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Reproductive - Reproductive Gynaecology > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is the role of LH in females? What cell type does it act on?

A

Promote production of oestrogen from the ovaries by acting on theca cells

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2
Q

What is the role of FSH in females? What cell type does it act on?

A

Promote the growth of ovarian follicles by acting on granulosa cells

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3
Q

Within each ovarian cycle, what happens to a developing follicle?

A

It matures, releases an oocyte and differentiates into the corpus luteum

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4
Q

In the follicular phase of the menstrual cycle, what hormone stimulates follicular development and granulosa cells to produce oestrogen?

A

FSH

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5
Q

In the follicular phase of the menstrual cycle, raising levels of which hormones by the dominant follicle inhibits FSH production?

A

Oestrogen and inhibin

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6
Q

At the end of the follicular phase of the menstrual cycle, the declining levels of FSH have what effect?

A

Atresia of all follicles except the dominant one

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7
Q

The rising levels of oestrogen peak between days 12 and 14 which triggers a surge of which hormone?

A

LH

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8
Q

What happens to the dominant follicle in response to the LH surge at ovulation?

A

It ruptures and releases an oocyte

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9
Q

What happens to the dominant follicle in the luteal phase of the menstrual cycle?

A

It becomes the corpus luteum

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10
Q

In the luteal phase of the menstrual cycle, granulosa cells in the corpus luteum produce what hormone?

A

Progesterone

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11
Q

What is the role of progesterone in the luteal phase of the menstrual cycle?

A

Inhibit the release of FSH to prevent further follicle development

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12
Q

If pregnancy does not occur, what happens to the corpus luteum and levels of oestrogen and progesterone?

A

The corpus luteum degenerates and oestrogen and progesterone levels drop

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13
Q

What effect does progesterone have on the uterine endometrium?

A

Matures the endometrium

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14
Q

What effect does oestrogen have on the uterine endometrium?

A

Stimulates endometrial growth

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15
Q

What endometrial stage corresponds to each of the following ovarian cycle stages a) follicular? b) ovulation? c) luteal?

A

a) Menstrual phase b) proliferative phase c) secretory phase

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16
Q

What days of the menstrual cycle correspond to a) the menstrual phase? b) the proliferative phase? c) the secretory phase?

A

a) Days 1-5 b) days 5-14 c) days 15-28

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17
Q

What hormone is responsible for the proliferative phase of the endometrial cycle? What happens?

A

Oestrogen - growth of endometrial glands and stroma

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18
Q

What happens to the cervical mucus during the proliferative phase of the endometrial cycle?

A

It becomes thin and sticky, making it more penetrable to sperm

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19
Q

What hormone is responsible for the secretory phase of the endometrial cycle? What happens?

A

Progesterone - there is glandular secretory activity and decidualisation in the later stages

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20
Q

The decrease in both oestrogen and progesterone at the end of the preceding cycle has what effect on the endometrium?

A

Cells in the functional endometrium die and this is shed (menstruation)

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21
Q

What is a normal amount of blood to lose during menstruation?

A

< 80mls

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22
Q

Are clots and flooding normal during menstruation?

A

No

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23
Q

What range is considered a normal length of menstrual cycle?

A

21-35 days

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24
Q

During the menstrual cycle, when would it be abnormal to have vaginal bleeding?

A

Inter-menstrually (i.e. between periods) or post-coital

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25
Q

What is the difference between amenorrhoea and oligomenorrhoea?

A

Amenorrhoea is when there has been an absence of menstruation for > 6 months, oligomenorrhoea is when there is menses at intervals of > 35 days

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26
Q

What are some physiological causes for amenorrhoea?

A

Pregnancy, lactation, menopause, hysterectomy

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27
Q

What is menorrhagia?

A

Prolonged and increased menstrual flow with a normal cycle

28
Q

What is metrorrhagia?

A

Regular inter-menstrual bleeding

29
Q

What is polymenorrhoea?

A

Menses occurring at < 21 day intervals

30
Q

What is polymenorrhagia?

A

Increased bleeding and a more frequent than average cycle

31
Q

What is menometrorrhagia?

A

Prolonged menses and inter-menstrual bleeding

32
Q

Menorrhagia can be divided into having organic and non-organic causes. What is non-organic and what is this often known as?

A

Heavy menstrual bleeding with absence of pathology, also known as dysfunctional uterine bleeding

33
Q

Non-organic causes of menorrhagia can only be diagnosed by what?

A

Excluding organic causes

34
Q

What are some systemic disorders that could present with menorrhagia?

A

Endocrine conditions, disorders of haemostasis, liver disorders, renal disease, drugs (anti-coagulants)

35
Q

What is the 1st priority in all women of reproductive age who present with abnormal vaginal bleeding?

