Menstrual Disorders Flashcards
What causes menstruation and how much blood loss is typical
- Fall in progesterone 2 weeks after ovulation, if not pregnant
- Mean blood loss 30-40ml
Definition of;
- Menorrhagia
- Dysmenorrhoea
- Intermenstrual bleeding (IMB)
- Postcoital bleeding (PCB)
- Oligiomenorrhoea
- Menorrhagia, Heavy periods (>80ml/cycle)
- Dysmenorrhoea, Painful periods
- Intermenstrual bleeding (IMB), Bleeding between periods
- Postcoital bleeding (PCB), Bleeding after intercourse
- Oligiomenorrhoea, Infrequent periods
Components of Hx for menstrual problems
- Clots/flooding/Pads +tampons
- Pain with heavy flow or premenstrual
- Effect of symptoms on lifestyle
Components of exam for menstrual problems
- General
- Abdo
- Speculum
- Bimanual
Investigation for menstrual problems
- FBC (if menorrhagia)
- Endometrial biopsy (mainly >45/persistent IMB/high risk)
- Chlamydia (esp. IMB, PCB, <25, new partner)
- Pregnancy test
- Ultrasound
Likely cause`s of menstrual problems in teens
- Anovulatory cycles
- Congenital anomaly
- Coagulation problems
Likely causes of menstrual problems in teens-40
- Chlamydia
- Contraception related
- Endometriosis/adenomyosis
- Fibroids
- Endometrial or cervical polyps
Likely causes of menstrual problems in 40-menopause
- Perimenopausal anovulation
- Endometrial cancer
- Thyroid dysfunction
Likely drug cause of menstrual problems
Warfarin
List the FIGO classification of causes for abnormal uterine bleeding in nongravid women (PALM COEIN)
P - Polyp
A - Adenomyosis
L - Leiomyoma (AKA Fibroids)
M - Malignancy/hyperplasia
C - Coagulation (Von Willebrand) O - Ovarian (PCOS/Perimenopausal anovulation) E - Endocrine (thyroid) I - Iatrogenic (Warfarin) N - Not yet classified
Define dysfunctional uterine bleeding (DUB)
Abnormal bleeding but no structural/endocrine/neoplastic/infectious cause found (yet)
Define endometriosis
Endometriosis is a disorder in which the tissue that forms the lining of your uterus grows outside of your uterine cavity.
Symptoms of endometriosis
- Premenstrual pain
- Dysmenorrhoea
- Deep dyspareunia
What is dyspareunia
Pain in the genital area or within the pelvis during/after sex
Signs of endometriosis
- May be none
- Tender nodules in rectovaginal septum
- Limited uterine mobility
- Adnexal mass
Investigations for endometriosis
- Laparoscopy
- MRI
- US
Endometriosis treatment
-Medical
Progesterone or combined pill
GnRH analogues (Leuprorelin)
-Surgical
Excision of deposits from peritoneum/ovary
Diathermy/laser ablation of deposits
Hysterectomy AND Oophorectomy
Define adenomyosis
Endometrial tissue found deep in myometrium
Symptoms/signs of adenomyosis
- Heavy painful periods
- Bulky tender uterus
How to diagnose adenomyosis
-Histology of uterine muscle (NOT ENDOMETRIAL BIOPSY)
-Probably US, laparoscopy, hysteroscopy
MRI may suggest diagnosis but limited availability
Treatment of adenomyosis
- Mirena may help (IUD containing progestin)
- Medical Rx often fails
- Hysterectomy
What are fibroids
- Smooth muscle growths in uterus, non-cancerous (leiomyoma)
- Common and usually asymptomatic
- Rarely become cancerous (leiomyosarcoma 0.01%)
How fibroids diagnosed
- Clinical exam
- US
- Hysteroscopy
3 types of fibroids
- Sub mucous, Protrude into uterine cavity
- Intramural, Within uterine wall
- Sub serous, Project out of uterus into peritoneal cavity
Symptoms of fibroids
- If large may cause pressure symptoms
- Menorrhagia (if they enlarge the surface area of uterine cavity)
- Intermenstrual bleeding (sub mucous)
Fibroids treatment
- Myomectomy
- Standard menorrhagia Rx (if cavity not too distorted)
- GnRH analogues
- Anti-progestogen
- Uterine artery embolisation
- Hysterectomy
Menorrhagia treatment
- Tranexamic acid
- Combined oral contraceptive pill
- Injected progestogen
Treatments for DUB
-Fertility conserving treatment
Menfenamic acid
Combined oral contraceptive pill
Progesterone IUD (Mirena)
-If family complete
Endometrial ablation
Hysterectomy
