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Reproduction and Sexual Health > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Name 2 gonadotrohpic hormones.

A

LH and FSH

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2
Q

Name 2 ovarian hormones.

A

Oestrogen and progesterone

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3
Q

What cells make oestrogen?

A

Granulosa cells

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4
Q

What does FSH stimulate?

A

Ovarian follicle development and the production of oestrogen by granulosa cells

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5
Q

What inhibits FSH production?

A

Raising oestrogen and inhibin by dominant follicles

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6
Q

What do declining FSH levels cause?

A

Atresia of all but dominant follicle

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7
Q

When does ovulation occur (in relation to LH surge)?

A

Ovulation occurs after the LH surge

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8
Q

What happens in ovulation?

A

The dominant follicle ruptures and releases oocyte

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9
Q

What does the luteal phase involve the formation of?

A

Corpus luteum

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10
Q

What hormones is produced in the luteal phase?

A

Progesterone

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11
Q

When does luteolysis occur?

A

14 days post ovulation

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12
Q

On what day of ovulation does your period usually start?

A

14 (when luteolysis occurs)

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13
Q

What happens to the endometrium in the proliferative phase?

A

There is oestrogen-induced growth of endometrial glands and stroma

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14
Q

Describe the luteal phase of the menstrual cycle.

A
  • Progesterone-induced glandular secretory activity.
  • Decidualisation in LATE SECRETORY phase.
  • Endometrial apoptosis and subsequent menstruation.
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15
Q

What happens to the endometrium during menstruation?

A

There is arteriolar constriction, and shedding of the functional endometrial layer

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16
Q

What inhibits scar tissue formation during menstruation\?

A

Fibrinolysis

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17
Q

How long does menstrual loss usually last?

A

4-6 days

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18
Q

When does menstrual flow peak?

A

Days 1-2

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19
Q

What volume of blood is lost per menstruation?

A

<80ml.

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20
Q

What is abnormal in terms of bleeding?

A

Clots and flooding

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21
Q

How long does a menstrual cycle usually last?

A

28 days +/- 7 days

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22
Q

Postcoital bleeding is ________

23
Q

What is menorrhagia?

A

Prolonged and increased menstrual flow

24
Q

The causes of menorrhagia can be organic or non-organic

25
Q

Organic causes

A

There is pathology

26
Q

Non-organic causes

A

No pathology

27
Q

What is 50% of all cases of non-organic causes of menorrhagia?

A

Dysfunctional uterine bleeding

28
Q

Describe what you would see on a transvaginal USS of someone with endometriosis.

A
  • Red or black spots.
  • Blood can’t escape, and causes an inflammatory reaction.
  • CHOCOLATE CYSTS!!!
29
Q

What is a fibrinoid?

A

Benign tumour of the myometrium which results in the uterus being much larger than normal

Don’t usually cause pain, but do result in painful periods

30
Q

What is adenomyosis?

A

Where there is endometrium present in the muscle of the uterus

Bleeding around this tissue each month causes a lot of pain.

31
Q

Describe endometrial hyperplasia.

A

Excessive proliferation which can go on to cause endometrial carcinoma.

32
Q

Where can endometriosis occur?

A

Anywhere in the peritoneal cavity, outside the uterus

33
Q

What do tumours of granulosa cells produce?

34
Q

List local causes of organic menorrhagia.

A
  • Fibrinoid
  • Adenomyosis
  • Endocervical/endometrial polyp
  • Cervical eversion
  • Endometrial hyperplasia
  • IUCD
  • PID
  • Endometriosis
  • Malignancy of cervix or uterus
  • Trauma
35
Q

Name 4 endocrine disorders which can cause organic menorrhagia.

A

Hyper/hypothyroidism.
Diabetes mellitus.
Adrenal disease.
Prolactin disorders

36
Q

What drugs can cause menorrhagia?

A

Anticoagulants

37
Q

What proportion of women with abnormal uterine bleeding have DUB?

38
Q

How is the diagnosis of DUB made?

A

By exclusion

39
Q

DUB can be divided into 2 groups. What are these?

A

Anovulatory + Ovulatory

40
Q

What percentage of DUB is anovulatory?

41
Q

When does anovulatory DUB occur?

A

At extremes of reproductive life

42
Q

What is the cycle like in ‘anovulatory DUB’?

43
Q

Who gets anovulatroy DUB?

A

Obese women

44
Q

Who gets ovulatory DUB?

A

Women aged 35-45 years.

45
Q

What does ovulatory DUB occur due to?

A

Inadequate progesterone production by the corpus luteum

46
Q

Why is TSH level checked when investigating DUB?

A

To exclude hyperthyroidism which is associated with amenorrhoea

47
Q

When should you do a transvaginal USS?

A

If you suspect a pelvic mass

48
Q

What can a transvaginal USS be used for?

A

Measuring endometrial thickness (to exclude endometrial carcinoma).

To identify the presence of fibroids and other pelvic masses.

49
Q

What are the 3 forms of endometrial sampling?

A
  • Pipelle biopsies
  • Hysteroscopic directed
  • Dilatation and curettage (D+C)
50
Q

Give examples of medical treatments of DUB.

A
  • Progestogens
  • Combined oral contraceptive pill
  • Danazol
  • GnRH analogues
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Anti-fibrinolytics
  • Capillary wall stabilisers
51
Q

What is the best drug to use in the treatment of DUB?

A

Tranexamic acid

52
Q

Outline the 1st and 2nd line in the treatment of DUB.

A 
1st line: mirena IUS. 
2nd line: 
Non-hormonal meds
e.g. tranexamic acid, NSAIDs. 
Hormonal meds e.g. COC, POP.
53
Q

What are the 2 surgical options in the management of DUB?

A

Endometrial resection/ablation.

Hysterectomy

54
Q

Endometrial ablation should be offered first, rather than a hysterectomy

Reproduction and Sexual Health (51 decks)

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