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Y3 Patient sem 1 > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is puberty?

A

Onset of hormonal maturity (girls before boys)

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2
Q

What is Precocious puberty?

A

Early onset of puberty (e.g. girls before 8 and 9 for boys)

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3
Q

What is delayed puberty?

A

No breast development by 13 and no menstruation by 15. Boys showing no signs by 14

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4
Q

What is Amenorrhoea/Dysmenorrhoea?

A

no periods/ pain with periods

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5
Q

What is Menorrhagia?

A

Heavy periods

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6
Q

What is PCOS?

A

Polycystic ovarian syndrome

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7
Q

What is Premenstrual syndrome?

A

Physical and emotional symptoms before period

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8
Q

What is Premature ovarian insufficiency?

A

Early menopause (before 40), linked to too much dieting/exercise and cancer

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9
Q

What is Menopause?

A

average age 51: women stop having periods

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10
Q

What is postmenopausal bleeding?

A

aged 70s, other reasons behind this

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11
Q

At what age are chances of concieving reduced?

A

35

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12
Q

What is Dysmonorrhoea subdivided into?

A

Primary and Secondary

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13
Q

What is primary Dysmenorrhoea?

A
  • Peak incidence teens to twenties
  • Pelvic pain and - Cramping (starts as period starts)
  • May radiate to thighs and back
  • GI symptoms – nausea, vomiting and diarrhoea
  • Headaches, fatigue or faintness
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14
Q

What is secondary dysmenorrhoea?

A
  • Peak incidence thirties, forties
  • Consequence of other pelvic pathology
  • Pain may begin before menstruation (3-5 days)
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15
Q

How does dysmenorrhoea occur?

A
  • Higher concentrations of prostaglandins in menstrual fluid [mainly PGF and PGE]
  • Increased myometrial contractility = cramping
  • Other potential mediators (of prostaglandins) include:
    • Endothelins – vasoactive peptides
      • Role in [local] regulation of prostaglandin synthesis
    • Vasopressin – post. Pituitary hormone
      • Stimulates uterine activity
      • Decreases uterine blood flow [vasoconstriction causes myometrial ischaemia]
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16
Q

What does progestogen withdrawal trigger?

A

Production of Arachidonic acid and leukotrienes.

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17
Q

What is Arachidonic acid a precursor to?

A

Prostaglandins (mainly PGF and PGE)

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18
Q

What do prostaglandins cause?

A

Vasoconstriction, myometrial ischaemia/hypoxia and myometrial contracility leading to pain (leukotrienes are thought to contribute to this)

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19
Q

What would inhibit formation of prostaglandins (from COX-1)?

A

NSAIDs e.g. aspirin, piroxicam

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20
Q

What is the pharmacological management of primary dysmenorrhoea?

A
  • NSAIDs – 1st line unless contraindicated
    • Ibuprofen, naproxen
  • OTC – Feminax Express, Feminax Ultra and measures to manage symptoms
  • Oral contraceptive pill – modulate hormone levels
    • Inhibits ovulation
    • Prevents increased PG synthesis in luteal phase
    • Decreased uterine contractility
  • Antispasmodics eg hyoscine butylbromide
    • Limited by poor oral bioavailability
    • Unlicensed OTC – used in IBS
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21
Q

What is the cause of secondary dysmennorhoea?

A
  • PG involvement
  • Underlying pelvis pathology
    • PID -pelvic inflammatory disease (would require antibiotic treatment)
    • Endometriosis
    • Menorrhagia
    • Fibroids
    • Uterine polyps etc…
22
Q

What is the pharmacological management of secondary dysmenorrhoea?

A
  • Investigate and ascertain underlying cause
  • Treat accordingly dependent upon underlying cause
    • Options include
      • Surgery – ablation (removal of thin uppermost layer of endometrium using heat methods), laser therapy etc
      • Symptomatic relief (pain relief)
      • Pharmacological interventions (non-analgesic treatments)
23
Q

What are some OTC options for period pain?

A

Co-codamol, ibuprofen, naproxen, heat wraps, hyoscine (unlicensed)

24
Q

What is endometriosis?

A

When endometrial tissue is found outside the uterus

  • Outside reproductive tract
  • GI tract
  • Urinary tract
  • lung
25
Q

How does endometriosis occur?

A
  • Theory 1: embryological – cells de-differentiate back to their primitive form to endometrial cells, have found endometrial cells in peritoneum and post-mortem feotuses
  • Theory 2: Retrograde menstruation:
    • reflux of menstrual loss?
    • Increased prevalance with outflow obstruction
26
Q

What are the common symptoms of endometriosis?

A
  • Most common: pain, fatigue and subfertility
  • Common symptoms
    • Dyspareunia
      - Dyschezia
    • Dysuria
    • Chronic pelvic pain & menstrual irregularities
27
Q

What are the rare symptoms of endometriosis?

A
  • Cyclical haematuria
  • Cyclical haemoptysis
    • Cyclical tenesmus
    • Others: ureteric obstruction, rectal bleeding or rectal obstruction
28
Q

What is Dyspareunia?

A

painful intercourse

29
Q

What is Dyschezia?

A

Difficulty defecating

30
Q

What is Dysuria?

