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Menstrual Disorders Flashcards

1
Q

What is the normal ages for menarche and menopause?

A

13-51

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2
Q

How long do periods tend to last? How long is the normal cycle of a period?

A

4-5 days

21-35 days

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3
Q

What triggers menstruation?

A

Fall in progesterone 2 weeks after ovulation if the egg is not fertilised

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4
Q

What is the mean blood loss for a period?

A

30-40ml + mucosa of endometrial and secretion from other halnds

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5
Q

What things may cause period abnormalities that are not pathologic?

A

Stress/medications etc. that disrupt hormones

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6
Q

Define menorrhagia

A

Heavy periods

Blood loss >80ml/cycle (or as the woman perceives)

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7
Q

In which conditions would you get menorrhagia?

A

Adenomyosis

Fibroids

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8
Q

Define dysmenorrhoea

A

Painful periods (recurrent lower ab pain during/shortly before period begins)

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9
Q

What may cause dysmenorrhoea?

A

Primary - normal pain occurring on first 1/2 days of period

Secondary - IUD, PID, endometriosis, fibroids, adenomyosis

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10
Q

What is intermenstrual bleeding?

A

Bleeding between periods

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11
Q

In which conditions would you get IMB?

A

Ovarian insufficiency, cervical/endometrial cancer, OCP use

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12
Q

What is post-coital bleeding?

A

Bleeding after sex

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13
Q

What is oligomenorrhoea?

A

Infrequent periods (45-90 day cycle)

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14
Q

What causes oligomenorrhoea?

A

Pregnancy, ectopic pregnancy, PCOS, insufficient calorific intake

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15
Q

What is amenorrhoea?

A

Absence of menses

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16
Q

What can cause amenorrhoea?

A

Pregnancy, ovarian disorders, e.g. PCO, endometriosis, endocrine disorders

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17
Q

What is mittelschmerz?

A

Midcycle pain that occurs with ovulation
Enlargement/rupture of follicle –> peritoneal irritation –> recurrent, unilateral lower abdominal pain

NORMAL

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18
Q

What investigations should you do for heavy periods?

A 
FBC
Thyroid function 
Coagulation testing if Hx suggestive 
Endometrial biopsy 
Pregnancy test
TVUS
Hysteroscopy
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19
Q

When would you do an endometrial biopsy?

A

> 45y, persistent IMB/irreg perimenopausal bleeding, other RFs for endometrial hyperplasia/endometrial thickness 4+cm

to rule out endometrial cancer/hyperplasia

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20
Q

What additional test should you do for IMB/PCB?

A

Chlamydia testing

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21
Q

What would you do a TVUS for?

A

PCO, assess endometrial thickness, adnexa, fibroids

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22
Q

What would you do a hysteroscopy for?

A

Persistent IMB, suspected endometrial pathology on USS

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23
Q

What is likely to be the menstrual disorder in early teens?

A

Coagulation problems

Anovulatory cycles

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24
Q

What are the likely menstrual disorders from teens to 40s?

A 
Chlamydia (esp IMB)
Contraception related
Endometriosis/adenomyosis
Fibroids (menorrhagia) 
Endometrial/cervical polyps (IMB/PCB)
Dysfunctional bleeding
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25
Q

What are the likely menstrual disorders in 40s-menopause?

A

Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction

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26
Q

What is the main complaint in endometriosis?

A

PAIN

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27
Q

What is the main compliant in adenomyosis?

A

MENORRHAGIA

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28
Q

What is an anovulatory cycle?

A

Menstrual cycle with absence of ovulation leading to menstrual irregularities

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29
Q

When is it most common to get anovulatory cycles?

A

In first few months/years after menarche

30
Q

Why do woman get anovulatory cycles?

A

HPO axis not fully established yet

31
Q

What are the symptoms of hypothyroidism?

A

Menorrhagia, tiredness, cold tolerance, wt gain, dry skin and hair etc.

32
Q

What are the symptoms of hyperthyroidism?

A

Olgiomenorrhoea/amenorrhoea, tachycardia, palpitations, HTN, excess sweating, diarrhoea, wt loss, hyperreflexia

33
Q

What is the PALM-COEIN FIGO classification for abnormal uterine bleeding?

A 
Polpys
Adenomyosis
Leiomyoma 
Malignancy/hyperplasia
Coagulation, e.g. vWF dx
Ovarian, e.g. PCOs/anovulatory cycles
Endocrine, e.g. thyroid
Iatrogenic, e.g. warfarin 
Not yet classified
34
Q

What is DUB?

A

Dysfunctional unterine bleeding
Abnormal bleeding with no structural/endocrine/neoplastic/infectious cause found as of yet

A lot can be different subjective opinion

35
Q

How many hysterectomies are for DUB?

A

50%

36
Q

Define endometriosis

A

Endometrial tissue outside the uterine cavity

37
Q

Why does endometriosis lead to symptoms?

A

This endometrial tissue is still oestrogen responsive so will grow and shed like normal endometrial tissue

–> inflammation, scarring, pain

38
Q

Where does this endometrial tissue in endometriosis tend to be found?

A

Ovary, pouch of Douglas, Fallopian tubes, pelvic peritoneum

Can be extra pelvic, e.g. lung/brain

39
Q

What are the theories for explaining the pathogenesis of endometriosis?

A

Retrograde menstruation - backflow of menstrual fluid containing endometrial tissue which implants in the tubes/ovaries etc.

