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Repro > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Primary amenorrhoea?

A

Not starting menstruation

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2
Q

Potential causes of primary amenorrhoea? (7)

A 
Hypogonadotrophic hypogonadism
Hypergonadotrophic hypogonadism
Hypothyroid
Hyperprolactinaemia
Congenital adrenal hyperplasia (CAH)
Androgen insensitivity syndrome (AIS)
Turner's syndrome (45XO)
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3
Q

What happens in hypogonadotropic hypogonadism?

A 
No gonadotrophin (LH/FSH) release from anterior pituitary, no stimulation to the ovaries/testes, so no sex hormones are produced
Problem is the hypothalamus or pituitary gland
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4
Q

Lab results in hypogonadotrophic hypogonadism?

A

Low LH and low FSH

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5
Q

What happens in hypergonadotropic hypogonadism?

A

No gonadal response to circulating gonadotrophins, therefore no negative feedback on pituitary, overproduction of gonadotrophins.
Problem is ovaries/testes

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6
Q

Lab results in hypergonadotrophic hypogonadism?

A

High FSH and high LH

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7
Q

Assessment in primary amenorrhoea?

A

Look for evidence of puberty
Excessive exercise, stress, eating disorder, low BMI
Signs of androgen excess, thyroid problems, high prolactin
Abdominal/pelvic examination

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8
Q

Investigations in primary amenorrhoea?

A 
Pelvic ultrasound
Hormone profile (LH, FSH, TSH, PROL)
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9
Q

Management of primary amenorrhoea?

A

Based on underlying cause,

Consider COCP in primary ovarian failure or PCOS

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10
Q

Secondary amenorrhoea?

A

No menstruation for more than 3 months having previously had periods

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11
Q

When is investigation indicated in secondary amenorrhoea?

A

Usually not until after 6 months

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12
Q

Possible causes of secondary amenorrhoea?

A 
Pregnancy (most common)
Menopause
Hypothalamic cause
Pituitary cause
Ovarian cause
Uterine causes
Hypothyroidism
Hyperprolactinaemia
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13
Q

Why can hyperprolactinaemia result in secondary amenorrhea?

A

High prolactin levels act on the hypothalamus to prevent release of GnRH, therefore no release of LH/FSH

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14
Q

Blood tests in secondary amenorrhoea?

A

LH/FSH
PROL
TSH
Progesterone stimulation test

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15
Q

Androgen insensitivity syndrome?

A

Insensitivity to androgens, so no male external genitalia development
Female phenotype, Male karyotype

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16
Q

Androgen insensitivity syndrome presentation?

A

Primary amenorrhoea

No internal female genitalia on examination (no upper vagina, uterus and fallopian tubes. Internal testes)

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17
Q

Premenstrual syndrome definition?

A

The fluctuation of hormones during the premenstrual period, especially fall in oestrogen and progesterone (due to degradation of corpus luteum) causing symptoms

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18
Q

Features of premenstrual syndrome?

A 
Bloating
Headaches
Back Aches
Anxiety
Low mood
Irritability

Symptoms improve with onset of menstruation

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19
Q

When features are severe and have significant effect on quality of life?

A

Premenstrual dysphoric disorder

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20
Q

Management options for premenstrual syndrome?

A

General healthy lifestyle changes
Combined oral contraceptive
SSRIs

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21
Q

Potential causes of menorrhagia? (6)

A 
Bleeding disorders
Endometriosis
Malignancy
Fibroids
Hormone imbalances
Contraceptives
Connective tissue disorders
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22
Q

Investigations in menorrhagia?

A

Pelvic examination

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23
Q

Indications for a pelvic and transvaginal ultrasound?

A

Abnormal pelvic exam
Postcoital bleeding
Intermenstrual bleeding
Other abnormal pelvic symptoms (pelvic pain)

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24
Q

Management of menorrhagia?

A

Exclude underlying pathology and manage underlying causes

Contraception (mirena coil, COCP, POP, Depo injection)

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25
Q

Management of menorrhagia if contraception is not wanted?

A 
Tranexamic acid
Mefenamic acid (NSAID)
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26
Q

Last resort treatment for menorrhagia?

A

Endometrial ablation

Hysterectomy

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27
Q

What are fibroids?

A

Oestrogen sensitive tumours of the smooth muscle wall, uterine leiomyomas

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28
Q

Common locations for fibroids to occur?

A

Intramural
Subserosal
Submucosal
Pedunculated

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29
Q

Which fibroids fill the abdominal cavity as they grow?

A

Subserosal

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30
Q

Which fibroids distort the uterus as they grow?

A

Intramural

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31
Q

How do fibroids present?

A 
Menorrhagia (most common)
Menstruation lasting >7 days
Abdominal pain, worse during menstruation
Bloating/full abdomen
Urinary or bowel symptoms
Deep dyspareunia
Reduced fertility
32
Q

Diagnosis of fibroids?

A

Pelvic/transvaginal ultrasound

33
Q

Conservative management of fibroids?

A

Symptomatic
Mirena coil (1st line)
COCP
GnRH agonists induce early menopause (goserelin, usually short term)

34
Q

Surgical management of fibroids?

A

Uterine artery embolisation
Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy

35
Q

Complications of fibroids? (6)

A 
Pregnancy complications due to space occupation
Infertility
Heavy bleeding (and anaemia)
Constipation
Urinary outflow obstruction
Red degeneration
36
Q

Differential diagnoses of abnormal bleeding (postcoital)? (9)

A

Malignancy (cervical or others)
Polyps
Trauma
No cause

Cervical ectropion
Cervical inflammation
Atrophic vaginitis

37
Q

Differential diagnoses of abnormal bleeding (intermenstrual)? (4)

A

Cervical ectropion, polyp, or cancer
STI
Endometrial polyp/cancer
Iatrogenic contraception related bleed

38
Q

Cervical Ectropion?