A

Similar to UTI, irritation when passing water

31
Q

What is Cyclical haematuria?

A

Endometrial tissue in the bladder bleeds in response to hormonal variation

32
Q

What is Cyclical haemoptysis?

A

Endometrial tissue in the lungs bleeds in response to hormonal variation

33
Q

What is Cyclical tenesmus?

A

Constant need to open bowels

34
Q

How is endometriosis diagnosed?

A
  • Pelvic exam (lumps, masses, reduced organ mobility – as tissues travel they stick organs together and lose mobility)
  • Pelvic ultrasound (transabdominal or transvaginal) to identify/characterise masses
  • Diagnostic laparoscopy
  • NOT RECOMMENDED – bloods or MRI
35
Q

How is the severity of endometriosis graded?

A

Grades 1-4: limited correlation to pain, sub-fertility, prognosis

36
Q

What is stage 1-2 of endometriosis?

A
  • Minimal to mild, poorly visualised on US

- Common implantation sites – uterine and ovarian

37
Q

What is stage 3-4 of endometriosis?

A
  • Mod to severe, commonly associated with adhesions

- Rectovaginal endometriosis (tissue grows out of the womb), bowel invasion (adenomyosis)

38
Q

What are the management options for endometriosis?

A

Surgical treatment (laparoscopy or hysterectomy*) aims to:
- Restore normal pelvic anatomy
- Divide adhesions
- Ablate endometrial tissue
Medical treatment aims to:
- Aims to provide symptomatic relief and improve
fertility if desired

39
Q

What 3 recommendations does the NICE quality standard for endometriosis follow?

A
  • Individuals presenting with suspected endometriosis should receive an abdominal and, if appropriate, a pelvic examination.
  • Individuals should be referred to a gynaecology service if initial hormonal treatment has not been effective, has not been well tolerated or is contraindicated.
  • Individuals with suspected or confirmed deep endometriosis with involvement of bowel, bladder or ureter should be referred to a specialist endometriosis service.
40
Q

What management option is an option in endometriosis for women who do not plan further/any pregnancy?

A

Hysterectomy

41
Q

What is the first line pharmacological management for endometriosis?

A

Analgesia - NSAIDS +/- paracetamol

42
Q

What is the second line pharmacological management for endometriosis?

A

“Shrinkers” treatments utilise the fact that endometrial tissue is oestrogen dependent
- Drugs opposing oestrogen will inhibit growth of
endometrial tissue
- Contraceptives: CHCs, POC, LNG – IUS
- Progestogens
- GnRH analogues – gonadotropin releasing
hormone( buserelin, goserelin, nafarelin, leuprorelin)
- Antiprogestogens - Gestrinone/danazol (last resort)

43
Q

What are the new treatments for endometriosis?

A

SARMS (selective androgen receptor modulator), immunomodulators, drugs targeting steroid biosynthetic pathways

44
Q

What volume of menstrual blood loss per month risks Fe deficiency?

A

above 80ml per month (menorrhagia)

45
Q

What are the symptoms of menorrhagia?

A
  • Menstrual blood loss above 80ml per month (risk of Fe deficiency anaemia)
  • Subjective – flooding, large clots (bigger than 50p), double sanitary protection, frequent sanitary changes
  • 3 days menorrhagia =1 month /year of reduced QOL
46
Q

What are the causes of menorrhagia?

A
  • DUB (60%): dysfunctional uterine bleeding
  • Menopause
  • Fibroids, PID
  • Miscarriage or ectopic pregnancy
  • IUD
  • Adenomyosis
  • Hepatic, renal or thyroid disease, PCOS
  • Blood thinning medication or condition
47
Q

What is Adenomyosis?

A

Inner lining of the uterus breaks through myometrium

48
Q

What symptoms suggest underlying pelvic pathology?

A
  • Irregular bleeding
  • Sudden change in blood loss
  • Intermenstrual bleeding
  • Post coital bleeding
  • Dyspareunia (painful intercourse)
  • Pelvic pain
  • Premenstrual pain
49
Q

How is Menorrhagia diagnosed?

A
  • Blood tests (FBC, Iron, Ferritin)
  • Physical exam (tummy, cervix, enlarged or tender ovaries/uterus)
  • Cervical smear (Pap smear/cervical smear)
  • Endometrial biopsy
  • Ultrasound (pelvic/transvaginal)
    uterus, ovaries and pelvis
  • Sonohysterography
  • Hysteroscopy
50
Q

What is the pharmacological management for menorrhagia if contraception is required?

A
  • CHC, POC

- IUS/parenteral progesterone (IUS most effective) (Mirena – licensed specifically)

51
Q

What is the pharmacological management for menorrhagia if contraception is NOT required?

A
  • Tranexamic acid – antifibrinolytic (reduces blood loss)
  • GnRH analogues/antagonists
  • Mefenamic acid (NSAID)
  • Oral progestogen (high dose [5mg] norethisterone – not used for contraception)
  • Antiprogestogens - Gestrinone/danazol (last resort)
52
Q

What are the surgical treatment options for menorrhagia?

A
  • UAE (uterine artery embolization)
  • Myomectomy
  • Hysterectomy (no more kids)

Y3 Patient sem 1 (22 decks)

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