Coelomic metaplasia: peritoneal cells & endometrial cells from same embryonic precursor so cells thought to undergo metaplasia

Haematogenous spread - menstrual blood enters BV and endometrial cells implant in various organs

Direct transplantation: e.g. scar endometriosis - endometrial cells implant on C-section/episitomy scars

40
Q

What are the symptoms of endometriosis?

A

Premenstrual pelvic pain
Dysmenorrhoea (2 days before periods - several days)
Deep dyspareunia
Subfertility

41
Q

Why do you get subfertility in some cases of endometriosis?

A

Adhesions/inflammation affect egg quality and implantation

42
Q

What signs do you get in endometriosis?

A

May be none
Tender nodules in rectovaginal septum if advanced
Limited uterine mobility
Adnexal masses

43
Q

What is used to diagnose endometriosis?

A

Laparoscopy - gold standard
MRI for deep endometriosis
USS to diagnose endometrioma

44
Q

How is endometriosis graded?

A

1–>4
1 = superficial lesions
4 = deep lesions

45
Q

What are chocolate cysts?

A

AKA endometriomas

Cyst like structures in ovaries containing blood, fluid and menstrual debris

46
Q

What is powder burn in endometriosis?

A

Mild endometriosis appears like superficial burn

47
Q

How does the appearance of the endometrial deposits change?

A

Red (flame red endometriosis) in active bleeding stage –> blue/back –> white and fibrous with the stages of the menstrual cycle

48
Q

What is involved in treatment of endometriosis?

A 
Progesterone - POP/LNG-IUS/depoProvera
COCP - tricycle (as symptoms predominantly during menstruation) 
GnRH analogues (leuprorelin) - induce perimenopause so implants regress

Surgery
Excision of deposits
Diathermy/laser ablation of deposits
Hysterectomy +/- oophorectomy

49
Q

What are the signs/symptoms of adenomyosis?

A

Heavy, painful periods
Bulky, tender uterus
Uniformly enlarged uterus

50
Q

How do you diagnose adenomyosis?

A

MRI may suggest diagnosis

Tend to diagnose post-hysterectomy via histology

51
Q

How do you treat adenomyosis?

A

LNG-IUS, POP, COCP

Often failed medical Rx/endometrial ablation –> hysterectomy

52
Q

What are fibroids?

A

Smooth muscle growths

AKA leiomyomas

53
Q

What are risk factors for fibroids?

A

Afro-caribbean, obesity, nulliparity, early menarche

54
Q

How do you diagnose fibroids?

A

Ex - irreg, enlarged uterus
TVUS/ab USS
Hysteroscopy (if think inside uterine cavity)

55
Q

What are the different kinds of fibroids?

A

Submucous - protruding into uterine cavity
Intramural - in uterine wall
Subserous - projecting into peritoneal cavity
May be called a polyp if it has a stalk

56
Q

What symptoms are associated with fibroids?

A

Often asymptomatic
Large fibroids –> pressure symptoms (constipation, urinary frequency/retention)
Menorrhagia (due to increased SA of endometrium)
Submucosal fibroids –> IMB

57
Q

How can fibroids complicate pregnancy?

A

Can grow rapidly in pregnancy and cause pain, malpresentation and obstruction in labour

58
Q

When do you treat fibroids?

A

Only if symptomatic

59
Q

How do you treat fibroids?

A

GnRH analogues/ulipristal acetate to temporarily shrink them before surgery
Submucous fibroids can be removed transcervically
Myomectomy (intramural/subserous)
Uterine artery embolization (block artery supplying fibroid so it dies)
Hysterectomy

60
Q

What are risk factors for adenomyosis?

A

Early menarche, increased parity, previous uterine surgery

61
Q

What are risk factors for endometriosis?

A

Retrograde menstruation

62
Q

How do you treat DUS?

A

Non-hormonal if trying to conceive: tranexamic acid/mefenamic acid
Hormonal: COCP, POP, LNG-IUS, Depo
Surgery: endometrial ablation/hysterectomy

63
Q

What is tranexamic acid?

A

Anti-fibrinolytic

Reduces blood loss by 60%

64
Q

What is mefenamic acid?

A

Prostaglandin inhibitor

Inhibits pain and reduces blood loss by 30%

65
Q

When is COCP CI?

A

Migraine, >35, smoker, high BMI

66
Q

Why might you not go for depo?

A

Stimulates appetite –> wt gain

67
Q

What are the different for endometrial ablation?

A

First gen: diathermy

Second gen: thermal balloon (85 degree water in balloon), radiofrequency

68
Q

What are the pre-requisites for endometrial ablation?

A

Uterine cavity length <11cm
Submucous fibroids <3/4cm
Previous normal endometrial biopsy (ensure no cancer which we may leak into the peritoneum –> spreading)

69
Q

What are the different ways a hysterectomy can be done?

A

Abdominally
Vaginally
Laparoscopically

70
Q

What are the different types of hysterectomy?

A

Subtotal: uterus only
Total: uterus and cervix
Total + bilat salphino-oophorectomy
Wertheim’s hysterectomy (T + BSO + upper vagina and parametrial tissue)

71
Q

What are the risks of hysterectomy?

A

Infection, DVT, bladder/bowel/vessels damage, altered bladder function, adhesions

72
Q

What are the disadvantages and advantages of oophorectomy?

A

Adv - reduces risk of ovarian cancer

Disadv - immediate menopause (HRT recommended until 50y)

Reproduction (28 decks)

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