Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Define Menorrhagia [2], Dysmenorrhoea, oligomenorrhoea, IMB & PCB?

A 
Menorrhagia = Heavy periods, technically >80ml but its subjective
Dysmenorrhoea = painful periods
Oligomenorrhoea = Irregular periods > 35 days apart
IMB = Intermenstrual bleeding
PCB = Post-coital bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What questions might you ask when a patient complains of heavy or painful periods? [5]

A

Clots? Size?
Tampons, pads?
Pain - heavy flow onset or premenstrual onset?
Do you ever flood (bleed through clothes)?
QOL questions - does it affect your work, hobbies or ability to go out in public?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Age is a good way of narrowing down the likely cause of abnormal bleeding, What problems might you expect in an early teenager? [2]

A

Probably anovulatory cycles, which is quite normal as they go through puberty
Or a coagulation disorder ( but unlikely to develop later)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What problems might you expect in someone from puberty up to their 40s? (fertile age) [4]

A

Chlamydia, contraception issues
Endometriosis or adenomyosis, Fibroids
Endometrial or cervical polyps
Dysfunctional Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What problems might you expect in someone >40s? [4]

A

Perimenopausal anovulation
Endometrial cancer
Iatrogenic bleeding - warfarin
Thyroid disfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

So if a woman comes to you with a bleeding problem what kind of blood tests would you like to do? [5]

A 
FBC
Thyroid function (if history indicates)
Coagulation screen (if younger)
Endometrial biopsy (if >45, persistent IMB or obese)
Pregnancy test (important to ALWAYS consider pregnancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What accompanying history would warrant a test for chlamydia

A

Any patient with IMB and/or PCB, especially if they’re in adolescent age group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations are worth considering in a menstrual disorder? [2]

A

Transvaginal US

Hysteroscopy for endometrial pathology e.g. polyps, fibroids or cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When would a hysteroscopy be indicated? [2]

A

Persistant IMB

Or if the US showed up a suspected endometrial pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What acronym do we use to remember the causes of abnormal uterine bleeding?

A

PALM-COEIN (FIGO classification):

  • Polyps
  • Adenomyosis & Endometriosis
  • Leiomyoma (fibroid)
  • Malignancy
  • Coagulation disorder
  • Ovarian (e.g. PCOS)
  • Endocrine (e.g. Thyroid)
  • Iatrogenic (e.g. Warfarin)
  • Not Classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Endometriosis? [2]

Sites [3]

A

When endometrial tissue is found outside the uterine cavity
A chronic estrogen-dependant condition
Sites: ovary, pouch of Douglas, pelvic peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Endometriosis can be asymptomatic but
how might it present otherwise?
Symptoms [4]
Signs [3]

A 
Symptoms:
Premenstrual pelvic pain
Dysmenorrhea - severe
Deep dyspareunia
Subfertility

On exam you may find tender nodules in rectovaginal septum, adnexal masses or limited uterine mobility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

So a 25yr old woman comes in complaining that her periods are painful and hurts before, she also experiences pain during intercourse. How would you test her for endometriosis? [3]

A 
Start with an exam 
Then:
- Laparoscopy is gold standard
- US for endometriomas (chocolate cysts)
- MRI for deep endometriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

You give a diagnosis of endometriosis, what medical treatments will you suggest? [3]

A

Hormonal contraceptives to control the symptoms:

  • cOCP
  • Progestogen (pill, injection, IUS)
  • GnRH analogues Gosorelin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What surgical treatments could you offer for endometriosis? [3]

A

Can excise the endometrial deposits
Can do diathermy or laser ablation
Can go as far as oophorectomy +/- hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adenomyosis is found to be very common in parous women and may co-exist with endometriosis
Define Adenomyosis?
Presentation [2]

A

Endometrial tissue appearing in the myometrium.
Menorrhagia and dysmenorrhea
Bulky tender uterus of 12 week size

17
Q

The diagnosis of adenomyosis is difficult. Give 2 ways in which it is done

A

Harder than endometriosis, generally its done by histology after a hysterectomy is done.
An MRI can suggest it but can’t differentiate from fibroids
Uterine muscle biopsy

18
Q

So if we suspect adenomyosis how can we treat them?
3 Rx
2 procedural treatments

A

Start with symptom control using hormonal contraceptives:

  • cOCP
  • Progestogens
  • LNG-IUS

Endometrial Ablation

Most cases these will fail and you’ll end up doing a hysterectomy

19
Q

Define a Fibroids or Leiomyoma? [2]

Higher incidence in which ethnic group

A

A smooth muscle growth in the uterine wall

Afro-carribean women

20
Q

Types of fibroid? [3]

Classified according to how they protrude in the abdominal space

A

Sub-mucosal project into uterine cavity
Intramural
Sub-serous project into peritoneal cavity

21
Q

May be asymptomatic and incidental finding.

What presentations could suggest fibroids? [5]

A
  • Pressure symptoms
  • Menorrhagia (increased uterine surface area)
  • IMB
  • Pain
  • Malpresentation (transverse) or obstructed labour in pregnancy (cervical)
22
Q

How do we test for a fibroid? [5]

A 
Exam: irregularly abdominal mass 
TVUSS
Endometrial biopsy
Colour flow doppler ddx from myometrium in pregnancy
Hysteroscopy
23
Q

Medical treatment of DUB [3]

A
  • Reassure that no sinister pathology if appropriate
  • Transexamic acid or mefanimic acid
  • Hormonal treatments: contraception
24
Q

What if a woman with a fibroid has a distorted uterine cavity? [5]

A

Treat surgically:

  • Transcervical resection for submucosal fibroids
  • Myomectomy
  • Uterine Artery Embolisation
  • Hysterectomy

Can use GnRH analogues neo-adjuvantly to shrink them for surgery

25
Q

Theories of pathogenesis in endometriosis [4]

A

Retrograde menstruation - menstrualblood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity

Coelomic metaplasia - both peritoneum and endometrium have common precursor, peritoneum can turn into endometrium

Haematogenous spread

Direct transplantation

26
Q

Hormonal treatments of DUB - 3 options
Which is first line?
Emergency management of excessive uterine bleeding [2]

A

LNG IUS, other progestogen - first line
COCP - regulates and lightens periods (add-on)
IV estrogen and/or surgery

27
Q 
Fibroid management
If desiring fertility [2]
If family complete [2]
If patient wants to preserve uterus [1]
Surgical mx for sub mucous fibroids [1]
A

If desiring fertility: myomectomy + GnRh analogue
If family complete: TAH
If patient wants to preserve uterus - uterine artery embolisation
Surgical mx for sub mucous fibroids - transcervical resection (hysteroscopy)

28
Q

Complications of fibroid: red degeneration in pregnancy [4]

A

Capsular vessel thrombosis then venous engorgement

  • causes abdo pain, vomiting and low grade fever with peritoneal tenderness
  • in last ½ pregnancy or puerperium
  • mx is bed rest and expectant mx

Repro (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions