Menstrual Disorders Flashcards
What are the causes of heavy menstrual bleeding?
- Uterine fibroids
- Endometrial polyps
- Endometriosis
- PID and pelvic infection
- Endometrial hyperplasia
- Polycystic ovary syndrome
- Coagulation disorders
- Hypothyroidism
- Liver or renal disease
- Anticoagulant treatment
- Herbal supplements
- Intrauterine contraceptive device
What are fibroids?
Non cancerous growths made of muscle and fibrous tissue
What can fibroids cause?
- HMB
- Pelvic pain
- Urinary symptoms
- Backache
- Infertility
- Miscarriage
How are fibroids diagnosed?
Ultrasound
How are fibroids managed?
- Symptom based
- For HMB +/- small fibroids: COCP, POP and mirena
- Large fibroids and fertility preservation: fibroid embolisation and myomectomy
- Submucosal fibroids: hysteroscopic fibroid resection
What is endometriosis?
Endometrial tissue present outside the lining of the uterus
How does endometriosis present?
- HMB
- Pelvic pain: painful menstraul cramps, pain during sex
- Multi-system involvement
- Severely affected QOL
- Can have infertility, fatigue and systemic symptoms
- Lower back pain
- Spotting between periods
- Diarrhoea, nausea and bloating
How can endometriosis be diagnosed?
- Pelvic exam
- USS
- Diagnostic laparoscopy
What are the management options for endometriosis?
- Analgesia
- Medical: COCP, POP, mirenam depo and GnRH
- Surgical: ablation, hysterectomy, excision, pelvic clearance
What is adenomyosis?
When the endometrium becomes embedded in the myometrium
How does adenomyosis present and how can it be treated?
- HMB
- Significant dysmenorrhoea
- Partial response to hormones
- Hysterectomy
How are endometrial polyps diagnosed and how are they managed?
- USS or hysteroscopy
- Polypectomy
How can heavy menstrual bleeding be managed?
- Pelvic exam
- Clotting profile and TFTs
- USS of Pelvis
- Laparoscopy (endometriosis)
- Biopsy if >44yrs and refractory to medical treatment
- Treatment depends on the pathology
What are the treatment options for menstrual disorders?
- Observation and monitoring
- Hormones
- Hormone containing IUD
- Endomyometrial resection
- