menstrual disorders Flashcards
where are FSH and LH released from
anterior pituitary
how many eggs stimulated each month to grow by FSH and LH
15-50
when is the surge of LH over 28 day cycle leading to ovulation
14 days before onset of menstruation (day 14)
what is day 1 of cycle
first day of menstruation
what hormone is high in the first 4 days of cycle
FSH- stimulates development of primary follicle in ovary. produces oestrogen
what happens if the ovum is not fertilised
corpus luteum breaks down, spiral arteries in the endothelial lining constrict and lining sloughs
where does the embryo embed
decidua
what are the phases
proliferation, secretion
what is primary amenorrhoea
failure to start menstruating, investigate in 15 or 14 year old if no breast tissue
what is secondary amenorrhoea
periods stop for >6 months, other than due to pregnancy
causes
hypothalamic pituitary ovarian causes; endo; ovarian; uterine
hypothalamic pituitary ovarian causes amenorrhoea
stress, incr exercise, weight loss
endocrine causes amenorrhoea
hyperprolactinaemia, thyroid, severe systemic disease
ovarian causes amenorrhoea
PCOS, tumours, insuffieicny/failure- chemo, radiotherapy
uterine causes amenorrhoea
pregnancy, ashermans syndrome, post pill
tests in amenorrhoea
BHCG, free androgen, FSH/LH- reduced in hypothalamic pituitary ovarian; prolactin; TFT; testosterone
what can cause increased prolactin levels
stress, hypothyroid, drugs, prolactinoma
treatment amenorrhoea
related to the cause. ovarian failure- hormone replacement, hypothal axis - clomifene
what is oligomenorrhoea
infreq periods- common at extremes of reproductive life- infrequent ovulation
what is a common cause oligomenorrhoea
PCOS
what is dysmenorrhoea
painful periods +- N+V
primary and secondary dysmenrrhoea
primary- in absence of pathology, secondary - pathology
what can cause secondary dysmenorrhoea
adenomyosis, endometriosis, fibroids
what is classified as post menopausal bleeding
bleeding >1y after last period. endometrial carcinoma until proven otherwise
causes post menopausal bleeding
vaginitis, FB, carcinoma of cervix or vulva, polyps, oestrogen withdrawal
causes menorrhagia
girls- pregnancy, functional uterine bleeding; older- IUCD, fibroids, adenomyosis, pelvic infection, polyps, endometriosis, hypothyroid
tests menorrhagia
FBC, TFT, clotting studies, ultrasound, laparoscopy, endometrial sampling, hysteroscopy
what is dysfunctional uterine bleeding
heavy and/or irregular bleeding in absence of recognisable pathology- common at extremes of reproductive age
medical management menorrhagia
Mirena (IUS), tranexamic acid (antifibrinolytic), mefenamic acid (anti prostaglandin), COC
surgical management menorrhagia
hysterectomy, myomectomy, endometrial ablation and resection
