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Year 3- Reproduction > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

How long is the average menstrual cycle?

A

28 days

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2
Q

How long does menstruation last?

A

2-7 days

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3
Q

How much blood is lost during average menstruation?

A

30-40mls but less than 80mls over seven days is considered normal

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4
Q

Menarche?

A

First time a girl starts her period

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5
Q

What is the usual age for menarche?

A

10-16yrs

->average 12yrs

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6
Q

When does menopause usually happen?

A

50-55yrs

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7
Q

For menstrual cycle to be termed frequent, normal and infrequent, how may days would the cycle need to last?

A

Frequent = <24 days
Normal= 24-38 days
Infrequent= >38 days

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8
Q

Heavy menstrual bleeding?

A

Difficult to quantify but some of the following:

-80mls over 7 days in someone with a regular cycle
-needing to change a menstrual product every 2 hours
-passage of clots >2.5cm
-bleeding through clothes

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9
Q

If someone is passing a lot of clots throughout the day, what are they at risk of?

A

Anaemia

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10
Q

List some uterine/ovarian pathologies which can cause heavy menstrual bleeding.

A

Uterine fibroids
Endometrial polyps
Endometriosis
Pelvic inflammatory disease
Endometrial hyperplasia/carcinoma
Polycystic ovarian syndrome

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11
Q

List some systemic diseases and disorders which can cause heavy menstrual bleeding.

A

Coagulation disorder (e.g. Willebrand disease)
Hypothyroidism
Liver or renal disease

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12
Q

What are some other potential causes of heavy menstrual bleeding?

A

Anticoagulant treatment
Herbal supplements (ginseng, gingko and soya)
Intrauterine contraceptive device

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13
Q

What are fibroids?

A

Non-cancerous growths made of muscle and fibour tissue

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14
Q

What are the symptoms of fibroids?

A

Can be asymptomatic
Heavy menstrual bleeding
Pelvic pain
Urinary symptoms
Pressure symptoms
Backache
Infertility
Miscarriage

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15
Q

What investigation is used to make a diagnosis of fibroids?

A

Ultrasound

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16
Q

Management of fibroids?

A

Symptom based

For HMB +/- small fibroids- COCP, POP Mirena

Large fibroids and fertility preservation- fibroid embolization, myomectomy

Submucosal fibroids- hysteroscopic fibroid resection

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17
Q

If medical treatment of fibroids fails or the patient refuses, which procedure can be done?

A

Hysterectomy

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18
Q

Endometriosis?

A

Endometrial tissue present outside the lining of the uterus

->during menstruation, this ectopic tissue behaves the same as endometrium and bleeds

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19
Q

How can endometriosis present?

A

HMB
Most often presents with pelvic pain

->multi-system involvement, can be devastating as greatly affects quality of life

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20
Q

What can endometriosis cause?

A

Infertility

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21
Q

Symptoms of endometriosis?

A

Painful menstrual cramps that get worse over time
Lower back pain
Abnormal bleeding or spotting between periods
Pain during and after sex
Painful bowel movements/urination
Diarrhoea
Nausea
Blotting

->very hard to diagnose due to the symptoms. Commonly said it’s normal or heavy periods, often IBS if bowel symptoms but need to remember IBS is a diagnosis of exclusion so need to rule out endometriosis first

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22
Q

Summarise the stages of endometriosis.

A

Stage 1- minimal

Stage 2- mild, more widespread and starting to infiltrate pelvic organs

Stage 3- moderate, peritoneum or other structures. Sometimes scarring and adhesions

Stage 4- severe, infiltrative, affecting many pelvic organs and ovaries, often with distortion of the anatomy and adhesions

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23
Q

How is a diagnosis of endometriosis made?

A

Ultrasound
Diagnostic laparoscopy

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24
Q

What are the management options for endometriosis?

A

Medical
Surgical
Analgesia

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25
Q

Medical management of endometriosis?

A

COCP
POP
Mirena IUS
Depot prvera
GnRH Analogues

26
Q

Surgical management of endometriosis?

A

Ablation
Hysterectomy endometrioma excision
Pelvic clearance
Hysterectomy

27
Q

Adenomyosis?

A

A condition where the endometrium becomes embedded in the myometrium

28
Q

Symptoms of adenomyosis?

A

Heavy menstrual bleed
May be significant dysmenorrhoea (cramps)

29
Q

What is the definitive treatment of adenomyosis?

