Menstrual disorders Flashcards
Briefly describe the hormonal control of the menstrual cycle?
- Increase in GnRH causes FSH and a little LH to be released by anterior pituitary gland.
- This causes the growth of follicles in the ovary; these then secrete oestrogen.
- Initially this inhibits LH but at a certain level in causes a surge in LH production. Oestrogen also causes growth of the endometrium
- This causes ovulation which causes the graafian follicle to be released.
- remaining part of the follicle (corpus luteum) then secreted progesterone.
What is a normal volume of blood to lose in a single menstruation?
Less than 80ml
How long does there have to be an absence on menstruation to be considered Amenorrhoea?
6 months
What term describes: prolonged and increased menstrual flow
Menorrhagia
What term describes: regular intermenstrual bleeding
Metrorrhagia
What term describes: Menses ocuring more frequently than every 21 days
Polymenorrhoea
What term describes: prolonged menses and intermenstrual bleeding
Menometrorrhagia
What term describes: increased bleeding and frequent cycle
Polymenorrhagia
How infrequently do periods have to come to be termes oligomenorrhoea?
Less frequently than every 35 days
What is andenomyosis?
The presence of endometrial tissue within the myometrium.
A women presents to your clinic complaining she has acute pain with her periods. She describes this as if her uterus is contracting and bearing down on her bladder. Se also says her periods are very heavy with clots and flooding.
Adenomyosis. (Ectopic endometrial tissue within the myometrium)
A women presents to your clinic complaining of painful heavy periods and pain during sex. She also says she feels tired and pale.
Endometriosis.
What is the gold standard investigation for endometriosis?
Laproscopy
What NSAID is most useful in endometriosis?
Mefenamic acid
What is the first line treatment for endometriosis in a women who does not wish to conceive yet?
- Pain relief (NSAID)
2. Hormonal contraception (COCP)
What non contracpetive hormonal treatment is used in the treatment of endometriosis?
Oral medroxyprogesterone
A 30 year old lady has severe pain and dysmennorhea due to her endometriosis. She has tried the COCP and NSAIDS already and they haven’t given her much relief. What are the next options?
- GnRH analogues - induing a reversible menopausal state and a regression of endometriosis deposits.
- Surgical ablation/excision of endometriosis deposits. Laproscopic surgery should ideally be done at the time of diagnosis via diathermy, laser ablation or excision. Radical surgery would involve a total abdominal hysterectomy and salpingo - oophorectomy and is only done when all other treatment have failed and the family is complete
What is the first line treatment for a women suffering from pain and menorrhagia who is wanting to fall preganant?
Tranexamic acid
What is the first line treatment for menorrhagia in a women who does not wish to fall pregnant right now?
Mirena IUS
What is the treatment for menorrhagia in a women who does not wish to fall pregnant but does not wish to use the mirena coil?
COCP
Tranexamic acid NSAID
What is the treatment for menorrhagia if the COCP and NSAIDs are both thought to be unsuitable?
Oral progesterone northisterone (taken during the follicular and luteal phases
Is oral northisterone appropriate for women wanting to conceive?
No. It is likely to inhibit ovulation (isn’t a reliable contraceptive though)
A 17 year old girl presents with cyclical pelvic pain which is getting worse. On examination a pelvis mass is palpated
Imperforate hymen
What is the treatment of an imperforate hymen?
Incision and drainage
What are the FSH and LH levels like in PCOS?
High LH
Low FSH
What will you see on US scan on a patient with PCOS?
Multiple follicular cysts up to 6 - 8mm in diameter (described as a pear necklace appearance)
In a women with amenorrhoea what does the serum prolactin level have to be above to diagnose a hyperprolactinaemia
800 mU/L
How does hyperprolactinaemia cause amenorrhoea?
Raised prolactin causes disturbance of the normal hypothalamic GnRH release which supresses LH pulsatility causing anovulation and amenorrhoea.
What 2 drugs are used to treat hyperprolactinaemia?
Bromocriptine
Cabergoline
(Dopamine agonists)
What does it mean if a women who is amennorhoeic responds to a progesterone challenge test?
- Uterus is present
- Some circulating oestrogen
What is meant by dysfunctional uterine bleeding?
Excessive bleeding where no organic lesion can be found
What is the mode of action of tranexamic acid?
Inhibits clot breakdown during menstruation
What is the mode of action of mefenamic acid?
Alters the imbalance of vasodilator prostoglandin PGE2 and the vasoconstrictor PGF2a.
What is removed in a subtotal hysterectomy?
Only the body of the uterus (the cervix is left)
