Menstrual Disorders Flashcards
What happens in the Follicular phase?
FSH stimulates pvarian follicle and granulosa cells to produce oestrogens raising oestrogen and inhibin by dominant follicles inhibit FSH production
Declining FSH levels cause atresia of but dominant follicle
What happens at ovulation?
Prior LH surge
Dominant follicle ruptures and release oocyte
What happens in the Luteal phase?
Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation
What other 3 things happen at the luteal phase?
Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation
What happens at the proliferative phase?
Oestrogen-induced growth of endometrial glands and stroma
What happens at menstruation?
Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation
Describe menstrual loss
Usually lasts 4-6 days
Menstrual flow peaks at day 1-2
<80ml per menstruation
No clots
What is the normal menstrual cycle?
Average 28 day cycle
Between 21-35 day cycle
No IMB or PCB
What is Menorrhagia?
Prolonged and increased menstrual flow
What is Metorrhagia?
Regular intermenstrual bleeding
What is Polymenorrhoea?
Menses occuring at <21 day interval
What is Polymenorrhagia?
Increased bleeding and frequent cycle
What is Menometrorrhagia?
Prolonged menses and intramenstrual bleeding
What is Amenorrhoea?
Absence of menstruation >6 months
What is Oligomenorrhoea?
Menses at intervals of >35 days
What is the non-organic cause of menorrhagia called?
Dysfunctional uterine bleeding
What are the local disorders leading to organic menorrhagia?
There’s loads, look at lectures
What endocrine disorders can cause organic menorrhagia?
Hyper/hypothyroidism
Diabetes mellitus
Adrenal disease
Prolactin disorders
What disorders of haemostasis can cause organic menorrhagia?
von Willebrand’s disease
ITP
Factor II, V, VII and XI def
What drugs can cause organic menorrhagia?
Anticoagulants
What issues regarding pregnancy cause organic menorrhagia?
Miscarriage
Ectopic
Gestational trophoblastic disease
Postpartum haemorrhage
What are the two subcategories of Dysfunctional Uterine Bleeding?
Anovulatory
and
Ovulatory
Describe the Anovulatory Dysfunctional Uterine Bleeding?
85% of cases
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women
Describe the ovulatory Dysfunctional Uterine Bleeding?
More common aged 35-45
Regular heavy periods
Due to inadequate progesterone production by corpus luteum
How do you investigate Dysfunctional Uterine Bleeding?
FBC Cervical smear TSH Coagulation screen Renal/Liver function tests Transvaginal ultrasound
What would be seen on a transvaginal ultrasound scan of Dysfunctional Uterine Bleeding?
Endometrial thickness
Presence of fibroids and other pelvic masses
What would be looked for with endometrial sampling with Dysfunctional Uterine Bleeding?
Pipelle biopsies
Hysteroscopic directed
Dilation and cutterage
What are non-surgical therapies for Dysfunctional Uterine Bleeding?
Progestogens Combined oral contraceptive pill Danazol GnRH analogues NSAIDs Anti-fibrolytics Capillary wall stabilisers
What is surgical management of Dysfunctional Uterine Bleeding?
Transverse endometrial resection (TCRE) Rollerball endometrial ablation (REA) Bipolar mesh endometrial ablation (Novasure) Thermal balloon ablation (Thermachoice) Thermal hydroablation (Hydroblate)
What types of hysterectomy are available?
Sub-total
Total abdominal
Vaginal
LASH/LAVH/TLH
