Menstrual disorders Flashcards
Describe normal menstruation?
Loss less than 80ml over 7 days (16 tsb) Average loss 30-40ml Average duration 2-7 days Length of cycle- 28 days (average 24-3 days) Menarche- 10-16 years, average 12 Menopase 50-55 years
What are the parameters surrounding frequency, regularity,duration, volume
Frequency- 24-38 days
Regularity- <20 days variation in a year
Duratin- normal 2-7 days
Volume–80mls
What are some good was to define heavy menstrual bleeding?
bleeding >80mls over 7 days
the need to change menstrual products every one to two hours
passing clots greater than 2.5cm
Bleeding through clothes
very heavy periods as reported by the woman, affecting QoL
Can occur alone or in combo with sypoms lke dysmenorrhea
What are some uterine and ovarian causes of heavy periods?
Fibroids (pelvic pain and dysmenorrhoea)
Endometrial polyps (intermenstral bleeding)
Endometriosis and adenomyosis (dysmenorrhoea, painful sex, pelvic pain,dficulty conceiving)
Pelvic inflammatory disease and pelvic infection (vaginal discharge, pelvic pain, inter menstrual and post coital bleeding, pelvic pain
Endometrial hyperplasia or carncioma(post coital bleeding, intermenstrual bleeidng, pelvic pain)
PCOS (anovulatory menorrhagia and irregular bleeding)
What are some systemic causes of heavy periods?
Coagulation disorders
Hypothyroidism (fatigue, constipation, intolerance of cold hair and skin changes)
Liver or renal disease
What are some iatrogenic causes of heavy periods?
Anticoagulant treatent
Herbal supplemets (ginsng, ginkgo and soya)
Intraterine contraceptive deice (IUD)
What are fibroids?
What symptoms may they present with?
Non cancerous growths made of muscle a fibroma
May be asymtomatic or may cause pelvic pain, urinary syptoms, pressure symptoms, backachem infertility miscarriage
How do you manage fibroids
Diagnose with ultrasound
Small fibroid- combined oral pill, POP, mirena
large fibroids- fertility preservation, fibroid embolisation, myomectomy
Submucosal fibroids- hysteroscopic fibrod resection
Declined or failed medical treatment, fertility not required- hysterectomy
What are the symptoms of endometriosis?
Painful menstrual cramps that get worse over time
Lower back pain
Abnormal bleeding or spotting between menstrual periods
Pain during and after sex
Painful bowel movements or urination
Diarrhoea, nausea and blotting
What are the stages of endometriosis?
Stage 1- minimal, small patches,lesions or inflammation in and around the organs in the pelvic cavity
Stage 2 mild- more widespread and starting to infiltrate pelvic organs
stage 3- moderate- peritoneum (pelvic side walls) or other structures, sometime there’s also scarring and adhesions
stage 4- severe- infiltration and affecting many pelvic organs and ovaries, often with distortion of the anatomy and adhesions
How do you manage endomeriosis?
COCP. POP, mirena, depot provama GnRH analogues, surgical ablation, hysterectomy, excision, pelvic clearance. Surgical management may be required as part of fertility treatment
What is adenomyosis
What are the symptoms
What is the treatment?
A condition where endometrium becomes embedded in myometrium
Leads to heavy menstrual bleeding
May have significant dysmenorrhea associated with it
May partially response to hormones
Definite treatment is hysterectomy
What are endometrial polyps
How are they managed?
Overgrowth of endometrial lining can lead to polyp formation which extend into the endometrium
Mostly benign, manage with polypectomy in bleeding is severe
Describe the process of investigating heavy bleeding?
Thorough history Pelvic examination (speculum, bi-manual) remember to look at cervix Clotting profile, thyroid function Pelvic ultrasound scan Laparoscopy if endometriosis suspected Management options depend on: impact on QoL Underlying pathology Desire for further fertility Woman's preferences Hysteroscopy Endometrial biopsy for all women aged 44 or above with heavy bleeding
What medical treatments are available to treat heavy menstrual bleeding
Tranexamic acid- reduces blood loss by 60%
Mefenmaic acid reduces blood loss 30% and pain
Both are take at times of periods
Suitable for those trying to conceive
Hormonal contraception, cop, make periods lighter, regular and less painful
LNG IUS and depo-provera reduces bleeding. may cause irregular bleeding some women will be amenorroeic
Oral progesterone e.g. provera 10mg od
day 5-25 cycle reduce and regulate
