menstrual disorders Flashcards
What is a menstrual cycle
time from the first day of period to the day before her next period
What is the normal blood loss in menstruation
less than 80ml over 7 days
How long does a cycle last
28 days
When is the menarche (first menstrual period)
10-16 years - 12 years average
When is menopause usually
Lat period - 50-55 years
Describe the menstrual cycle with regards to hormones
FSH which is released from the pituitary gland which then causes the production of estrogen
The follicles of the ovary start to develop but only one begins to mature – the dominant follicle
There is a LH surge which causes ovulation
Following the LH surge, the estrogen starts to decrease while the progesterone begins to increase
What is a sign that someone is having heavy menstrual bleeding
Clots are seen in the menstrual bleeding
What are the causes of heavy menstrual bleeding
Uterine fibroids
Endometrial polyps
Endometriosis and adenomyosis
Pelvic inflammatory disease or infections e.g chlamydia
Endometrial hyperplasia or carcinoma
Polycystic ovary syndrome
Coagulation disorders
Hypothyroidism
Renal or liver disease
What are fibroids
Non cancerous growths made of muscle or fibrous tissue - also known as a myoma
What are the symptoms caused by fibroids
Heavy menstrual bleeding, Pelvic pain, urinary symptoms, pressure symptoms, backache, infertility and miscarriage
Asymptomatic
How are fibroids diagnosed
Ultrasound
What is the treatment for large fibroids with preservation of fertility desired
Fibroid embolisation or myomectomy
What is the treatment for submucosal fibroids
Hysteroscopic fibroid resection
What is the treatment for Heavy menstrual bleeding and small fibroids
COCP
POP
Mirena
What is a myomectomy
Surgery to remove uterine fibroids
What is endometriosis
Endometrial tissue present outside the lining of the uterus - this tissue behaves like the endometrium during menstruation and bleeds
What are the symptoms of endometriosis
Heavy menstrual bleeding, painful menstrual clamps that progressively get worse, infertility, fatigue and systemic symptoms, painful bowel movements or urination, pain during or after intercourse, abnormal bleeding or spotting in between menstrual periods, diarrhoea, nausea and bloating, lower back pain
Describe the stage 1 of endometriosis
Minimal - surface lesions or inflammation around pelvic organs in the pelvic cavity
Describe stage 2 of endometriosis
Mild - infiltrating pelvic organs and more widespread than stage 1
Describe stage 3 endometriosis
Moderate - Peritoneum (pelvic side walls) and other structures affected - sometimes there is scarring
Describe stage 4 endometriosis
Infiltrative and affecting many pelvic organs and ovaries often with distortion of the anatomy
What is the treatment for endometriosis
Analgesia
COCP, POP, Mirena IUS, GnRH analogues
Surgical - ablation, hysterectomy endometrioma excision, pelvic clearance, hysterectomy
What is adenomyosis
Condition in which the endometrium becomes embedded in the myometrium
What are the symptoms of adenomyosis
Heavy menstrual bleeding
Dysmenorrhoea
Partial response to hormones
What is the definitive treatment for adenomyosis
Hysterectomy
What are endometrial polyps
Overgrowth of endometrial lining leading to pediculated structures called polyps which extend into the endometrium
How are endometrial polyps diagnosed
Mainly ultrasound
What is the management of polyps
Polypectomy
What is the function of tranexamic acid
Reduces blood loss by 60%
What is the function of mefenamic acid
Reduces blood loss 30% and pain
What is the function of the combined oral contraceptive pill (COCP) with regards to periods
Makes periods lighter, regular and less painful
What is the function of LNG IUS and Depo-provera
Reduces bleeding but can cause irregular bleeding and make some women amenorrhoeic
What is the function of oral progesterone with regards to periods
reduce bleeding and regulate period
What is hysterectomy
Surgical removal of the uterus
What does hysterectomy guarantee with regards to periods
Amenorrhoea
What is a salpingo-oophorectomy
Removal of tubes and ovaries
What are the advantages and disadvantages of oophorectomy
Disadvantage - Immediate menopause
Advantage - reduced risk ovarian cancer
What is oligomenorrhoea
Infrequent periods
What is amenorrhoea
Absent periods
What is polycystic ovary syndrome
2/3 of the following:
Ultrasound appearance of ovary
Clinical hyperandrogegism e.g excess facial hair
Biochemical hyperandrogegism
What is polycystic ovarian syndrome linked with
Infertility and obesity
What is the treatment for polycystic ovarian syndrome
Symptom based treatment:
COCP, POP, Mirena IUS
Why are 3 periods required a year at least for polycystic ovarian syndrome
To prevent endometrial hyperplasia
What is dysfunctional uterine bleeding
Common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or systemic disease