A

Columnar epithelium of the endocervix is displayed on the ectocervix, visible on speculum examination

39
Q

Treatment of symptomatic cervical ectropion?

A

Silver nitrate or diathermy

40
Q

Nabothian cysts?

A

Fluid filled cysts on the surface of the cervix, harmless, may be biopsied to exclude pathology

41
Q

Potential causes of Nabothian cysts?

A

Childbirth

Cervicitis secondary to pelvic infection

42
Q

Endometriosis?

A

Ectopic endometrial tissue outside the uterus that responds to the menstrual cycle

43
Q

Presentation of endometriosis?

A 
Cyclical abdominal/pelvic pain
Deep dyspareunia
Cyclical bleeding from other sites
Fertility problems
Endometrial tissue may be visible on speculum examination
44
Q

Management of endometriosis?

A 
Simple analgesia
COCP
Progesterone treatment 
GnRH agonist (medical menopause)
Laparoscopic surgery
Hysterectomy and bilateral salpingo-oophorectomy (last resort)
45
Q

What blood test is important in ovarian cysts?

A

CA125 to exclude ovarian cancer

46
Q

Complications of ovarian cysts?

A

Torsion
Haemorrhage of cyst
Rupture (bleeding into peritoneum)

47
Q

Types of benign ovarian cysts?

A 
Follicular cyst (most common and harmless)
Corpus luteum cyst
Serous cystadenoma
Mucinous cystadenoma
Dermoid cysts
48
Q

Presentation of ovarian torsion?

A

Acute iliac fossa pain and tenderness
Nausea and vomiting
Palpable mass

49
Q

Complications of ovarian torsion?

A

Pain
Infection
Rupture
Loss of function of ovary

50
Q

PCOS features?

A 
Weight gain
Hirsutism
Infrequent ovulation or anovulation
Acanthosis nigricans
Impaired glucose tolerance
51
Q

Hormone profile in PCOS?

A 
LH raised
LH:FSH ratio raised
Insulin can be raised
Testosterone can be raised
SHBG can be low due to increased insulin
52
Q

Rotterdam criteria?

A

Two out of three:
Infrequent of absent ovulation
Hyperandrogenism
Polycystic ovaries on ultrasound (or ovarian volume >10mls)

53
Q

General management of PCOS?

A

Weight loss

COCP

54
Q

Managing infertility in PCOS?

A

Stepwise:
Weight loss
Metformin
Clomifene

55
Q

Managing hisutism in PCOS?

A

Dianette
Topical eflornithine
(Specialist - spironolactone, finasteride)

56
Q

Premature ovarian failure?

A

Menopause before the age of 40

57
Q

Causes of POF?

A 
Idiopathic
Chemotherapy
Radiotherapy
Autoimmune
Turners Syndrome
58
Q

When can menopause be diagnosed?

A

12 months after last menstrual period

Caused by drop in oestrogen and progesterone, FSH and LH usually high as a result

59
Q

How long is contraception recommended in menopause?

A

2 years after LMP <50

1 year after LMP >50

60
Q

Perimenopausal symptoms?

A 
Hot flushes
Emotional instability
Premenstrual syndrome
Irregular periods
Heavier/lighter periods
Vaginal dryness
Reduced libido
61
Q

Management of perimenopausal symptoms?

A 
HRT
General lifestyle advice
Tibolone
SSRIs
Clonidine (alpha-2 agonist)
CBT
62
Q

HRT considerations?

A

Perimenopausal vs menopausal
Local vs systemic
Uterus vs no uterus

63
Q

HRT with a uterus?

A

Add progesterone

64
Q

Risks of HRT

A

Oestrogen only increases risk of endometrial cancer

Addition of progesterone reduces endometrial risk but increases risk of breast cancer

65
Q

Side effects of HRT

A

Bloating
Breast swelling and tenderness
Weight gain
Headaches

66
Q

What forms the uterus?

A

Müllerian ducts (paramesonephric ducts)

67
Q

Pelvic organ prolapse?

A

Descent of pelvic organs into the vagina, caused by weakness of ligaments and muscles

68
Q

Uterine prolapse?

A

Uterus descends into vagina

69
Q

Rectocele?

A

Rectum prolapses into posterior wall of vagina

70
Q

Cystocele?

A

Anterior vaginal wall defect, bladder prolapses into the vagina

71
Q

Risk factors for pelvic organ prolapse?

A 
Multiple vaginal births
Traumatic vaginal births
Advanced age
Obesity
Chronic constipation
72
Q

Management of pelvic organ prolapse?

A
  1. Conservative (physio)
  2. Vaginal pessary
  3. Surgery
73
Q

Types of urinary incontinence?

A 
Urge incontinence (overactivity of the bladder)
Stress incontinence (weakness of the sphincter)
74
Q

Risk factors for urinary incontinence?

A

Increased age
Increased BMI
Previous pregnancies and vaginal deliveries

75
Q

Management of stress incontinence?

A 
Weight loss
Avoiding caffeine/ diuretics/ overfilling the bladder
Pelvic floor exercises
Duloxetine (SNRI)
Surgery
76
Q

Management of urge incontinence?

A 
Bladder retraining
Antimuscarinic medication (oxybutinin/ tolterodine/ solifenacin)

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