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Obs & Gynae > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

What changes to the endometrium occur during the follicular/proliferative phase?

A

Endometrium thickens due to the influence of oestrogen

Endometrial glands begin to form

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2
Q

In which women is ovulatory DUB more common and why does this happen?

A

Women aged 35-40, due to inadequate progesterone production by the corpus luteum

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3
Q

What pregnancy-related issues can cause menorrhagia?

A

Miscarriage

Ectopic pregnancy

Gestational trophoblastic disease

Postpartum haemorrhage

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4
Q

What additional therapy is required following endometrial ablation?

A

Combined hormone replacement therapy

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5
Q

What is endometriosis?

A

A condition where the lining of the uterus is found outwith the uterus, e.g. in the peritoneum

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6
Q

What is adenomyosis?

A

A condition where the lining of the uterus is also found in the muscle/myometrium

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7
Q

What is second line treatment for menorrhagia and how is this taken??

A

Syntethic progesterone:

Taken from days 5-25 of cycle

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8
Q

What is metorrhagia?

A

Regular intermenstrual bleeding

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9
Q

What investigations are done for menorrhagia?

A

Full blood count

Cervical smear

TSH

Coagulation screen

Renal/Liver function tests

Transvaginal ultrasound scan

Endometrial sampling

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10
Q

What is the second phase of the ovulatory cycle called and why?

A

Luteal phase - ovulation has occured at the dominant follicle, leaving behind the corpus luteum as the secondary oocyte is expelled

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11
Q

What device can be used to treat menorrhagia?

A

Progesterone-releasing IUCD

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12
Q

What is polymenhorrheoa?

A

Menstruation occuring at <21 day interval

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13
Q

When does menstruation occur in the menstrual cycle?

A

14 days after ovulation/beginning of the luteal phase

Luteolysis occurs after 14 days if no fertilisation has occured

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14
Q

Why is hysterectomy not the first line surgical procedure for menorrhagia?

A

Longer recovery time

Greater risk of complications

Major operation

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15
Q

Why is hysteroscopy not commonly used, and when is there an exception?

A

Time consuming

Can cause complications e.g. perforation of bladder

Done if a biopsy is required but difficult to obtain otherwise, e.g. cervical stenosis

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16
Q

What are fibroids?

A

Benign tumours of the muscle wall of the uterus

These are usually small

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17
Q

What are the features of a normal menstruation?

A

Lasts 4-6 days

Occurs every 28 days

Menstrual flow peaks day 1-2

Blood loss <80ml

No clots

No intermenstrual bleeding

No post-coital bleeding

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18
Q

What systemic disorders can cause menorrhagia?

A

Endocrine: diabetes, hypothyroidism, adrenal disease, prolactin disorders

Haem: Von Willebrands disease, clotting factor deficiency

Liver disease
Renal disease

Drugs e.g. anticoagulants

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19
Q

What is amenorrheoa?

A

Absence of periods >6months

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20
Q

What happens to FSH and oestrogen levels in the follicular phase of the ovulatory cycle?

A

FSH causes growth of ovarian follicles and granulosa cells, which produce oestrogen, causing these levels to rise

Rising oestrogen levels decrease the levels of FSH, due to the negative feedback loop

21
Q

Why does lowered progesterone in second half of menstrual cycle or stopping oral contraceptive pill early cause menhorragia?

A

Sudden decrease in progesterone levels causes ‘withdrawl bleed’

22
Q

What is the mainstay of treatment for irregular or shortened cycles with menorrhagia, and why is it effective?

A

Combined oral contraceptive pill:

This can be used until menopause

Effective as progesterone levels from pill will override endogenous progesterone production, so cycle is regulated efficiently

23
Q

What changes to the endometrium occur during the luteal/secretory phase?

A

Glands develop further and produce secretions

Endometrial apoptosis occurs at the late end of the luteal phase

24
Q

What is the risk associated with becoming pregnant following endometrial ablation?

A

Pregnancy is fine and normal, embryo implants onto the myometrium and can be carried to term

The diffiuclty is during labour when the placenta has to separate - this becomes difficult and painful and can cause haemorrhaging

25
Q

What hormonal surge occurs roughly 12 hours before ovulation?

A

Increase in LH, to trigger release of egg

26
Q

How does endometrial ablation work?

A

Destruction of endometrium to the basal layer of the uterus will stop endometrial regeneration with the menstrual cycle and thus stop periods

27
Q

What is the initial phase of the ovulatory cycle called and why?

A

Follicular phase FSH stimulates ovarian follicle development and a dominant follicle is selected

28
Q

What additional therapy is required following a hysterectomy?

A

Oestrogen-only HRT

29
Q

What is menorrhagia?

A

Prolonged and increased menstrual flow

30
Q

Why does anovulatory DUB most commonly occur during menopause/pre-menopause?

A

Eggs at this stage of life tend to be lower quality, lower quality corpus luteum produces lower progesterone levels, distrupting second half of menstrual cycle

31
Q

What happens to progesterone levels during the luteal phase of the ovulatory cycle?

A

Progesterone levels increase because of the corpus luteum

32
Q

In which women does endometrial carcinoma tend to occur?

A

Post-menopausal women, aged 40-45+

33
Q

What investigations should be done if endometrial carcinoma suspected?

A

Difficult as can’t see into uterine cavity

Ultrasound is a good screening tool - endometrial thickness >4cm must be investigated further

Pipelle biopsy tends to be next line

34
Q

What is the first line surgical treatment for menorrhagia?

A

Endometrial ablation

35
Q

What is polymenorrhagia?

A

Frequent bleeding and shortened cycle

36
Q

What is oligomenhorrheoa?

A

Periods at >35 day intervals

37
Q

How do GnRH analogues work?

A

These downregulate the FH/LSH axis, reducing the stimulation of ovaries and inducing a medical menopause

38
Q

What is menomethorragia?

A

Prolonged menstruation and intermenstrual bleeding

39
Q

Why can GnRH analogues not be used for too long?

A

Risk of osteoporosis

40
Q

What is ‘club tube’?

A

When the fimbrae of the ovarian tube become folded into the head of the tube, forming a club shape and blocking the tube

This can occur following pelvic inflammatory disease

41
Q

What is endometrial hyperplasia?

A

A pre-malignant condition to endometrial carcinoma, characterised by thickening of the endometrium

42
Q

What is the benefit of performing a sub-total hysterectomy?

A

Leaving the cervix behind reduces the risk of complications during the surgery due to the proximity of the cervix to the rectum and urethra

43
Q

What is the most common type of dysfunctional uterine bleeding?

A

Anovulatory DUB occuring at beginning or end of reproductive life

Most commonly menopause/pre-menopause

44
Q

Why are extensive investigations into menorrhagia in younger patients unneccesary?

A

Investigations beyond blood tests not required as usually DUB

Treat for DUB, if symptoms persist, then investigate further

45
Q

Do fibroids cause painful menses?

A

Not painful, just heavy

46
Q

What might intermenstrual bleeding indicate?

A

Endometrial carcinoma

Endometrial polyps

47
Q

What might post-coital bleeding indicate?

A

Pelvic inflammatory disease

48
Q

What type of drug is mefanamic acid?

A

NSAID

49
Q

What type of drug is tranexamic acid?

A

Anti-fibrinolytic

Obs & Gynae (20 decks)

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