Menstrual Disorders Flashcards
What is the definition of menorrhagia?
Heavy period of over 80ml per cycle
What infection can be a cause of inter menstrual bleeding?
Chlamydia
What is the FIGO classification for abnormal uterine bleeding?
PALM-COEIN P- polyp A- adenomyosis L- leiomyoma M- malignancy/hyperplasia C- coagulation (von willebrand’s disease) O- ovarian (polycystic ovaries/anovulatory cycles) E – endocrine (thyroid) I- iatrogenic (warfarin) N- not yet classified
What is dysfunctional uterine bleeding?
Abnormal bleeding but no structural /endocrine /neoplastic/infectious cause found
What is endometriosis?
Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature
What are the symptoms of of endometriosis?
Dysmenorrhoea Chronic or cyclic pelvic pain Dyspareunia Sub-fertility Uterosacral ligament nodularity Pelvic mass Fixed, retroverted uterus Depression Dysuria, flank pain, haematuria Dyschezia, haematochezia
What investigations should be done for endometriosis?
Transvaginal ultrasound (TVUS) Rectal endoscopic ultrasound 3D ultrasonography Hysterosalpingography MRI pelvis Diagnostic laparoscopy
What is the management of endometriosis?
OCP NSAIDS Progestogen GnRH Antagonist GnRH Agonist Laparoscopy Hysterectomy
What is adenomyosis?
Presence of endometrial tissue in the myometrium
What are the symptoms of adenomyosis?
Menorrhagia
Dysmenorrhoea
Bulky, tender uterus
How is adenomyosis diagnosed?
MRI can suggest diagnosis
Uterine histology from hysterectomy is diagnostic
How is adenomyosis managed?
Treat symptoms of heavy and painful periods with hormonal contraception
LNG IUS (Mirena)
Progestogens
Combined oral contraceptive pill
What tissue are leiomyomas formed from?
Smooth muscle
What three types of leiomyoma are there?
Sub mucous-protrude into uterine cavity
Intramural-within uterine wall
Sub serous-project out of uterus into peritoneal cavity
What are the symptoms of a leiomyoma?
Asymptomatic Menorrhagia Intermenstrual Bleeding Irregular firm central pelvic mass Pelvic pain Pelvic pressure Dysmenorrhoea Bloating Infertility Urinary complaints Constipation Enlarged uterus
What investigations are done for a leiomyoma?
Ultrasound Endometrial biopsy Sonohysterography Hysteroscopy MRI Laparoscopy
What treatment is available for leiomyomas?
Only if symptomatic
Standard menorrhagia treatment if cavity not too distorted
GnRH analogues or Ulipristal acetate may be used temporarily to shrink the fibroids – usually preoperatively
Submucous fibroids: Transcervical resection hysteroscopically
Myomectomy
Uterine artery embolisation
Hysterectomy
What treatments are available for dysfunctional uterine bleeding?
Non hormonal: Tranexamic acid or Mefanamic acid
Hormonal: Progestogen only tablets, injections (Depo Provera), Levonorgesterel Intrauterine System, Combined pill
Endometrial ablation
Hysterectomy
