Menstrual Disorders Flashcards
what does FSH do?
stimulates follicle development
stimulates granulosa cells to make oestrogen
when does FSH rise?
start of the cycle
there is a surge in what chemical in ovulation
LH
what promotes the formation of a dominant follicle?
decrease in FSH
at what stage of the menstrual cycle does the dominant follicle rupture?
ovulation
when does the corpus luteum break down?
14 days post ovulation
what hormone is produced in the luteal phase?
progesterone
name the 2 phases of the menstrual cycle
proliferative
secretory
what does oestrogen do in the proliferative phase?
promotes growth of the endometrial glands and stroma
what does progesterone do in the luteal phase?
promote glandular secretory activity
what happens to arterioles in menstruation?
they constrict
scar tissue formation is prevented in menstruation by what?
fibrinolysis
normal duration of menstruation?
4-6 days
clots are normal in a period T or F
T
what is polymenorrhoea?
period cycle less than 21 days
define oligomenorrhoea
period cycle more than 35 days
amenorrhoea is absence of menstruation > _ months
6
define metrorrhagia?
regular intermenstrual bleeding
2 types of menorrhagia?
organic ie due to pathology
non-organic ie dysfunctional uterine bleeding (diagnosis of exclusion)
benign local causes of menorrhagia?
fibroids
polyps
endocervical gland contains what kind of epithelium?
columnar epithelium
what foreign bodies can cause menorrhagia?
IUD (copper)
main cause of PID in UK?
chlamydia
pathological local causes of menorrhagia?
adenomyosis PID endometriosis malignancy trauma endometrial hyperplasia
severe pain and heavy bleeding make you think what conditions?
PID
endometriosis
adenomyosis
what 2 gynae cancers can cause menorrhagia
cervical carcinoma endometrial carcinoma (uterus)
post-menopausal bleeding….
endometrial carcinoma
what gynae cancers produce hormones?
granulosa cell tumour (ovarian cancer that produces oestrogen)
how can you tell laparoscopically if tubes are blocked?
inject a dye into the cervix, if it doesnt spill out the end of the fallopian tube its blocked
what is endometriosis
ectopic endometrium elsewhere in the pelvis
gross appearance of endometriosis over time
red spot with bleeding that fibroses to become black
what happens in untreated endometriosis
blood accumulates leading to cyst formation
“chocolate cyst”
ovarian endometrioma (cyst formation as a result of undiagnosed endometriosis)
what endocrine disorders can cause menorrhagia
hyper/hypothyroidism
diabetes
adrenal disease
prolactin disorders tend to cause what menstrual disorder and why?
amenorrhoea (suppresses LH and FSH production)
what haematological disorders can cause menorrhagia?
haemophilia (carriers)
von willebrand’s disease
thrombocytopaenia
clotting factor deficiency
what drugs can cause menorrhagia?
anticoagulants
what are the main age groups who present with menorrhagia
teenagers
women in late 40s
obstetric causes of organic menorrhagia?
miscarriage
ectopic pregnancy
gestational trophoblastic disease
PPH
bleeding in early pregnancy….
ectopic pregnancy
2 subtypes of dysfunctional uterine bleeding?
anovulatory
ovulatory
most common subtype of DUB?
anovulatory
describe anovulatory DUB; who gets it?
irregular cycle at extremes of reproductive life
very young and meopausal women
OBESE WOMEN ++++
what happens in ovulatory DUB and why?
regular heavy periods due to inadequate progesterone production by poor quality corpus luteum
why are you most fertile in younger age?
release your best quality eggs at the beginning
corpus luteum’s quality decreases
haematological Ix of DUB
FBC Hb (exclude anaemia) TSH for thyroid dsysfunction coag screen renal/LFTs
screening Ix of DUB
smear
transvaginal USS
endometrial sampling
when would you do a transvaginal USS?
assess endometrial thickness
detect fibroids and other pelvic masses
the ___ the endometrium, the __ likely you are to have an endometrial carcinoma
thicker
more
mean age for endometrial carcinoma?
60 yrs old
above what age should you consider endometrial carcinoma?
40
Ix endometrial carcinoma
- transvaginal USS to assess endo thickness
2. pipelle biopsy to sample endometrium if USS is abnormal
hysteroscopy tends to be done under general anaesthetic T or F
T
when does FSH rise?
start of the cycle
there is a surge in what chemical in ovulation
LH
what non-pharmacological contraceptive can be used to treat DUB?
IUS (hormonal)
surgical Tx of DUB
- endometrial resection/ablation
2. hysterectomy
what foreign bodies can cause menorrhagia?
IUD (copper)
“chocolate cyst”
ovarian endometrioma (cyst formation as a result of undiagnosed endometriosis)
non surgical Tx of DUB
progestogens (from day 5-25)
OCP
NSAIDs (minimises prostaglandin production in the corpus luteum breakdown phase)
GnRH analogues
why is progestogen used in treatment over progesterone
has a longer half life
what days in the menstrual cycle count as the period?
day 1 to 5
surgical Tx of DUB
endometrial resection/ablation
hysterectomy
3 methods of doing a hysterectomy?
vaginally
abdominally
laparoscopically