A

Ruling out pregnancy related causes

36
Q

What are some pregnancy related causes of menorrhagia?

A

Miscarriage, ectopic pregnancy, gestational trophoblastic disease, postpartum haemorhage

37
Q

What are some differentials of menorrhagia associated with pain?

A

Endometriosis, PID, adenomyosis

38
Q

Abnormal vaginal bleeding with a history of other bleeding abnormalities suggests what?

A

Coagulation disorder

39
Q

How could you tell if abnormal vaginal bleeding was due to fibroids?

A

They are palpable on pelvic and vaginal exam

40
Q

What examinations are used to exclude more sinister causes of abnormal vaginal bleeding?

A

Speculum and pelvic exam

41
Q

What is the difference in the demographic of women who tend to get cervical vs uterine cancer?

A

Cervical tends to present in younger women while uterine is more commonly postmenopausal

42
Q

For about 50% of women who present with abnormal uterine bleeding, what is the cause?

A

Dysfunctional uterine bleeding

43
Q

What are the two subtypes of dysfunctional uterine bleeding?

A

Anovulatory and ovulatory

44
Q

What is anovulatory dysfunctional uterine bleeding?

A

There is an irregular cycle, and because there isn’t ovulation every month, periods may be delayed and cause excessive bleeding

45
Q

Who does anovulatory dysfunctional uterine bleeding usually occur in?

A

Usually at extremes of reproductive life, more common in obese women

46
Q

What is ovulatory dysfunctional uterine bleeding?

A

Regular heavy periods due to inadequate progesterone production by the corpus luteum

47
Q

Who does ovulatory dysfunctional uterine bleeding usually occur in?

A

Those aged 35-45

48
Q

How do you get an idea of how much blood is passed in a period?

A

Ask about sanitary products, having to change once an hour is abnormal, also clots and flooding suggests heavy menstrual bleeding

49
Q

What is the most important blood test to do in someone presenting with dysfunctional uterine bleeding? Why?

A

FBC to exclude anaemia

50
Q

What are some blood tests which may or may not be done for a presentation of abnormal uterine bleeding depending on clinical suspicion?

A

TSH, coagulation screen, renal and liver function tests

51
Q

As well as FBC, what is a first line investigation for abnormal uterine bleeding if not up to date?

A

Cervical smear

52
Q

If a pelvic examination for abnormal uterine bleeding is abnormal, what is the next indicated investigation?

A

Transvaginal ultrasound

53
Q

What is a transvaginal ultrasound good for detecting?

A

Endometrial thickness, fibroids and other pelvic masses

54
Q

If an US scan for abnormal uterine bleeding is not conclusive, what are some other imaging tests which could be done?

A

Hysteroscopy or MRI

55
Q

When would endometrial sampling be done for someone with abnormal uterine bleeding? Why?

A

In those > 40 with persistent inter-menstrual bleeding to exclude an endometrial carcinoma

56
Q

What is the first line treatment for dysfunctional uterine bleeding?

A

Progestogen releasing IUCD - Mirena coil

57
Q

What are the advantages to using the Mirena coil as treatment for dysfunctional uterine bleeding?

A

Lasts for 5 years so no compliance issues, distributed locally so few systemic side effects

58
Q

What are some medical treatments that can be used for dysfunctional uterine bleeding?

A

Progestogens, COCP, tranexamic acid (anti-fibrinolytic)

59
Q

For who is the COCP a good treatment for dysfunctional uterine bleeding?

A

Young nulliparus women who also want contraception

60
Q

What is progestogen? How should it be taken?

A

A synthetic progesterone which has a longer half-life so requires less frequent dosing. It should be taken 5 days into the period and continued until day 21 of the cycle, with bleeding occurring after this to regulate periods

61
Q

Patients who you are giving the COCP to must not have what two things?

A

Any predisposing factors to thrombotic disease and no renal disease

62
Q

What are the surgical management options for dysfunctional uterine bleeding?

A

Endometrial ablation or resection or hysterectomy

63
Q

When should surgical managements for dysfunctional uterine bleeding be used?

A

When medical management has failed

64
Q

How does endometrial ablation/resection work?

A

The endometrium which bleeds excessively can be destroyed or removed by ablation or resection respectively. This damaged tissue is then replaced with fibrous tissue during healing.

65
Q

Who is surgical management of dysfunctional uterine bleeding suitable for?

A

Women who do not want children or have completed their families

66
Q

What is the advantage of vaginal hysterectomy?

A

Shorter recovery time than abdominal surgery

67
Q

What is the main advantage of medical treatment of dysfunctional uterine bleeding over surgical?

A

Fertility is retained

Reproductive - Reproductive Gynaecology (12 decks)

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