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Year 3 Repro (JK) > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

Normal age for menstrual cycles and a normal cycle

A

13-51

4-5days/21-35

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2
Q

Mean RBC loss per cycle

A

30-40ml

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3
Q

Menorrhagia

A

heavy periods >80ml/cycle

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4
Q

Heavy periods investigation

A

FBC, thyroid and coagulation

endometrial biopsy if over 45, persistent IMB, obesity

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5
Q

What should you always think of with IMB and PCB?

A

chlamydia

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6
Q

investigations - other

A

pregnancy test
transvaginal USS
hysteroscopy

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7
Q

2 likely things in early teens - abnormal bleeding

A

anovulatory cycles

coagulation problems

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8
Q

teens-40 abnormal bleeding

A 
chlamydia 
contraception related 
endometriosis/adenomyosis
fibroids 
endometrial or cervical polyps
dysfunctional bleeding
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9
Q

40-menopause abnormal bleeding additional 4 reasons

A

thyroid dysfunction
endometrial cancer
perimenopausal ovulation
warfarin

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10
Q

2 things to always remember with abnormal bleeding

A

pregnancy test

look at cervix

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11
Q

FIGO classification of abnormal bleeding

A 
Polyps
Adenoyosis
Leiomyomas
Malignancy/hyperplasia
Coagulation
Ovarian
Endocrine
Iatrogenic
Not yet classified
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12
Q

What is meant by dysfunctional uterine bleeding?

A

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

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13
Q

Where is endometriosis usually found

A

ovary, pouch of douglas, pelvic peritoneum

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14
Q

3 theories of endometriosis

A

retrograde menstruation
haematogenous spread
direct transplant eg scar endometriosis

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15
Q

symptoms of dysfunctional uterine bleeding

A

premenstrual pelvic pain
subfertility
dysmenorrhoea
deep dyspareunia

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16
Q

signs of dysfunctional uterine bleeding

A

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

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17
Q

gold standard for diagnosing dysfunctional uterine bleeding

A

laparoscopy
MRI
USS for endometrioma

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18
Q

Laparoscopic dysfunctional uterine bleeding - what is seen?

A

clear vesicles

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

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19
Q

endometrioma

A

chocolate cyst in the ovary

20
Q

medical treatment of dysfunctional uterine bleeding

A

hormone treatment and analgesics

  1. progestogen oral/injection/LNG IUS
  2. COCP
  3. GnRH analogues
21
Q

surgical treatment of dysfunctional uterine bleeding

A

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

22
Q

Adenomyosis

A

presence of endometrial tissue in the myometrium

23
Q

symptoms/signs of adenomyosis

A

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

24
Q

diagnosing adenomyosis

A

MRI
histology of uterine muscle - after hysterectomy
symptoms and exam

25
Q

Treatment of adenomyosis

A

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

26
Q

Fibroids - epidemiology

A

Afro-Caribbean

up to 60% of 40 year olds

27
Q

diagnosis of fibroids

A

clinical exam - irregularly bumpy uterus

USS and hysteroscopy

28
Q

3 types of fibroids and where they lie

A

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

29
Q

symptoms of fibroids

A

pressure symptoms - asymptomatic - menorrhagia - IMB

30
Q

fibroids in pregnancy

A

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

31
Q

Treatment of fibroids

A

only if asymptomatic

menorrhagia treatment - GnRH analogues - myomectomy - uterine artery embolization - hysterectomy

32
Q

Treatment for submucous fibroids

A

transcervical resection hysteroscopically

33
Q

3 treatments for DUB

A

reassurance
medical
surgical

34
Q

medical treatment of DUB

A 
non hormonal (tranexamic acid or mefenamic acid)
hormonal - progestogen only oral, injection, LNG IUS, COCP
35
Q

Surgical treatment of DUB

A

endometrial ablation

hysterectomy

36
Q

What do tranexamic acid and mefenamic acid help with?

A

reduce blood loss and mefenamic helps with pain

37
Q

Advantages of non-hormonal treatment of DUB

A

taken at time of periods

suitable for those trying to conceive

38
Q

Endometrial ablation

A

permanent destruction of endometrium using different energy sources

39
Q

1st gen endometrial ablation

A

under hysteroscopic vision using diathermy

40
Q

2nd gen endometrial ablation

A

thermal balloon, radiofrequency

41
Q

pre-requisites for endometrial ablation

A

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

42
Q

Ways of doing a hysterectomy

A

abdominal, vaginal, laparascopic

LGVH, LH, TLH, LASH

43
Q

Important to remember in subtotal hysterectomy

A

cervix left –> SMEARS

44
Q

Risks associated with hysterectomy

A

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

45
Q

What does hysterectomy guarantee?

A

amenorrhoea

46
Q

Disadvantage of salpingo-oophrectomy

A

immediate menopause - HRT until 50

47
Q

Advantage of salpingo-oophrectomy

A

decrease risk of ovarian cancer

Year 3 Repro (JK) (33 decks)

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