Menstrual disorders Flashcards

1
Q

What is the menstrual cycle?

A

The time from the first day of a woman’s period to the day before her next period

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2
Q

What is normal blood loss from menstruation?

A

Less than 80mls over 7 days

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3
Q

What is the average duration of menstruation?

A

2-7 days

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4
Q

What is the average length of the cycle?

A

24-35 days

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5
Q

When is menarche normal?

A

10-16 years

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6
Q

When is normal for menopause?

A

50-55years

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7
Q

What are the 4 categories of disturbance of menstruation?

A

Disturbance of frequency
Irregularity
Abnormal duration of flow
Abnormal menstrual volume

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8
Q

How can heavy menstrual bleeding be quantified?

A

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

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9
Q

What is the main health implication of heavy menstrual bleeding?

A

Anaemia

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10
Q

What are causes of heavy menstrual bleeding?

A
Fibroids
Endometrial polyps
Endometriosis
PID
PCOS
Coagulation disorders
Hypothyroidism
Liver/renal disease
Anticoagulant treatment
Herbal supplements
IUD
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11
Q

What are fibroids?

A

Non-cancerous growths made of muscle and fibrous tissue, also called lieomyoma

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12
Q

What are symptoms of fibroids?

A
May be asymptomatic
Heavy menstrual bleeding
Pelvic pain
Urinary symptoms
Pressure symptoms
Backache
Infertility
Miscarriage
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13
Q

How are fibroids diagnosed?

A

Ultrasound scan

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14
Q

How are fibroids managed if medical treatment is declined or failed and fertility preservation is not required?

A

Hysterectomy

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15
Q

What is endometriosis?

A

Endometrial tissue outside the lining of the uterus

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16
Q

Why does endometriosis cause heavy menstrual bleeding?

A

The tissue behaves like Endometrium and bleeds

17
Q

What are symptoms of endometriosis?

A
Pelvic pain
Heavy menstrual bleeding
Infertility
Fatigue
Systemic symptoms
18
Q

How is endometriosis diagnosed?

A

Pelvic examination
Ultrasound scan
Diagnostic laparoscopy

19
Q

How is endometriosis managed?

A

Analgesia
Medical - COCP, POP, Mirena IUS
Surgical - ablation, hysterectomy, endometrioma excision

20
Q

What is adenomyosis?

A

A condition where the endometrium becomes embedded in the myometrium

21
Q

What are symptoms of adenomyosis?

A

Heavy menstrual bleed

May have significant dysmenorrhoea

22
Q

How is adenomyosis treated?

A

Hysterectomy

23
Q

What are endometrial polyps?

A

Overgrowth of endometrial lining which extend into endometrium

24
Q

How are endometrial polyps diagnosed?

A

Ultrasound or hysteroscopy

25
How are endometrial polyps managed?
Polypectomy
26
What medications can be given for heavy menstrual bleeding?
``` Tranexamic acid Mefanamic acid Hormonal contraception Combined contraceptive pill Oral progesterones ```
27
What is salpingo-oophectomy?
Removal of tubes and ovaries
28
What is the main disadvantage of salpingo-oophectomy?
Immediate menopause - HRT is recommended until age 50
29
What are advantages of salpingo-oophectomy?
Reduce risk of subsequent ovarian cancer
30
What is oligomenorrhoea?
Infrequent or abnormally light menstruation
31
What is amenorrhoea?
Absent menstruation
32
What life changes can cause oligo/amenorrhoea?
``` Stress Eating disorders Malnourishment Obesity Intense exercise ```
33
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 ```
34
What is used to diagnose PCOS?
USS appearance of ovary Biochemical hyperandrogenism Clinical hyperandrogenism Diagnosed if 2 of 3 criteria met
35
What is PCOS associated with clinically?
Infertility Oligo/amenorrhoea Increased risk with obesity
36
What is the main management for PCOS?
Lifestyle management to achieve normal BMI
37
Why are bleeds required in PCOS?
Prevents hyperplasia - 3 bleeds per year required
38
What is dysfunctional uterine bleeding?
Excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisabe uterine or systemic disease