Menstrual Disorders Flashcards
what is the normal amount of blood lost during menstruation?
- less than 80ml over 7 days (16 tsp)
- average loss: 30-40ml (6-8tsp)
list the potential causes of heavy menstrual bleeding
- uterine fibroids
- endometrial polyps
- endometriosis and adenomyosis
- PID and infection
- endometrial hyperplasia or carcinoma
- PCOS
- coagulation disorders
- hypothyroidism
- liver or renal disease
- anticoagulant treatment
- herbal supplements (gingseng, ginkgo, soya)
- IUD
what are uterine fibroids?
- non-cancerous growths made of muscle and fibrous tissue, also called myoma or lieomyoma
uterine fibroids symptoms
- HMB
- pelvic pain
- urinary symptoms
- pressure symptoms
- backache
- infertility
- miscarriage
uterine fibroids diagnosis imaging
US
uterine fibroids levels of treatment
- for HMB +/- small fibroids > COCP, POP, Mirena
- large fibroids and fertility preservation desired > fibroid embolisation, myomectomy
- submucosal fibroids > hysteroscopic fibroid resection
- declined or failed medical treatment & fertility preservation not required > hysterectomy
endometriosis definition
Defined as endometrial tissue present outside the lining of uterus .During menstruation this ectopic tissue behaves the same as endometrium and bleeds
endometriosis symptoms
- may present with HMB
- painful menstrual cramps that worsen over time
- pain during and after intercourse
- lower back pain
- painful bowel movements or urination
- abnormal bleeding ot spotting between menstrual periods
- infertility
- fatigue
- diarrhoea, nausea, bloating
what are the four stages of endometriosis?
- stage 1, minimal: small patches, surface lesions or inflammation on or around organs in pelvic cavity
- stage 2, mild: more widespread and starting to infiltrate pelvic organs
- stage 3, moderate: peritoneum or other structures, sometimes also scarring and adhesions
- stage 4, severe: infiltrative and affecting many pelvic organs and ovaries, often with distortion of the anatomy and adhesions
endometriosis diagnostic investigations
- pelvic exam
- US, diagnostic laparoscopy
endometriosis management options
- analgesia]
- medical: COCP, POP, Mirena IUS, depot provera, GnRH analogues
- ## surgical: ablation, hysterectomy endometrioma excision, pelvic clearance, hysterectomy
describe uterine adenomyosis
- a condition where endometrium becomes embedded in myometrium
adenomyosis symptoms
- HMB
- may have dysmenorrhea
adenomyosis treatment
- may respond to hormones partially
- definitive treatment is hysterectomy
describe endometrial polyps
- overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
- mostly benign
endometrial polyps diagnosis
US
hysteroscopy
HMB investigations
- thorough history
- pelvic exam (speculum, bimanual) remember to look at cervix
- clotting profile, thyroid function
- pelvic US scan
- laparoscopy if endometriosis suspected
- endometrial biopsy from all patients aged 44 or above with HMB, refractory to medical treatment
HMB medical treatment
- tranexamic acid (antifibrolytics) reduces blood loss by 60%
- mefenamic acid (prostaglandin inhibitor) reduces blood loss 30% and pain
- hormonal contraception
- COCP
- LNG IUS and Depo-Provera reduces bleeding
- oral progestogens e.g. provera
hysterectomy risks
- infection
- dvt
- bladder/bowel/vessel injury
- altered bladder function
- adhesions
list some causes of oligo/amenorrhea
infrequent, absent or abnormally light menstruation
- life changes: stress, eating disorders/malnourishment, obesity, intense exercise
- hormones: POP, mirena, depot injection
- primary ovarian insuffiecieny
- PCOS
- hyperprolactinaemia
- prolactinomas
- thyroid (Grave’s disease)
- obstructions of the uterus, cervix, and/ or vagina
PCOS is a metabolic syndrome, with diagnosis confirmed if 2 of the following 3 criteria are met:
- abnormal US appearance of ovary
- biochemical hyperandrogegism
- clinical hyperandrogegism
what is considered dysfunctional uterine bleeding?
- DUB is a common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases.
