Menstrual Disorders Flashcards
What is the normal loss of blood during a menstrual cycle?
Less than 80ml over 7 days - 16 tsp
Average is 30-40ml
Average duration is 2-7 days
What is the average length of the menstrual cycle?
28 days
When is the average menarche?
10-16 years, average is 12 years
What is the average age for menopause?
50-55 years
What are disturbances of menstruation?
Menstrual frequency
Irregular menstrual bleeding - absent or irregular
Abnormal duration of flow
Abnormal menstrual volume
What are the normal and abnormal limits of frequency of periods?
Frequent is under 24 days
Normal is 24-38
Infrequent is more than 38 days
What are the normal and abnormal limits of regularity of period?
Absent/ amenorrhoea
Regular is less than 20 days variation in 12 months and irregular is more than 20 days
What are the normal and abnormal limits of volume of periods?
Heavy is more than 80ml
Normal is 5-80ml
Light is less than 5ml
What is the definition of heavy menstrual bleeding?
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
What is a common health complication of heavy menstrual bleeding?
Anaemia
What are some uterine and ovarian pathologies causing HMB?
Uterine fibroids
Endometrial polyps
Endometriosis and adenomyosis
PID and pelvic infection
Endometrial hyperplasia or carcinoma
Polycystic ovary syndrome
What are some systemic disease which can cause HMB?
Coagulation disorders - Willebrand disease
Hypothyroidism
Liver or renal disease
What are some iatrogenic causes of HMB?
Anticoagulation treatment
Herbal supplements - ginseng, ginkgo and soya
Intrauterine contraceptive device (CU IUD)
What does PALM COEIN stand for?
Polyps, Adenomyosis, Leiomyoma/ fibroid and Malignancy
Coagulopathy, Ovulation dysfunction, Endometrium, Iatrogenic and Not classified
What are fibroids?
Non cancerous growths made of muscle and fibrous tissue
Also called myoma and leiomyoma
What is the presentation of fibroids?
May be asymptomatic
HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility and miscarriage
How are fibroids diagnosed?
US
What is the management for fibroids?
HMB and small - COCP, POP and Mirena
Large and fertility preservation - embolization and myomectomy
Submucosal - hysteroscopic resection
Hysterectomy
What is endometriosis?
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
What are the symptoms of endometriosis?
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
What are the stages of endometriosis?
Minimal - small patches, surface lesions or inflammation in pelvic cavity
Mild - infiltrates pelvic organs
Moderate - peritoneum
Severe - pelvic organs and ovaries
How is endometriosis diagnosed?
Pelvic examination
US and diagnostic laparoscopy
What are the management options for endometriosis - medical?
COCP, POP, Mirena IUS, depot provera and GnRH analogues
What is the surgical management for endometriosis?
Ablation, hysterectomy endometrioma excision and pelvic clearance hysterectomy
Surgery may be needed for fertility treatment
What is adenomyosis?
Endometrium becomes embedded in the myometrium
HMB and significant dysmenorrhoea
May respond to hormones but definitive treatment is hysterectomy
What are endometrial polyps?
Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into the endometrium
Mostly benign
How is endometrial polyps diagnosed and managed?
US or hysteroscopy
Polypectomy
What is the management of HMB?
History, pelvic exam, clotting profile, thyroid function, pelvic US, laparoscopy and management options
Biopsy if above 44 years old
What are some non-hormonal treatments for menstrual disorders?
Mefenamic acid, tranexamic acid and GnRH analogues
Endometrial ablation, fibroid embolization and hysterectomy
What does tranexamic acid do?
Antifibrinolytic
Reduces blood loss by 60%
What does mefenamic acid do?
Prostaglandin inhibitor
Reduces blood loss by 30% and pain
Describe endometrial ablation
Permanent destruction of endometrium using different energy sources
Under hysteroscopic vision or thermal balloon and radio frequency
What are the pre-requests for endometrial ablation?
Uterine cavity length more than 11cm
Submucosal fibroids less than 3cm
Previous normal endometrial biopsy
What are the types of surgical removal of the uterus?
Abdominal, vaginal and laparoscopic - LAVH and TLH
Total - cervix and uterus removed
Subtotal - uterus and cervix left
What are the risks of hysterectomy?
Infection, DVT, bladder, bowel, vessel injury, altered bladder function and adhesions
What are the advantages and disadvantages of oophorectomy?
Immediate menopause - recommend HRT till age 50
Reduces risk of subsequent ovarian cancer
What is amennorhoea?
Infrequent, absent or abnormally light menstruation
What are the causes of amennorrhoea?
Life changes (stress, eating disorders, obesity and exercise), hormones, primary ovarian insufficiency, polycystic ovarian disease, hyperprolactinemia, thyroid disorders and obstructions
What is polycystic ovary syndrome?
Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria met
US appearance of ovary
Biochemical hyperandrogenism
Clinical hyperandrogenism
What is polycystic ovary syndrome associated with?
Associated with infertility and obesity
Results in amenorrhoea
What is the management for polycystic ovary syndrome?
Lifestyle adjustments - normal BMI
Symptom based treatment
3 withdrawal bleeds required to prevent hyperplasia
COCP, POP and Mirena IUS
What is dysfunctional uterine bleeding (DUB)?
Common disorder of excessive uterine bleeding affecting premenopausal women
Underlying physiology is ovarian hormonal dysfunction
Exclude PALM COEIN
What is the management for dysfunctional uterine bleeding (DUB)?
GnRh analogues - cause a pseudo menopause
Up to 6 months therapy
Add back HRT till patient is confirmed menopausal
