Menstrual Disorders Flashcards
What is “normal” menstruation volume?
<80mls over 7 days
2-7 days
What are the common disturbances of menstruation?
Disturbed menstrual frequency
Irregular menstrual bleeding
Abnormal duration of flow
Abnormal volume
What is a prolonged menstruation?
> 8 days
What is a shortened menstruation?
<2 days
What is a frequent menstruation?
<24 days
What is a infrequent menstruation?
> 38 days
What is heavy menstrual bleeding?
Bleeding >80mls over 7 days Need to change products every 1/2hrs Passage of clots >2.5cm Bleeding through clothes "described as very heavy"
What are the types of causes of heavy menstrual bleeding?
Uterine/ovarian Pathologies
Systemic Disorders
Iatrogenic causes
What are the Uterine/ovarian Pathologies causing heavy menstrual bleeding?
Uterine Fibroids Endometrial polyps Endometriosis/adenomyosis PID Endometrial hyperplasia/cancer PCOS
What are the Systemic disorders causes of heavy menstrual bleeding?
Coagulopathy (von Willebrand)
Hypothyroidism
Liver renal disease
What are the Iatrogenic causes of heavy menstrual bleeding?
Anticoagulants
Herbal supplements
IUD
How do uterine fibroids present?
HMB
Dysmenorrhoea
Pelvic pain
How do endometrial polyps present?
HMB
Intermenstrual bleeding
How do endometriosis/adenomyosis present?
HMB Lower back pain Dysmenorrhoea Dyspareunia Pelvic pain Pain during/after sex Painful bowel movements Difficulty conceiving
How does PID present?
HMB Discharge Pelvic pain IM/postcoital bleeding Fever
How does endometrial hyperplasia present?
HMB
Postcoital bleed
IM bleeding
Pelvic pain
Which herbal supplements are associated with HMB?
(alter estrogen levels)
Soya
Ginseng
Ginkgo
What are fibroids?
Leiomyomae
How are fibroids diagnosed?
USS
How are fibroids managed?
Symptomatic
Embolisation
Myomectomy
Hysterectomy
What are the stages of endometriosis?
1 (minimal) Small patches, surface lesions
2 (mild) More widespread, infiltrating pelvic organs
3 (moderate) peritoneum, scarring, adhesions
4 (severe) Infiltrative, anatomical distortion
How is endometriosis diagnosed?
Pelvic examination
USS/laparoscopy
How is endometriosis managed medically?
Analgesia
Mirena IUS
GnRH analogues
Depot provera
How is endometriosis managed surgically?
Ablation
Hysterectomy
Excision
Hysterectomy
Surgical management of endometriosis may be required due to what?
Fertility treatment
What is adenomyosis?
Endometrium embedded within the myometrium
How does adenomyosis present?
Heavy menstrual bleed
Dysmenorrhoea
How is adenomyosis treated?
?hormones
Hysterectomy
What are endometrial polyps?
Overgrowth of endometrial lining
How are endometrial polyps diagnosed?
USS/Hysteroscopy
How are endometrial polyps managed?
Polypectomy
How is HMB managed?
History Pelvic exam Clotting profile Thyroid function USS Laparoscopy (endometrosis)
Management of HMB depends on what?
Impact on QoL
Underlying pathology
Desire for further fertility
Endometrial biopsy is indicated in which women?
Women >44y/o with HMB
Which non-hormonal therapies are indicated for HMB?
Mefenamic acid
Tranexamic acid
GnRH analogues
(Surgery)
What risks are associated with hysterectomy?
Infection
DVT
Bladder/bowel issues
Adhesions
What are the disadvantages of Oophorectomy?
Immediate menopause
Recommended HRT til 50
What are the causes of amenorrhoea?
Life changes Hormones Primary ovarian insufficiency PCOS Hyperprolactinaemia Prolactinomas Grave's disease Obstructions of uterus/cervix
How is PCOS diagnosed?
2 of 3:
- USS ovary
- Biochemical hyperandrogenism
- Clinical hyperandrogenism
PCOS is associated with what?
Infertility
Obesity
Oligo/amenorrhoea
How is hyperplasia prevented in PCOS?
Minimum 3 withdrawal bleeds per year
COCP, POP, Mirena IUS
What is dysfunctional uterine bleeding?
Excessive bleeding in premenopausal women not due to any disease
What is the cause of dysfunctional uterine bleeding?
Ovarian hormonal dysfunction
How is dysfunctional uterine bleeding managed?
Conservative based on symptoms/patient wishes
GnRH analogues
HRT
