

  • Definition
  • Risk factors
  • Symptoms + signs
  • Investigations
  • Management
A

Adenomyosis:

  • Definition: endometrial tissue in the myometrium
  • Risk factors: post menopausal, uterine surgery, multiparity
  • Symptoms + signs : dysmenn, dyspar, menorrhagia, tender boggy uterus
  • Investigations : transvag uss
  • Management : tranexmic acid, mirena, gnrh agonist
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11
Q

Endometrial hyperplasia:

  • Definition + types
  • Symptoms
  • Risk factors
  • Causes
  • Investigations
  • Management
A

Endometrial hyperplasia:

  • Definition + types: benign hyperplasia -> EIN —> endo met adenocarc
  • Symptoms: bleeding abnormal
  • Risk factors: post menopausal, late menopausal/early menarche, tamoxifen, thyroid, pcos, diab
  • Causes: obese, pcos, menopausal, tamoxifen, granulosa cell tumours
  • Investigations : transvag uss + biopsy if >4mm post/>12mm pre
  • Management: mirena, tah + BSO if atypia
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12
Q

Menopause:

  • Definition
  • Symptoms
  • Complications
  • Management - contraception and symptom, lifestyle
  • HRT: indications (4), benefits, risks, contraindications, assessment before
A

Menopause:

  • Definition: dec in follicles means less oest therefore inc lh/fsh
  • Symptoms: no periods 12 months/irreg, hot flushes, night swabs, mood changes, reduced libido/dry, urinary freq
  • Complications: osteoporosis, cvs, urin incont/prolapse
  • Management - contraception and symptom, lifestyle
    Cont: if >50 cont for 1 year from last period, if <50 2 years (ius/iud/imp/inj)
    lifestyle: exercise, sleep, weight, stress, vag lubricants
    For vasomotor symptoms only then cbt, fluoxetine, citalopram
  • HRT: indications (4), benefits, risks, contraindications, assessment before: can use hrt to reduce porosis risk, reduce symptoms. Cont: unexplained bleeding, endomet hyperp, oest/breast cancer
    Risks: vte (not if transderm), stroke (oral oest only), chd (combined), ovarian, breast (combined)
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13
Q

Premature ovarian insufficiency:

  • Causes
  • Investigations
  • Management
A

Premature ovarian insufficiency:

  • Definition: onset of menopausal symptoms and elevated gonadotrophin levels before age 40
  • Causes: idiopathic/fx, coaeliac, t1dm, chemo/radio, bilat oophorectomy
  • Investigations: lh/fsh >25 on 2 separate occasions over a month apart, low oest
  • Management: cocp/hrt until 51
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14
Q

Premenstrual syndrome:

  • Definition
  • Investigations
  • Management
A

Premenstrual syndrome:

  • Definition : emotional and physical symptoms in luteal phase
  • Investigations
  • Management : if mild lifestyle advice. if mod cocp. if severe ssri cont or during luteal
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15
Q

Cervical ectropion:
- definition
- risk factors
- symptoms
- mx

A

Cervical ectropion:
- definition: transformation zone on ectocervix where strat sq meets columnar, more columnar
- risk factors: inc oest (cocp, preg, ovulating)
- symptoms: discharge, post coital bleeding
- mx: nothing, ablation if troublesome

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16
Q

Post coital bleeding causes

A

cervical ectropion
cervicitis secondary to chlamydia
cervical ca
polyps
trauma
idiopathic

Obs and gynae (11 decks)

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