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Menstrual Disorders Flashcards

1
Q

What causes menstruation and how much blood loss is typical

A
  • Fall in progesterone 2 weeks after ovulation, if not pregnant
  • Mean blood loss 30-40ml
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2
Q

Definition of;

  • Menorrhagia
  • Dysmenorrhoea
  • Intermenstrual bleeding (IMB)
  • Postcoital bleeding (PCB)
  • Oligiomenorrhoea
A
  • Menorrhagia, Heavy periods (>80ml/cycle)
  • Dysmenorrhoea, Painful periods
  • Intermenstrual bleeding (IMB), Bleeding between periods
  • Postcoital bleeding (PCB), Bleeding after intercourse
  • Oligiomenorrhoea, Infrequent periods
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3
Q

Components of Hx for menstrual problems

A
  • Clots/flooding/Pads +tampons
  • Pain with heavy flow or premenstrual
  • Effect of symptoms on lifestyle
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4
Q

Components of exam for menstrual problems

A
  • General
  • Abdo
  • Speculum
  • Bimanual
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5
Q

Investigation for menstrual problems

A
  • FBC (if menorrhagia)
  • Endometrial biopsy (mainly >45/persistent IMB/high risk)
  • Chlamydia (esp. IMB, PCB, <25, new partner)
  • Pregnancy test
  • Ultrasound
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6
Q

Likely cause`s of menstrual problems in teens

A
  • Anovulatory cycles
  • Congenital anomaly
  • Coagulation problems
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7
Q

Likely causes of menstrual problems in teens-40

A
  • Chlamydia
  • Contraception related
  • Endometriosis/adenomyosis
  • Fibroids
  • Endometrial or cervical polyps
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8
Q

Likely causes of menstrual problems in 40-menopause

A
  • Perimenopausal anovulation
  • Endometrial cancer
  • Thyroid dysfunction
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9
Q

Likely drug cause of menstrual problems

A

Warfarin

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10
Q

List the FIGO classification of causes for abnormal uterine bleeding in nongravid women (PALM COEIN)

A

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
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11
Q

Define dysfunctional uterine bleeding (DUB)

A

Abnormal bleeding but no structural/endocrine/neoplastic/infectious cause found (yet)

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12
Q

Define endometriosis

A

Endometriosis is a disorder in which the tissue that forms the lining of your uterus grows outside of your uterine cavity.

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13
Q

Symptoms of endometriosis

A
  • Premenstrual pain
  • Dysmenorrhoea
  • Deep dyspareunia
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14
Q

What is dyspareunia

A

Pain in the genital area or within the pelvis during/after sex

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15
Q

Signs of endometriosis

A
  • May be none
  • Tender nodules in rectovaginal septum
  • Limited uterine mobility
  • Adnexal mass
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16
Q

Investigations for endometriosis

A
  • Laparoscopy
  • MRI
  • US
17
Q

Endometriosis treatment

A

-Medical
Progesterone or combined pill
GnRH analogues (Leuprorelin)

-Surgical
Excision of deposits from peritoneum/ovary
Diathermy/laser ablation of deposits
Hysterectomy AND Oophorectomy

18
Q

Define adenomyosis

A

Endometrial tissue found deep in myometrium

19
Q

Symptoms/signs of adenomyosis

A
  • Heavy painful periods

- Bulky tender uterus

20
Q

How to diagnose adenomyosis

A

-Histology of uterine muscle (NOT ENDOMETRIAL BIOPSY)

-Probably US, laparoscopy, hysteroscopy
MRI may suggest diagnosis but limited availability

21
Q

Treatment of adenomyosis

A
  • Mirena may help (IUD containing progestin)
  • Medical Rx often fails
  • Hysterectomy
22
Q

What are fibroids

A
  • Smooth muscle growths in uterus, non-cancerous (leiomyoma)
  • Common and usually asymptomatic
  • Rarely become cancerous (leiomyosarcoma 0.01%)
23
Q

How fibroids diagnosed

A
  • Clinical exam
  • US
  • Hysteroscopy
24
Q

3 types of fibroids

A
  • Sub mucous, Protrude into uterine cavity
  • Intramural, Within uterine wall
  • Sub serous, Project out of uterus into peritoneal cavity
25
Q

Symptoms of fibroids

A
  • If large may cause pressure symptoms
  • Menorrhagia (if they enlarge the surface area of uterine cavity)
  • Intermenstrual bleeding (sub mucous)
26
Q

Fibroids treatment

A
  • Myomectomy
  • Standard menorrhagia Rx (if cavity not too distorted)
  • GnRH analogues
  • Anti-progestogen
  • Uterine artery embolisation
  • Hysterectomy
27
Q

Menorrhagia treatment

A
  • Tranexamic acid
  • Combined oral contraceptive pill
  • Injected progestogen
28
Q

Treatments for DUB

A

-Fertility conserving treatment
Menfenamic acid
Combined oral contraceptive pill
Progesterone IUD (Mirena)

-If family complete
Endometrial ablation
Hysterectomy

Reproduction (22 decks)

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