Menstrual Disorders Flashcards
A fall in the level of which hormone causes menstruation?
Progesterone
What is meant by menorrhagia?
Heavy periods (>80ml/cycle)
What is meant by dysmenorrhoea?
Painful periods
What is meant by inter-menstrual bleeding?
Bleeding between periods
What is meant by postcoital bleeding?
Bleeding after intercourse
What is meant by oligomenorrhoea?
Infrequent periods (bleeding every 45-90 days)
What are important points to ask a patient about when they are presenting with menstrual problems?
1 - The patients perception of the problem
2 - Are there clots present?
3 - Is she flooding her tampon/pad and having to use several of these per day?
4 - Is there pain associated with her period?
5 - How are her symptoms impacting on her lifestyle and quality of life
What types of examination should be carried out when checking woman with menstrual problems?
1 - General
2 - Abdominal
3 - Speculum
4 - Bimanual
What investigations should be performed on woman presenting with heavy periods?
- Full blood count
- Thyroid function and coagulation (if history suggestive)
- Endometrial biopsy (if >45/persistent IMB/obesity)
What menstrual problems are early teens likely to face?
- Anovulatory cycles
- Coagulation problems
What menstrual problems are those aged from teens-40 y.o. most likely to face?
- Chlamydia
- Contraception related
- Endometriosis/adenomyosis
- Fibroids
- Endometrial or cervical polyps
What are the causes of menstrual bleeding in woman who are between 40 y.o. and the menopause?
1 - Perimenopausal anovulation
2 - Endometrial cancer
3 - Warfarin
4 - Thyroid dysfunction
What two points are extremely important to remember when establishing the cause of menstrual problems in woman?
1 - Always consider pregnancy
2 - Always look at the cervix
What is a useful pnemonic to remember the causes of abnormal uterine bleeding?
PALM-COEIN
P - Polyp
A - Adenomyosis
L - Leiomyoma (fibroids)
M - Malignancy/hyperplasia
C - Coagulation disorders (von willebrands disease)
O - Ovarian (polycystic ovaries)
E - Endocrine (Thyroid)
I - Iatrogenic (e.g. warfarin)
N - Not yet classified
What is dysfunctional uterine bleeding?
Abnormal bleeding but NO structural/endocrine/neoplastic/infectious cause identified
What is endometriosis?
Endometrial type tissue found outside the uterine cavity
Which hormone plays an important role in development of endometriosis?
Oestrogen
Where does endometriosis usually occur?
1 - Ovary
2 - Pouch of Douglas
3 - Pelvic peritoneum (more common on left side due to direction of peritoneal fluid flow)
What are the signs & symptoms of endometriosis?
Symptoms:
1 - Premenstrual pelvic pain
2 - Dysmenorrhoea (painful periods)
3 - Deep dyspareunia (deep pain during sex)
4 - Subfertility
Signs:
1 - Tender rectovaginal nodules
2 - Limited uterine mobility
3 - Adnexal mass
How is endometriosis diagnosed?
Gold standard = Laparoscopy
Deep endometriosis = MRI
Endometrioma (chocolate cyst) = USS
How is endometriosis treated?
Medical:
- Hormonal treatment (Progestogen, combined oral contraceptive pill, GnRH analogues)
- Analgesics
Surgical:
- Excision of deposits from peritoneum/ovary
- Diathermy/laser ablation of deposits
- Removal of ovaries with or without hysterectomy
What is adenomyosis?
The presence of endometrial tissue in the myometrium
What are the signs & symptoms of adenomyosis?
1 - Heavy, painful periods
2 - Bulky tender uterus
3 - Usually observed in parous woman
How is adenomyosis diagnosed?
MRI
Histology of uterine muscle
