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Reproductive System > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Normal Menstruation

A
  • MENSTRUAL CYCLE - 1st day of period - day before next period
    • NORMAL LOSS < 80 mL over 7 days (16tsp)
    • AVERAGE LOSS ~ 30 - 40 mL (6 - 8tsp)
    • AVERAGE DURATION (2 - 7 days)
    • LENGTH of CYCLE - 28 days (average 24 - 35 days)
    • MENARCHE - 10-16yrs, average 12 yrs
    • MENOPAUSE - 50-55yrs
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2
Q

Menstrual Disorders

A

Menstrual freq. disturbed - infrequent/freq.

    Frequent < 24 days
Normal - 24-38 days
Infrequent > 38 days

Irregular menstrual bleeding - absent/irregular

Absent/amenorrhoea - no bleeding
Regular < 20 days variation in 12 months
Irregular > 20 days variation in 12 months

Abnormal duration of flow - prolonged/shortened

Prolonged > 8 days
Normal - 2-7 days
    Shortened < 2 days

Abnormal menstrual vol. - heavy/light

Heavy > 80mL
Normal - 5-80mL
Light < 5mL
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3
Q

Heavy Menstrual Bleeding: presentation

A

Heavy bleeding = > 80mL over 7 days, bleeding through clothes and/or passage of clots > 2.5cm or 10p coin, affecting QoL, need to change menstrual products every 1-2hrs

Other symptoms e.g. dysmenorrhoea

Health implications e.g. anaemia

AFFECTING QoL - emotional, work, leisure

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4
Q

Heavy Menstrual Bleeding: aetiology

A

PALM COEIN

POLYPS
ADENOMYOSIS
LEIOMYOMA
MALIGNANCY

COAGULOPATHY
OVULATORY DYSFUNCTION
ENDOMETRIUM/HYPERPLASIA
IATROGENIC
NOT YET CLASSIFIED

Uterine/ovarian pathologies - fibroids, endometrial polyps, endometriosis + adenomyosis, pelvic inflammatory disease + pelvic infection, endometrial hyperplasia/carcinoma, cervical cancer, PCOS

Systemic diseases - coagulation disorders, hypothyroidism, liver/renal disease

Iatrogenic - anticoagulants, herbal supplements, IUD

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5
Q

Heavy Menstrual Bleeding: investigations/diagnosis

A
  • THOROUGH Hx - PAST, PRESENT, OTHER ASS. FEATURES
    • PELVIC EXAM (speculum, bimanual, look at cervix + ask about smears - cervical cancer)
    • CLOTTING PROFILE, TFTs
    • PELVIC USS - fibroids, polyps, adenomyosis
    • LAPAROSCOPY if endometriosis suspected - minor deposits can ve treated at same time w/ diathermy

ENDOMETRIAL BIOPSY from ALL WOMEN ≥ 44YRS w/ HMB + REFRACTORY to MEDICAL Rx

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6
Q

Heavy Menstrual Bleeding: management

A

Depend on impact on QoL, underlying pathology, desire for future fertility, women’s preferences

HORMONAL Rx:

  • MIRENA IUS - long-lasting, don’t give if pt. wants to have children soon
  • COCP - lighter periods, regular, less painful, CI in migraine, DVT
  • POP - wgt. gain, mood changes
  • DEPO-PROVERA, LNG IUS - reduces bleeding, may cause irregular bleeding, some women amenorrhoeic

• ORAL PROGESTOGENS e.g. Provera 10mg od

* Day 5 - 25 - reduces bleeding + regulates
* Day 15 - 25 - may regulate cycle, DOES NOT REDUCE BLEEDING

NON-HORMONAL Rx:

  • MEFENAMIC ACID - prostaglandin inhibitor, reduces pain
  • TRANEXAMIC ACID - antifibrinolytic, reduces bleeding
    • Taken AT TIME of PERIOD
  • GnRH ANALOGUES (AGONISTS; HRT given if > 6 months)
  • ENDOMETRIAL ABLATION
  • FIBROID EMBOLISATION
  • HYSTERECTOMY
    • Total hysterectomy - cervix + uterus removed
    • Subtotal hysterectomy - uterus removed, cervix left
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7
Q

Fibroids: definition

A

NON-CANCEROUS GROWTH made of MUSCLE + FIBROUS TISSUE (leimyoma)

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8
Q

Fibroids: presentation

A
  • ASYMPTOMATIC
    • HEAVY MENSTRUAL BLEEDNG
    • PELVIC PAIN
    • URINARY SYMPTOMS
    • PRESSURE SYMPTOMS
    • BACKACHE
    • INFERTILITY
    • MISCARRIAGE
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9
Q

Fibroids: investigations/diagnosis

A

USS

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10
Q

Endometriosis: definition

A

ENDOMETRIAL TISSUE PRESENT OUTISDE UTERINE LINING

DURING MENSTRUATION - ECTOPIC TISSUE BEHAVES SAME AS IN ENDOMETRIUM and BLEEDS (causing PAIN, ADHESIONS etc.)

