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Reproductive System > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is the normal loss of blood during a menstrual cycle?

A

Less than 80ml over 7 days - 16 tsp
Average is 30-40ml
Average duration is 2-7 days

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2
Q

What is the average length of the menstrual cycle?

A

28 days

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3
Q

When is the average menarche?

A

10-16 years, average is 12 years

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4
Q

What is the average age for menopause?

A

50-55 years

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5
Q

What are disturbances of menstruation?

A

Menstrual frequency
Irregular menstrual bleeding - absent or irregular
Abnormal duration of flow
Abnormal menstrual volume

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6
Q

What are the normal and abnormal limits of frequency of periods?

A

Frequent is under 24 days
Normal is 24-38
Infrequent is more than 38 days

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7
Q

What are the normal and abnormal limits of regularity of period?

A

Absent/ amenorrhoea
Regular is less than 20 days variation in 12 months and irregular is more than 20 days

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8
Q

What are the normal and abnormal limits of volume of periods?

A

Heavy is more than 80ml
Normal is 5-80ml
Light is less than 5ml

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9
Q

What is the definition of heavy menstrual bleeding?

A

Bleeding over 80ml over 7 days and/ or need to change menstrual products every one to two hours and/ or bleeding through clothes
Affecting patients QoL

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10
Q

What is a common health complication of heavy menstrual bleeding?

A

Anaemia

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11
Q

What are some uterine and ovarian pathologies causing HMB?

A

Uterine fibroids
Endometrial polyps
Endometriosis and adenomyosis
PID and pelvic infection
Endometrial hyperplasia or carcinoma
Polycystic ovary syndrome

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12
Q

What are some systemic disease which can cause HMB?

A

Coagulation disorders - Willebrand disease
Hypothyroidism
Liver or renal disease

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13
Q

What are some iatrogenic causes of HMB?

A

Anticoagulation treatment
Herbal supplements - ginseng, ginkgo and soya
Intrauterine contraceptive device (CU IUD)

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14
Q

What does PALM COEIN stand for?

A

Polyps, Adenomyosis, Leiomyoma/ fibroid and Malignancy
Coagulopathy, Ovulation dysfunction, Endometrium, Iatrogenic and Not classified

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15
Q

What are fibroids?

A

Non cancerous growths made of muscle and fibrous tissue
Also called myoma and leiomyoma

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16
Q

What is the presentation of fibroids?

A

May be asymptomatic
HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility and miscarriage

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17
Q

How are fibroids diagnosed?

A

US

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18
Q

What is the management for fibroids?

A

HMB and small - COCP, POP and Mirena
Large and fertility preservation - embolization and myomectomy
Submucosal - hysteroscopic resection
Hysterectomy

19
Q

What is endometriosis?

A

Endometrial tissue present outside the lining of the uterus
During menstruation this ectopic tissue behaves the same as endometrium and bleeds
Affects women of reproductive age

20
Q

What are the symptoms of endometriosis?

A

Painful menstrual cramps that get worse over time, pain during and after intercourse, lower back pain, painful bowel movements/ urination, abnormal bleeding and diarrhoea, nausea and blotting

21
Q

What are the stages of endometriosis?

A

Minimal - small patches, surface lesions or inflammation in pelvic cavity
Mild - infiltrates pelvic organs
Moderate - peritoneum
Severe - pelvic organs and ovaries

22
Q

How is endometriosis diagnosed?

A

Pelvic examination
US and diagnostic laparoscopy

23
Q

What are the management options for endometriosis - medical?

A

COCP, POP, Mirena IUS, depot provera and GnRH analogues

24
Q

What is the surgical management for endometriosis?

A

Ablation, hysterectomy endometrioma excision and pelvic clearance hysterectomy
Surgery may be needed for fertility treatment

25
Q

What is adenomyosis?

A

Endometrium becomes embedded in the myometrium
HMB and significant dysmenorrhoea
May respond to hormones but definitive treatment is hysterectomy

26
Q

What are endometrial polyps?

A

Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into the endometrium
Mostly benign

27
Q

How is endometrial polyps diagnosed and managed?

A

US or hysteroscopy
Polypectomy

28
Q

What is the management of HMB?

A

History, pelvic exam, clotting profile, thyroid function, pelvic US, laparoscopy and management options
Biopsy if above 44 years old

29
Q

What are some non-hormonal treatments for menstrual disorders?

A

Mefenamic acid, tranexamic acid and GnRH analogues
Endometrial ablation, fibroid embolization and hysterectomy

30
Q

What does tranexamic acid do?

A

Antifibrinolytic
Reduces blood loss by 60%

31
Q

What does mefenamic acid do?

A

Prostaglandin inhibitor
Reduces blood loss by 30% and pain

32
Q

Describe endometrial ablation

A

Permanent destruction of endometrium using different energy sources
Under hysteroscopic vision or thermal balloon and radio frequency

33
Q

What are the pre-requests for endometrial ablation?

A

Uterine cavity length more than 11cm
Submucosal fibroids less than 3cm
Previous normal endometrial biopsy

34
Q

What are the types of surgical removal of the uterus?

A

Abdominal, vaginal and laparoscopic - LAVH and TLH
Total - cervix and uterus removed
Subtotal - uterus and cervix left

35
Q

What are the risks of hysterectomy?

A

Infection, DVT, bladder, bowel, vessel injury, altered bladder function and adhesions

36
Q

What are the advantages and disadvantages of oophorectomy?

A

Immediate menopause - recommend HRT till age 50
Reduces risk of subsequent ovarian cancer

37
Q

What is amennorhoea?

A

Infrequent, absent or abnormally light menstruation

38
Q

What are the causes of amennorrhoea?

A

Life changes (stress, eating disorders, obesity and exercise), hormones, primary ovarian insufficiency, polycystic ovarian disease, hyperprolactinemia, thyroid disorders and obstructions

39
Q

What is polycystic ovary syndrome?

A

Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria met
US appearance of ovary
Biochemical hyperandrogenism
Clinical hyperandrogenism

40
Q

What is polycystic ovary syndrome associated with?

A

Associated with infertility and obesity
Results in amenorrhoea

41
Q

What is the management for polycystic ovary syndrome?

A

Lifestyle adjustments - normal BMI
Symptom based treatment
3 withdrawal bleeds required to prevent hyperplasia
COCP, POP and Mirena IUS

42
Q

What is dysfunctional uterine bleeding (DUB)?

A

Common disorder of excessive uterine bleeding affecting premenopausal women
Underlying physiology is ovarian hormonal dysfunction
Exclude PALM COEIN

43
Q

What is the management for dysfunctional uterine bleeding (DUB)?

A

GnRh analogues - cause a pseudo menopause
Up to 6 months therapy
Add back HRT till patient is confirmed menopausal

Reproductive System (33 decks)

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