Menstrual Disorders Flashcards
What is the normal ages for menarche and menopause?
13-51
How long do periods tend to last? How long is the normal cycle of a period?
4-5 days
21-35 days
What triggers menstruation?
Fall in progesterone 2 weeks after ovulation if the egg is not fertilised
What is the mean blood loss for a period?
30-40ml + mucosa of endometrial and secretion from other halnds
What things may cause period abnormalities that are not pathologic?
Stress/medications etc. that disrupt hormones
Define menorrhagia
Heavy periods
Blood loss >80ml/cycle (or as the woman perceives)
In which conditions would you get menorrhagia?
Adenomyosis
Fibroids
Define dysmenorrhoea
Painful periods (recurrent lower ab pain during/shortly before period begins)
What may cause dysmenorrhoea?
Primary - normal pain occurring on first 1/2 days of period
Secondary - IUD, PID, endometriosis, fibroids, adenomyosis
What is intermenstrual bleeding?
Bleeding between periods
In which conditions would you get IMB?
Ovarian insufficiency, cervical/endometrial cancer, OCP use
What is post-coital bleeding?
Bleeding after sex
What is oligomenorrhoea?
Infrequent periods (45-90 day cycle)
What causes oligomenorrhoea?
Pregnancy, ectopic pregnancy, PCOS, insufficient calorific intake
What is amenorrhoea?
Absence of menses
What can cause amenorrhoea?
Pregnancy, ovarian disorders, e.g. PCO, endometriosis, endocrine disorders
What is mittelschmerz?
Midcycle pain that occurs with ovulation
Enlargement/rupture of follicle –> peritoneal irritation –> recurrent, unilateral lower abdominal pain
NORMAL
What investigations should you do for heavy periods?
FBC Thyroid function Coagulation testing if Hx suggestive Endometrial biopsy Pregnancy test TVUS Hysteroscopy
When would you do an endometrial biopsy?
> 45y, persistent IMB/irreg perimenopausal bleeding, other RFs for endometrial hyperplasia/endometrial thickness 4+cm
to rule out endometrial cancer/hyperplasia
What additional test should you do for IMB/PCB?
Chlamydia testing
What would you do a TVUS for?
PCO, assess endometrial thickness, adnexa, fibroids
What would you do a hysteroscopy for?
Persistent IMB, suspected endometrial pathology on USS
What is likely to be the menstrual disorder in early teens?
Coagulation problems
Anovulatory cycles
What are the likely menstrual disorders from teens to 40s?
Chlamydia (esp IMB) Contraception related Endometriosis/adenomyosis Fibroids (menorrhagia) Endometrial/cervical polyps (IMB/PCB) Dysfunctional bleeding
What are the likely menstrual disorders in 40s-menopause?
Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction
What is the main complaint in endometriosis?
PAIN
What is the main compliant in adenomyosis?
MENORRHAGIA
What is an anovulatory cycle?
Menstrual cycle with absence of ovulation leading to menstrual irregularities