Menstrual disorders Flashcards
Describe what happen in the three endometrial events:
- proliferative phase
- luteal phase
- menstruation
Proliferative phase:
-estrogen induced growth of glands/stroma
Luteal phase:
- progesterone induced glandular secretory activity
- decidualisation in late secretory phase
- endometrial apoptosis and subsequent menstruation
Menstruation:
- Arteriolar constriction and shedding functional endometrial layer
- fibrinolysis inhibits scar tissue formation
what is: menorrhagia metrorrhagia menometrorrhagia polymenorrhea polymenorrhagia amenorrhea oligomenorrhea post menopausal bleeding
Menorrhagia: prolonged and increased menstrual flow
Metrorrhagia: regular IMB
menometrorrhagia: prolonged menses and IMB
polymenorrhea: menses occurring <21days per cycle
Polymenorrhagia: menses occurring <21days and heavy bleeding (menses should be <80ml per menstruation)
amenorrhea: absence menstruation >6mths
oligomenorrhea: cycle longer than 35days
Post menopausal bleeding: AUB >1yr cessation menses
What can you split menorrhagia causes into?
- organic and local
- systemic
- drugs
- pregnancy problems
- non-organic
There are 13 organic and local causes for menorrhagia: what are these?
Fibroids: pressure symptoms/painless
Adenomyosis: invasion of myometrium by endometrial tissue
=painful menses, uniformly enlarged uterus, dysmenorrhea
=inflammation/pain/formation adhesions
Endocervical/ectocervical polyp: also causes IMB
Cervical eversion (ectropion): endocervix columnar epithelium protudes into vagina through external os and undergoes squamous metaplasia
Combined oral contraceptive pill: excess estrogen
Endometrial hyperplasia: pre-malignant condition
IUCD
PID: infection of upper genital tract - usually ascending from cervix = pain
Endometriosis: growth endometrial tissue in other sites other than uterin cavity
=chronic estrogen dependant condition
=pain
Malignancy cervix/uterus:
- Cervical 20s-30s
- Endometrial 60’s PMB
Hormone producing tumours
Trauma
Others: arterio-venous malformation
What 4 systemic disorders can cause menorrhagia?
Endocrine: hyper/hypo thyroid, D.M, adrenal disease, prolactin disorders
Haemostasis: VWF disease, ITP, factors 2,5,7,11 deficiency
Liver disorder
Renal disease
What type of drugs can cause menorrhagia?
anticoag.
What could cause menorrhagia in pregnancy?
miscarriage
ectopic pregnancy
gestational trophoblastic disease
post-partum haemorrhage
What is non-organic menorrhagia? is this common? what can this be divided into?
Dysfunctional uterine bleeding
- 50% cases
- ovulatory or anovulatory
What is the pathophysiology of anovulatory dysfunctional uterine bleeding? is this common? when does it usually occur? what is another symptoms apart from menorrhagia? what type of women is this more common in?
Corpus luteum doesn’t form and progesterone secretion doesnt occur so estrogen = proliferation endometrium which eventually outgrows it’s blood supply and incompletely sloughs
- 85% of DUB
- occurs at extremes of reproductive life
- irregular cycle
- more common in obese women
What is the pathophysiology of ovulatory dysfunctional uterine bleeding? at what age does this usually occur? are periods regular or irregular?
egg and corpus luteum of little quality and doesn’t secrete as much progesterone = bleeding (inadequate prog. secretion of corpus luteum)
- women aged 35-45yrs
- regular heavy periods
What tests are done on everyone with DUB by the GP?
FBC: Hb=anaemia - even if there's no anaemia, treat pt. Smear: if due TSH: hypothyroidism - uncommon Coag: VWF disease Renal/LFTs
If the patient is over the age of 40 what is done to rule out endometrial carcinoma?
Transvaginal US or sampling
What is transvaginal US and what is being looked for? What is endometrial sampling?
Transvaginal US (1st line):
- endometrial thickness >4mm
- if it is do pipelle biopsy
- see presence fibroids/uterin masses
Endometrial sampling:
- pipelle biopsy if pt can tolerate and is possible (some do this 1st line as going to do anyway if >4mm)
- hysteroscopic directed endometrial sampling (only if can’t get pipelle, 40min procedure)
- dilatation and curettage (GA)
If a patient is under the age of 40 with AUB what is the approach to management?
manage as DUB and if no improvement do investigations
What is the management of DUB in general?
Drugs then mirena then endometrial op. then hysterectomy