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11
Q

Endometriosis: presentation

A
  • HEAVY MENSTRUAL BLEEDING
    • PAINFUL MENSTRUAL CRAMPS WORSENING OVER TIME
    • ABNORMAL BLEEDING/INTERMENSTRUAL BLEEDING (SPOTTING)
    • DYSMENORRHOEA
    • PELVIC PAIN
    • LOWER BACK PAIN
    • DYSPAREUNIA
    • PAINFUL BOWEL MOVEMENTS/URINATION
    • DIARRHOEA, NAUSEA, BLOTTING
    • MULTI-SYSTEM INVOLVEMENT
    • SEVERELY AFFECTS QoL
    • INFERTILITY, FATIGUE, SYSTEMIC SYMPTOMS
    • SEVERITY of DEPOSITS may NOT CORRESPOND w/ SYMPTOMS
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12
Q

Endometriosis: investigations/diagnosis

A
  • PELVIC EXAMINATION

* USS, DIAGNOSTIC LAPAROSCOPY, MRI

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13
Q

Endometriosis: management

A

ANALGESIA

MEDICAL: COCP, POP, MIRENA IUS, DEPO-PROVERA, GnRH ANALOGUES

SURGICAL: ABLATION, HYSTERECTOMY ENDOMETRIOMA EXCISION, PELVIC CLEARANCE, HYSTERECTOMY

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14
Q

Adenomyosis: definition

A

ENDOMETRIUM EMBEDDED in MYOMETRIUM

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15
Q

Adenomyosis: presentation

A
  • HEAVY MENSTRUAL BLEEDING

* DYSMENORRHOEA - significant, during periods

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16
Q

Adenomyosis: management

A
  • PARTIAL RESPONSE to HORMONES

* DEFINITIVE MANAGEMENT = HYSTERECTOMY

17
Q

Endometrial polyps: definition

A
  • OVERGROWTH of ENDOMETRIAL LINING leading to formation of PEDUNCULATED STRUCTURES which EXTEND INTO ENDOMETRIUM
    • Mostly BENIGN
18
Q

Endometrial polyps: presentation

A

HEAVY MENSTRUAL BLEEDING, INTERMENSTRUAL BLEEDING

19
Q

Endometrial polyps: investigations/diagnosis

A

USS/HYSTEROSCOPY

20
Q

Endometrial polyps: management

A

POLYPECTOMY

21
Q

Oligo/amenorrhoea: definition

A
  • INFREQUENT/ABSENT/ABNORMALLY LIGHT MENSTRUATION
    • IMPORTANT to CHECK if NORMAL to PT.

INVESTIGATE + TREAT CAUSE

22
Q

Oligo/amenorrhoea: aetiology

A
  • LIFE CHANGES - STRESS, EATING DISORDERS/MALNOURISHMEN, OBESITY, INTENSE EXERCISE - usually temporary + reversible
    • HORMONES - POP, MIRENA, DEPO INJECTION
    • PRIMARY OVARIAN INSUFFICIENCY
    • PCOS
    • HYPERPROLACTINAEMIA - elevated lvls of prolactin in blood
    • PROLACTINOMAS - adenomas on anterior pituitary gland
    • THYROID DISORDERS e.g. Grave’s disease
    • OBSTRUCTIONS of UTERUS, CERVIX, VAGINA
23
Q

Dysfunctional uterine bleeding: definition

A

• COMMON disorder of EXCESSIVE UTERINE BLEEDING affecting PRE-MENOPAUSEAL WOMEN

	○ NOT due to PREGNANCY/ANY RECOGNISABLE UTERINE or SYSTEMIC DISEASES
24
Q

Dysfunctional uterine bleeding: pathophysiology

A

UNDERLYING OVARIAN HORMONAL DYSFUNCTION

25
Q

Dysfunctional uterine bleeding: investigations/diagnosis

A

EXCLUDE COMMON CAUSES e.g. PALM COEIN

26
Q

Dysfunctional uterine bleeding: management

A
  • CONSERVATIVE, MEDICAL, SURGICAL rx based on SEVERITY of SYMPTOMS + PT. WISHES
    • GnRH ANALOGUES - good for bridging for pt. who are nearly menopausal + have not responded to/declined other medical rx + surgical management undesirable○ UP TO 6 MONTH THERAPY; FURTHER DESIRED by PT. + NO CI = ADD-BACK HRT til pt. confirmed menopausal

Reproductive System (16 decks)

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