Menstrual Disorders Flashcards
What is normal menstruation?
Age 13-51 from monarch-menopause
Cycle 4-5/21-35
4-5 days bleeding
21-35 cycle length, time from start of one period to start of the next
Menstruation is triggered by a fall in progesterone 2 weeks after ovulation if not pregnant
Mean blood loss 30-40ml
What is menorrhagia?
Heavy periods - > 80ml per cycle
What is dysmenorrhoea?
Painful periods
What is intermenstrual bleeding?
Bleeding between periods
What is postcoital bleeding?
Bleeding after sexual intercourse
What is oligomenorrhoea?
Infrequent periods e.g. 45-90
What percentage of gynaecology outpatient referrals are accounted for by menstrual abnormality?
20%
What percentage of women see their GP with menstrual problems in any year?
3% of women aged 30-49
What are the important features of history in a woman with a menstrual problem?
Subjective - what is normal for that woman
Clots/flooding - pads and tampons used together, will give an idea of how “heavy”
Pain - with heavy flow or premenstrual, premenstrual may be endometriosis
Ask about effect of symptoms on lifestyle/quality of life
What are the appropriate examinations to do for a woman with menstrual problems?
General e.g. anaemic
Abdominal - large fibroids
Speculum - polyps
Bimanual pelvic - size of uterus, adnexal masses
What are the investigations that you might do for a woman with menstrual problems?
FBC if menorrhagia Endometrial biopsy Chlamydia test Thyroid/coagulation if other symptoms Pregnancy test Transvaginal US scan Hysteroscopy Laparoscopy
What are the likely causes of menstrual problems in early teens?
Anovulatory cycle
Congenital anomaly
Coagulation problems
Always consider pregnancy and always look at cervix
What are the likely causes of menstrual problems in teens-40s?
Chlamydia Contraception-related Endometriosis/adenomyosis Fibroids Endometrial or cervical polyps Dysfunctional bleeding
Always consider pregnancy and always look at cervix
What are the likely causes of menstrual problems in 40s-menopause?
Perimenopausal anovulation Endometrial cancer (rare in premenopausal women) Warfarin Thyroid dysfunction Chlamydia Contraception-related Endometriosis/adenomyosis Fibroids Endometrial or cervical polyps Dysfunctional bleeding
Always consider pregnancy and always look at cervix
According to the FIGO classification, what are the causes of abnormal uterine bleeding?
Palm Coe In
P - polyp A - adenomyosis L - leiomyoma M - malignancy C - coagulation e.g. Von Willebrand's O - ovarian e.g. PCO, perimenopausal anovulatory cycles E - endocrine e.g. thyroid I - iatrogenic e.g. warfarin N - not yet classified
What is dysfunctional uterine bleeding?
Abnormal uterine bleeding but no structural, endocrine, neoplastic or infectious cause found (yet)
What percentage of women who complain of heavy periods lose < 80ml per cycle?
50%
What percentage of hysterectomies are done for dysfunctional uterine bleeding?
50%
What is endometriosis?
Endometrial type tissue outside the uterine cavity
Usually in ovary, pouch of Douglas or pelvic peritoneum
May be asymptomatic
May resolve without treatment
What kind of bleeding can endometriosis cause?
Retrograde bleed
What are the symptoms of endometriosis?
Premenstrual pain, particularly 1 week before period starts
Dysmenorrhoea
Deep dyspareunia
Sub-fertility
What are the signs of endometriosis?
May be none
Tender nodules in rectovaginal septum
Limited uterine mobility
Adnexal mass
What are the investigations done to diagnose endometriosis?
Laparoscopy
MRI
USS endometrioma
What is the medical treatment of endometriosis?
Progestogen - oral, injection or Mirena IUS, coil will have fewer general side-effects
Combined pill or patch for 3 months (9 weeks) at a time
GnRH analogues e.g. leuprorelin
