Menstrual Disorders Flashcards
What happens in the follicular phase (pituitary and ovary)?
FSH stimulates ovarian follicle development & granulosa cells to produce oestrogens
Raising oestrogen & inhibin by dominant follicles inhibit FSH production
Declining FSH levels cause atresia of but dominant follicle
What happens in ovulation (pituitary and ovary)?
Prior LH surge
Dominant follicle ruptures and releases oocyte
What happens in the luteal phase (pituitary and ovary)?
Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation
What endometrial events occur in the proliferative phase?
Oestrogen-induced growth of endometrial glands and stroma
What endometrial events occur in the luteal phase?
Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation
What endometrial events occur in the menstruation?
Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation
What is the normal menstrual cycle and loss?
Lasting 4-6 days over 21-35 day cycle (28 avg)
Peaks day 1-2
<80ml per menstruation
No clots, IMB or PCB
What is menorrhagia?
Prolonged and increased menstrual flow
What is metrorrhagia?
Regular intermenstrual bleeding
What is polymenorrhoea?
Menses occurring at <21d interval
What is menometrorrhagia?
Prolonged menses and intermenstrual bleeding
What is amenorrhoea?
Absence of menstruation >6months
What is oligomenorrhoea?
Menses at intervals of >35 days
What is non-organic menorrhagia?
Absence of pathology
Aka dysfunctional uterine bleeding
What are some local causes of organic menorrhagia?
Fibroids Adenomyosis Endocervical or Endometrial polyp Cervical eversion Endometrial hyperplasia Intrauterine contraceptive device (IUCD) Pelvic inflammatory disease (PID) Endometriosis Malignancy of the cervix or uterus Hormone producing tumours Trauma Others e.g. arteriovenous malformations
What systemic disorders cause organic menorrhagia?
Hyper/hypothyroidism DM Adrenal disease PRL disorders Von Willebrand's disease ITP Factor II,V,VII and XI deficiency Liver disorders Renal disease Anticoagulants
What obstetric disorders cause organic menorrhagia?
Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Postpartum haemorrhage
How many women with abnormal uterine bleeding will have dysfunctional uterine bleeding (DUB)?
50%
How is the diagnosis of DUB made?
By exclusion
What are the two categories of DUB?
Anovulatory
Ovulatory
Describe anovulatory DUB
85% of all DUB
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women
Describe ovulatory DUB
More common in women aged 35-45 years
Regular heavy periods
Due to inadequate progesterone production by corpus luteum
What Ix are required in DUB?
FBC Smear TSH Coag Screen Renal/LFTs Transvaginal US Endometrial sampling
What is assessed in DUB by the transvaginal US?
Endometrial thickness
Presence of fibroids and other pelvic masses
What occurs in endometrial sampling in the investigation of DUB?
Pipelle biopsies
Hysteroscopic directed
Dilatation & curettage (D & C)
What is the non-surgical management of DUB?
Progesterone Combined pill Danazol GnRH analogues NSAIDs Anti-fibrinolytics Capillary wall stabilisers Progestogen-released IUCD: Mirena IUS
What is the surgical management of DUB?
Endometrial resection/ablation
Hysterectomy
What endometrial resection/ablation can be used in management of DUB?
Transcervical endometrial resection (TCRE) Rollerball endometrial ablation (REA) Bipolar mesh endometrial ablation (Novasure) Thermal balloon ablation (Thermachoice) Thermal hydroablation (Hydroblate)
What are the hysterectomy options in management of DUB?
Sub-total hysterectomy
Total abdominal hysterectomy
Vaginal hysterectomy
LASH/LAVH/TLH
Is fertility retained in surgical management of DUB?
No
What HRT is required after an endometrial ablation and hysterectomy?
EA: Combined HRT
Hysterectomy: Oestrogen-only HRT (unless cervix retained)
