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Y4 Obstetrics and Gynaecology > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

What is colposcopy ?

A

This is a procedure to examine an illuminated magnified view of the cervix & tissues of the vagina & vulva

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2
Q

Define what menstruation is

A

This is the process of discharging blood & other material from the linning of the uterus (shedding of endometrial layer)

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3
Q

What is the menstrual cycle defined as ?

A

It is defined as the first day from one period to the first day of the next period

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4
Q

What is day 1 of the menstrual cycle ?

A

The first day of menstruation

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5
Q

What is the average length of the menstrual cycle ?

A

28 days

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6
Q

What is the average range of menstrual cycle duration ?

A

21 - 35 days

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7
Q

How long does menstruation (menstrual flow) usually last ?

A

4-6 days

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8
Q

How long does peak flow of menstruation usually last ?

A

1-2 days

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9
Q

What is normal blood loss defined as during menstruation ?

A

< 80ml per menstruation with no clots (so in total loose < 80ml)

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10
Q

Is it normal to have Intermenstrual bleeding (IMB) or post-coital bleeding (PCB)?

A

No

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11
Q

Define what IMB is

A

This is vaginal bleeding (other than PCB) at any time during the menstrual cycle except during menstruation

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12
Q

Define what PCB is

A

This is non-menstrual bleeeding that occurs immediately after sexual intercourse

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13
Q

Define what menhorragia is

A

This is increased blood loss > 80ml per menstruation

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14
Q

Define what metrorrhagia is

A

This regular IMB

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15
Q

Define polymenhorrhea ?

A

menses occurring at < 21 day interval (think poly as many as they will have more frequent periods essentially)

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16
Q

Define what polymenhorragia means

A

increased bleeding and frequent cycle (menhorragia + polymenorrhoea)

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17
Q

Define menometrorrhagia

A

Prolonged menses & IMB

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18
Q

Define dysmenorrhoea

A

painful periods

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19
Q

What can amenorrhea be classified as ?

A

Primary or secondary

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20
Q

Define primary amenorrhoea

A

Failure to start menstruating

21
Q

When does primary amenorrhoea require management ?

A
  1. Girls who have no secondary sexual characteristics who have not started menstruating by 14. OR.
  2. Girls with normal secondary sexual characteristics who have not started menstruating by 16
22
Q

Define secondary amenorrhoea

A

Absence of menstruation for > 6months, other than that caused by pregnancy

23
Q

Define oligomenorrhoea

A

menses at intervals > 35 days (infrequent periods)

24
Q

What are the 2 main types of causes of menorrhagia ?

A
  1. Organic = when there is pathology causing it
  2. Non-organic = when there is absence of pathology (so all possible pathologies ruled out), this accounts for 50% of cases
25
Q

List the local organic cause of menorrhagia

A
  • Fibroids
  • Endometriosis
  • Endocervical or endometrial polyp
  • Cervical ectropion
  • Endometrial hyperplasia
  • Intrauterine contraceptive device (IUD)
  • Pelvic inflammatory disease
  • Malignancy of the cervix or uterus
  • Hormone producing tumours
  • Trauma e.g. rape/sexual assault
  • Others e.g. arteriovenous malformations
26
Q

What are fibroids ?

A

They are benign smooth muscle tumours (of the myometrium), they are often multiple & vary greatly in size

27
Q

What are the typical presenting features of fibroids ?

A

Often asymptomatic but can cause:

  • Fertility problems
  • Pain
  • Mass (large ones may be felt abdominally)
  • May press on the bladder causing increased frequency
  • Menorrhagia
28
Q

What is endometriosis ?

A

This is a foci of endometrial glandular tissue, (inner linning of the uterus) which looks like the head of a burnt match stick, occuring outside the uterine cavity in other parts of the body e.g. on an ovary, in rectovaginal pouch, uterosacral ligaments, pelvic peritoneum, rarley in the umbilicus, lower abdo scars or other organs e.g. lungs

29
Q

What is a endocervical or endometrial polyp ?

A

It is a mass of tissue projecting from a mucous membrane such as the cervix or endometrium

30
Q

What is a cervical ectropion (cervical eversion)

A

This is a condition in which the cells from the inside of the cervical canal (columnar epithelium or ‘glandular cells’) are present on the outside i.e. vaginal portion of the cervix, these cells are more prone to bleeding

Note - squamous epithelium is what usually lines the outside portion of the cervix

31
Q

What is endometrial hyperplasia due to and what does it result in?

