Menstrual disorders Flashcards by Jade Kiersten

Normal age for menstrual cycles and a normal cycle

13-51

4-5days/21-35

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Mean RBC loss per cycle

30-40ml

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Menorrhagia

heavy periods >80ml/cycle

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Heavy periods investigation

FBC, thyroid and coagulation

endometrial biopsy if over 45, persistent IMB, obesity

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What should you always think of with IMB and PCB?

chlamydia

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investigations - other

pregnancy test
transvaginal USS
hysteroscopy

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2 likely things in early teens - abnormal bleeding

anovulatory cycles

coagulation problems

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teens-40 abnormal bleeding

chlamydia 
contraception related 
endometriosis/adenomyosis
fibroids 
endometrial or cervical polyps
dysfunctional bleeding

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40-menopause abnormal bleeding additional 4 reasons

thyroid dysfunction
endometrial cancer
perimenopausal ovulation
warfarin

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2 things to always remember with abnormal bleeding

pregnancy test

look at cervix

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FIGO classification of abnormal bleeding

Polyps
Adenoyosis
Leiomyomas
Malignancy/hyperplasia
Coagulation
Ovarian
Endocrine
Iatrogenic
Not yet classified

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What is meant by dysfunctional uterine bleeding?

abnormal bleeding but no structural/endocrine/neoplastic/infectious cause found

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Where is endometriosis usually found

ovary, pouch of douglas, pelvic peritoneum

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3 theories of endometriosis

retrograde menstruation
haematogenous spread
direct transplant eg scar endometriosis

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symptoms of dysfunctional uterine bleeding

premenstrual pelvic pain
subfertility
dysmenorrhoea
deep dyspareunia

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signs of dysfunctional uterine bleeding

may be none - limited uterine mobility
tender nodules in rectovaginal septum
adnexal mass

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gold standard for diagnosing dysfunctional uterine bleeding

laparoscopy
MRI
USS for endometrioma

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Laparoscopic dysfunctional uterine bleeding - what is seen?

clear vesicles

red, blue/black, white lesions –> powder burn

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endometrioma

chocolate cyst in the ovary

medical treatment of dysfunctional uterine bleeding

hormone treatment and analgesics

progestogen oral/injection/LNG IUS
COCP
GnRH analogues

surgical treatment of dysfunctional uterine bleeding

excision of deposits
diathermy/laser ablation
remove ovaries with or without hysterectomy

Adenomyosis

presence of endometrial tissue in the myometrium

symptoms/signs of adenomyosis

heavy painful periods
bulky tender uterus, globular
parous women
?co-exist with endometriosis

diagnosing adenomyosis

MRI
histology of uterine muscle - after hysterectomy
symptoms and exam

Treatment of adenomyosis

hormonal contraception - LNG IUS (mirena), progestogens, COCP

Fibroids - epidemiology

Afro-Caribbean | up to 60% of 40 year olds

diagnosis of fibroids

clinical exam - irregularly bumpy uterus | USS and hysteroscopy

3 types of fibroids and where they lie

sub mucous - protrude into uterine cavity intra-mural - within uterine wall sub serous - project out of uterus into peritoneal cavity

symptoms of fibroids

pressure symptoms - asymptomatic - menorrhagia - IMB

fibroids in pregnancy

can increase in size quickly and cause pain, malpresentation or obstruction in labour

Treatment of fibroids

only if asymptomatic | menorrhagia treatment - GnRH analogues - myomectomy - uterine artery embolization - hysterectomy

Treatment for submucous fibroids

transcervical resection hysteroscopically

3 treatments for DUB

reassurance medical surgical

medical treatment of DUB

``` non hormonal (tranexamic acid or mefenamic acid) hormonal - progestogen only oral, injection, LNG IUS, COCP ```

Surgical treatment of DUB

endometrial ablation | hysterectomy

What do tranexamic acid and mefenamic acid help with?

reduce blood loss and mefenamic helps with pain

Advantages of non-hormonal treatment of DUB

taken at time of periods | suitable for those trying to conceive

Endometrial ablation

permanent destruction of endometrium using different energy sources

1st gen endometrial ablation

under hysteroscopic vision using diathermy

2nd gen endometrial ablation

thermal balloon, radiofrequency

pre-requisites for endometrial ablation

uterine cavity length <11cm submucous fibroids <3cm previous normal endometrial biopsy

Ways of doing a hysterectomy

abdominal, vaginal, laparascopic | LGVH, LH, TLH, LASH

Important to remember in subtotal hysterectomy

cervix left --> SMEARS

Risks associated with hysterectomy

infection, DVT, bladder, bowel, vessel injury, altered bladder function, adhesions

What does hysterectomy guarantee?

amenorrhoea

Disadvantage of salpingo-oophrectomy

immediate menopause - HRT until 50

Advantage of salpingo-oophrectomy

decrease risk of ovarian cancer