Menstrual disorders Flashcards
What changes to the endometrium occur during the follicular/proliferative phase?
Endometrium thickens due to the influence of oestrogen
Endometrial glands begin to form
In which women is ovulatory DUB more common and why does this happen?
Women aged 35-40, due to inadequate progesterone production by the corpus luteum
What pregnancy-related issues can cause menorrhagia?
Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Postpartum haemorrhage
What additional therapy is required following endometrial ablation?
Combined hormone replacement therapy
What is endometriosis?
A condition where the lining of the uterus is found outwith the uterus, e.g. in the peritoneum
What is adenomyosis?
A condition where the lining of the uterus is also found in the muscle/myometrium
What is second line treatment for menorrhagia and how is this taken??
Syntethic progesterone:
Taken from days 5-25 of cycle
What is metorrhagia?
Regular intermenstrual bleeding
What investigations are done for menorrhagia?
Full blood count
Cervical smear
TSH
Coagulation screen
Renal/Liver function tests
Transvaginal ultrasound scan
Endometrial sampling
What is the second phase of the ovulatory cycle called and why?
Luteal phase - ovulation has occured at the dominant follicle, leaving behind the corpus luteum as the secondary oocyte is expelled
What device can be used to treat menorrhagia?
Progesterone-releasing IUCD
What is polymenhorrheoa?
Menstruation occuring at <21 day interval
When does menstruation occur in the menstrual cycle?
14 days after ovulation/beginning of the luteal phase
Luteolysis occurs after 14 days if no fertilisation has occured
Why is hysterectomy not the first line surgical procedure for menorrhagia?
Longer recovery time
Greater risk of complications
Major operation
Why is hysteroscopy not commonly used, and when is there an exception?
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
What are fibroids?
Benign tumours of the muscle wall of the uterus
These are usually small
What are the features of a normal menstruation?
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
What systemic disorders can cause menorrhagia?
Endocrine: diabetes, hypothyroidism, adrenal disease, prolactin disorders
Haem: Von Willebrands disease, clotting factor deficiency
Liver disease
Renal disease
Drugs e.g. anticoagulants
What is amenorrheoa?
Absence of periods >6months
What happens to FSH and oestrogen levels in the follicular phase of the ovulatory cycle?
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
Why does lowered progesterone in second half of menstrual cycle or stopping oral contraceptive pill early cause menhorragia?
Sudden decrease in progesterone levels causes ‘withdrawl bleed’
What is the mainstay of treatment for irregular or shortened cycles with menorrhagia, and why is it effective?
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
What changes to the endometrium occur during the luteal/secretory phase?
Glands develop further and produce secretions
Endometrial apoptosis occurs at the late end of the luteal phase
What is the risk associated with becoming pregnant following endometrial ablation?
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
