Menstrual disorders Flashcards
what is the menstrual cycle defined as?
The menstrual cycle is the time from the first day of a woman’s period to the day before her next period
How can the menstrual cycle be disturbed
- Frequency
- Irregularity
- Duration
- Volume
What sort of factors to use to assess whether someone is having heavy bleeding?
´Bleeding>8dys menorrhea ml over 7 days, regular cycle
´AND/OR the need to change menstrual products every one to two hours
´AND/OR passage of clots greater than 2.5 cm
´Bleeding through the clothes
´AND/OR ‘very heavy’ periods as reported by the woman/affecting quality of life
Aetiology of heavy bleeding?
- Uterine/ ovarian pathologies
- Systemic diseases and disorders
- Iatrogenic causes
list some of the uterine and ovarian pathologies which can cause HMB?
´Uterine fibroids ´Endometrial polyps ´Endometriosis and adenomyosis ´Pelvic inflammatory disease and pelvic infection ´Endometrial hyperplasia or carcinoma ´Polycystic ovary syndrome
List some of the systemic diseases which can lead to HMB?
´Coagulation disorders (for example von Willebrand disease).
´Hypothyroidism
´Liver or renal disease.
List some of the iatrogenic disease which can lead to HMB?
´ Anticoagulant treatment.
´ Herbal supplements
´ Intrauterine contraceptive device
Investigation
- history
- pelvic examination
- clotting profile
- PUS
- Laparoscopy
- Endometrial biopsy for al women over 44
what are fibroids?
´Non cancerous growths made of muscle and fibrous tissue.
What are fibroids also known as?
myoma
lieomyoma
Symptoms of fibroids?
´ Can be asymptomatic ´ HMB ´ pelvic pain ´ urinary symptoms ´ pressure symptoms ´ backache ´ Infertility ´ Miscarriage
Management of fibroids?
small: COP, POP, Mirena
large with fertility preservation:
- fibroid embolisation
- myomectomy
Submucosal
-hysteroscopic fibroid resection
Failed medical treatment and no need for fertility preservation:
-Hysterectomy
what is endometriosis?
Defined as endometrial tissue present outside the lining of uterus .
During menstruation this ectopic tissue behaves the same as endometrium and bleeds.
symptoms of endometriosis?
oPainful menstrual cramps- get worse over time
oLower back pain
oAbnormal bleeding or spotting between menstrual periods
oPain during/after sexual intercourse
oPainful bowel movements or urination
oDiarrhoea/nausea/bloating
what can endometriosis cause?
´May present with HMB
´Most often pelvic pain .
´Multi-system involvement .
´ severely affects quality of life -can be devastating.
´in addition to pelvic symptoms , can cause infertility, fatigue and systemic symptoms
what is the diagnosis of endometriosis?
o often misdiagnosed : IBS, Period pain, PCOS, Fatigue..
oPelvic examination
oUltrasound scan, Diagnostic laparoscopy
stages of endometriosis?
4
stage 1 and 2 of endometriosis?
Stage 1: minimal
o small patches/ surface lesions/ inflammation on or around organs in the pelvic cavity
Stage 2: mild
o more widespread
o starts to infiltrate pelvic organs
stage 3 and 4 of endometriosis
Stage 3: Moderate
oPeritoneum/ pelvic side walls infiltrated
oSometime with scarring/adhesions
Stage 4: severe
oInfiltrative
oAffects lots of pelvic organs and ovaries
oOften with distorsion of anatomy and adhesions
Management of endometriosis?
Medical o COCP o POP o Mirena IUS o Depot prover o GnRH Analogues
Surgical o Ablation o Hysterectomy endometrioma excision o pelvic clearance o Hysterectomy ´ Surgical management may be required as part of fertility treatment.
what is adenomyosis?
A condition where endometrium becomes embedded in myometrium .
treatment of adenomyosis?
- may respond to hormones?
- hysterectomy
what are endometrial polyps?
how are they managed?
Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
POLYPECTOMY
Treatment for menstrual disorders?
o Observation and monitoring o Hormones o Hormone-containing IUD o Endomyometrial resection o Endometrial ablation : NovaSure o Remove fibroids/polyps o Hysterectomy : robotic/laparoscopic
Medical treatment
- Tranexamic acid reduces blood loss 60%
- Mefenamic acid reduces blood loss 30% and pain
- Both of them are taken at the time of periods , Do not regulate cycles
- Suitable for those trying to conceive
- Hormonal contraception
- Combined contraceptive pill (COCP) makes periods lighter, regular and less painful
- LNG IUS and Depo-Provera reduces bleeding – may cause irregular bleeding, some women will be amenorrhoeic
- Oral progestogens
Surgical treatment
- Endometrial ablation
- Hysterectomy
- Removal of ovaries
- Salpingo-oophorectomy= removal of the tubes and ovaries
what is Oligo/amennorea?
´Infrequent, absent or abnormally light menstruation
´Important to check if its normal to a person
Aetiology for oligo/amenorroea
➢Life changes:stress, eating disorders/malnourishment, obesity, Intense exercise
➢Hormones:POP, Mirena, depot injection
➢Primary ovarian insufficiency
➢Polycystic ovarian syndrome ,
➢Hyperprolactinemia (elevated levels of prolactin in the blood)
➢Prolactinomas (adenomas on the anterior pituitary gland)
➢Thyroid disorders (Graves’s disease)
➢Obstructions of the uterus, cervix, and/or vagina
what is dysfunctional uterine bleeding?
•Dysfunctional uterine bleeding (DUB) is a common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases.