A

This is a result of high oestrogen levels, it results in the eventual breakdown of the endometrium ==> causing irregular bleeding

32
Q

What does endometrial hyperplasia carry a small increased risk of ?

A

Endometrial carcinoma

33
Q

What is pelvic inflammatory disease ?

A
  • This is an infection of the female upper genital tract - the fallopian tubes & ovaries can be affected
  • 90% of these infections are sexually aquired with chlamydia being the most common cause
  • the other 10% are caused by childbirth or instrumentation (IUD, TOP)
34
Q

List some of the systemic disorders which can cause menorrhagia

A
  • Endocrine disorders e.g. hyper/hypothyroidism (more so hypo), DM, adrenal disease, prolactin disorders
  • Disorders of homeostasis - von willebrands disease, immune thrombocytopenia, factor II, V, VII &XI deficiency
  • Liver disorders
  • Renal disease
  • Drugs e.g. anti-coagulants
35
Q

List some of the causes of menorrhagia specific to pregnancy

A
  • Msicarriage
  • Ectopic pregnancy
  • GTD (gestational trophoblastic disease)
  • PPH
36
Q

Define what Dysfunctional Uterine Bleeding (DUB) is

A

This is heavy &/or irregular bleeding in the absence of recognisable pelvic pathology

37
Q

How is a diagnosis of DUB made ?

A

Exlcuding other pathologies

38
Q

How is DUB subdivided ?

A

Into anovulatory & ovulatory

39
Q

Describe what causes anvoulatory DUB

A
  • The women does not properly develop & release a mature egg (dont ovulate). When this happens the corpus luteum (which produces progesterone) does not form.
  • As a result oestrogen is produced continuously causing an overgrowth of the endometrial lining of the uterus.
  • The period is delayed in such cases (==> irregular cycle) & when it does occur menstruation can be very long & prolonged
40
Q

Describe the features suggestive of an anovulatory DUB is (include when it occurs usually)

A
  • This is DUB when ovulation is not occuring
  • Accounts for 85% of DUB
  • It occurs most commonly at the exstremes of reproductive life (ealry puberty or perimenopausal) and is more common in the obese
  • Irregular cycle
41
Q

What is ovulatory DUB ?

A

It is DUB which occurs in women who ovulate but there is inadequate production of progesterone by the corpus luteum

42
Q

Describe the features suggestive of a ovulatory DUB is (include when it occurs usually)

A
  • It is more common in women 35-45
  • They get regular heavy periods
43
Q

What are the investigations which should be carried out in women with potential DUB ?

A
  • FBC - rule out iron def. anaemia,
  • Cervical smear
  • Coagulation screen - for coag disorders e.g. von willebrands etc
  • Renal/liver function tests
  • Transvaginal USS - check thickness of endometrium (if > 4mm then endometrial sampling done) & to look for polyps or other pelvic masses
44
Q

When should coagulation disorders be considered in women with menhorragia ?

A

It should be considered for those who have a history of menhorragia since menarche & a personnel or fam history of a coagulation disorder

45
Q

What is the 1st line treatment option for DUB ?

A

1st line = LNG-IUS esp for those needing contraception

46
Q

What are the second line options for treatment of DUB?

A

2nd line = Tranexamic acid, or NSAID’s, or combined oral contraceptives

47
Q

How do you decide between the 3 different 2nd line options for DUB treatment ?

A
  • Tranexamic acid is chosen if regular cycle but heavy periods
  • NSAID’s are used if they have dysmenorrhoea as well
  • COC used if they have cycle problems (as it makes them more regular)
48
Q

What is the 3rd line option for treatment of DUB ?

A

3rd line = Progestogens (long acting progestogen only injectable) or Norethisterone

Progestogens used if cycle problems

49
Q

What is the 4th line treatment option DUB ?

A

Surgical management: (esp for fibroids as if >3cm size pharma has limited effect)

  • 1st line = endometrial resection/ablation
  • 2nd line = hysterectomy

GnRH anagloues e.g. Goserelin may be used pre-op to help de-bulk or in those unfit for surgery

Y4 Obstetrics and Gynaecology (63 decks)

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