Menstrual disorders Flashcards
Normal age for menstrual cycles and a normal cycle
13-51
4-5days/21-35
Mean RBC loss per cycle
30-40ml
Menorrhagia
heavy periods >80ml/cycle
Heavy periods investigation
FBC, thyroid and coagulation
endometrial biopsy if over 45, persistent IMB, obesity
What should you always think of with IMB and PCB?
chlamydia
investigations - other
pregnancy test
transvaginal USS
hysteroscopy
2 likely things in early teens - abnormal bleeding
anovulatory cycles
coagulation problems
teens-40 abnormal bleeding
chlamydia contraception related endometriosis/adenomyosis fibroids endometrial or cervical polyps dysfunctional bleeding
40-menopause abnormal bleeding additional 4 reasons
thyroid dysfunction
endometrial cancer
perimenopausal ovulation
warfarin
2 things to always remember with abnormal bleeding
pregnancy test
look at cervix
FIGO classification of abnormal bleeding
Polyps Adenoyosis Leiomyomas Malignancy/hyperplasia Coagulation Ovarian Endocrine Iatrogenic Not yet classified
What is meant by dysfunctional uterine bleeding?
abnormal bleeding but no structural/endocrine/neoplastic/infectious cause found
Where is endometriosis usually found
ovary, pouch of douglas, pelvic peritoneum
3 theories of endometriosis
retrograde menstruation
haematogenous spread
direct transplant eg scar endometriosis
symptoms of dysfunctional uterine bleeding
premenstrual pelvic pain
subfertility
dysmenorrhoea
deep dyspareunia
signs of dysfunctional uterine bleeding
may be none - limited uterine mobility
tender nodules in rectovaginal septum
adnexal mass
gold standard for diagnosing dysfunctional uterine bleeding
laparoscopy
MRI
USS for endometrioma
Laparoscopic dysfunctional uterine bleeding - what is seen?
clear vesicles
red, blue/black, white lesions –> powder burn
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
