Menstrual disorders Flashcards
What is the menstrual cycle?
The time from the first day of a woman’s period to the day before her next period
What is normal blood loss from menstruation?
Less than 80mls over 7 days
What is the average duration of menstruation?
2-7 days
What is the average length of the cycle?
24-35 days
When is menarche normal?
10-16 years
When is normal for menopause?
50-55years
What are the 4 categories of disturbance of menstruation?
Disturbance of frequency
Irregularity
Abnormal duration of flow
Abnormal menstrual volume
How can heavy menstrual bleeding be quantified?
Bleeding >7days
Need to change menstrual products every 1-2 hours
Passage of clots greater than 2.5cm
Bleeding through clothes
Heavy periods as reported by patient impeding on QoL
What is the main health implication of heavy menstrual bleeding?
Anaemia
What are causes of heavy menstrual bleeding?
Fibroids Endometrial polyps Endometriosis PID PCOS Coagulation disorders Hypothyroidism Liver/renal disease Anticoagulant treatment Herbal supplements IUD
What are fibroids?
Non-cancerous growths made of muscle and fibrous tissue, also called lieomyoma
What are symptoms of fibroids?
May be asymptomatic Heavy menstrual bleeding Pelvic pain Urinary symptoms Pressure symptoms Backache Infertility Miscarriage
How are fibroids diagnosed?
Ultrasound scan
How are fibroids managed if medical treatment is declined or failed and fertility preservation is not required?
Hysterectomy
What is endometriosis?
Endometrial tissue outside the lining of the uterus
Why does endometriosis cause heavy menstrual bleeding?
The tissue behaves like Endometrium and bleeds
What are symptoms of endometriosis?
Pelvic pain Heavy menstrual bleeding Infertility Fatigue Systemic symptoms
How is endometriosis diagnosed?
Pelvic examination
Ultrasound scan
Diagnostic laparoscopy
How is endometriosis managed?
Analgesia
Medical - COCP, POP, Mirena IUS
Surgical - ablation, hysterectomy, endometrioma excision
What is adenomyosis?
A condition where the endometrium becomes embedded in the myometrium
What are symptoms of adenomyosis?
Heavy menstrual bleed
May have significant dysmenorrhoea
How is adenomyosis treated?
Hysterectomy
What are endometrial polyps?
Overgrowth of endometrial lining which extend into endometrium
How are endometrial polyps diagnosed?
Ultrasound or hysteroscopy
How are endometrial polyps managed?
Polypectomy
What medications can be given for heavy menstrual bleeding?
Tranexamic acid Mefanamic acid Hormonal contraception Combined contraceptive pill Oral progesterones
What is salpingo-oophectomy?
Removal of tubes and ovaries
What is the main disadvantage of salpingo-oophectomy?
Immediate menopause - HRT is recommended until age 50
What are advantages of salpingo-oophectomy?
Reduce risk of subsequent ovarian cancer
What is oligomenorrhoea?
Infrequent or abnormally light menstruation
What is amenorrhoea?
Absent menstruation
What life changes can cause oligo/amenorrhoea?
Stress Eating disorders Malnourishment Obesity Intense exercise
What are other causes of oligo/amenorrhoea outside of lifestyle changes?
Hormonal problems Primary ovarian sufficency PCOS Hyperprolactinaemia Prolactinomas Thyroid disorders Obstructions of the uterus
What is used to diagnose PCOS?
USS appearance of ovary
Biochemical hyperandrogenism
Clinical hyperandrogenism
Diagnosed if 2 of 3 criteria met
What is PCOS associated with clinically?
Infertility
Oligo/amenorrhoea
Increased risk with obesity
What is the main management for PCOS?
Lifestyle management to achieve normal BMI
Why are bleeds required in PCOS?
Prevents hyperplasia - 3 bleeds per year required
What is dysfunctional uterine bleeding?
Excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisabe uterine or systemic disease