A

Hysterectomy

->may respond to hormone treatment partially

30
Q

Endometrial polpys?

A

Overgrowth of the endometrial lining, mostly benign

31
Q

How is diagnosis of endometrial polyps made?

A

Ultrasound or hysteroscopy

32
Q

Management of endometrial polyps?

A

Polypectomy

33
Q

What are some things to do when a patient presents with heavy menstrual bleeding?

A

Thorough history
Pelvic examination
Clotting profile
Thyroid scan
Pelvic ultrasound
Laparoscopy if endometriosis is suspected

34
Q

What are some of the hormone treatment options for menstrual disorders?

A

Mirena IUS
COCP
POP
Depot provera

35
Q

What are some of the non-hormone treatment options for menstrual disorders?

A

Mefenamic acid
Tranexamic acid
GnRh analogues

Endomometrial ablation
Fibroid embolization
Hysterectomy

36
Q

What is the purpose of tranexamic/mefenamic acid?

A

Reduces blood loss

->TA by 60%, MA by 30%
They do not regulate cycles

37
Q

What are the benefits of hormonal contraception in the management of menstrual conditions?

A

Makes period light, more regular and less painful

38
Q

What are the benefits of IUS or Depo-Prevera in the management of menstrual conditions?

A

Reduces bleeding
May cause irregular bleeding
Some women will be amenorrhagic

39
Q

What happens in endometrial ablation?

A

Permanent destruction of endometrium using different energy sources

40
Q

What are some of the pre-requisites for endometrial ablation?

A

Uterine cavity length <11cm
Sub mucous fibroids <3cm
Previous normal endometrial biopsy

41
Q

Hysterectomy?

A

Surgical removal of the uterus

42
Q

Total hysterectomy?

A

Cervix and uterus removed

43
Q

Subtotal hysterectomy?

A

Uterus removed, cervix left

44
Q

Hysterectomy can be done abdominally, vaginally or laparoscopically.
What is the preferred choice these days?

A

Laparoscopic

->especially if smaller uterus and no complications. Recovery is quicker.

45
Q

If the patient has had a total hysterectomy, do they need to keep getting smears?

A

No, as cervix has been removed.

Those with subtotal hysterectomy’s still will need smears

46
Q

Risks of hysterectomy?

A

Infection
DVT
Bladder/bowel/vessel injury
Altered bladder function
Adhesions

47
Q

What is one guarantee of a hysterectomy?

A

Amenorrhoea- no periods

48
Q

Salpingo-oophorectomy?

A

Removal fallopian tubes and ovaries

49
Q

When may the ovaries and the uterus be removed?

A

Women with endometriosis or presence of ovarian pathology

50
Q

What is a disadvantage of ooporectomy?

A

Immediate menopause

51
Q

Which drug is recommended until the age of 50 for anyone who has to get an oophorectomy?

A

HRT

52
Q

What is an advantage of an oophorectomy?

A

Reduces risk of subsequent ovarian cancer

53
Q

Oligo/menorrhea?

A

Infrequent, absent or abnormally light menstruation

54
Q

There are manyyyyy causes of oligo/amennorhea.

List some for awareness :)

A

Life changes: stress, ED/malnourishment, obesity, intense exercise

Hormones: POP, mirena, depot injection

Primary ovarian insufficiency

Hyperprolactinemia

Prolactinomas (adenomas on the anterior pituitary gland)

Thyroid disorders: Graves

Obstruction of the uterus, cervix and/or vagina

55
Q

What is polycystic ovary syndrome associated with?

A

Obesity
Infertility

56
Q

What are the three main features of PCOS?

A

Irregular periods
Excess androgen (hyperandrogegism)
Polycystic ovaries

->2/3 required for diagnosis

57
Q

What are some features of excess androgen (hyperandrogegism)?

A

Excess facial or baby hair due to high levels of testosterone

58
Q

Management of PCOS?

A

Lifestyle adjustment with aim to achieve normal BMI

59
Q

Patients with PCOS need to have at least 3 periods a year. Why? How is this done?

A

To reduce risks of endometrial hyperplasia

Can be done with either COCP, POP or mirena IUS

60
Q

What is dysfunctional uterine bleeding?

A

Common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic disease

->treatment based on severity of symptoms

61
Q
A

Year 3- Reproduction (33 decks)

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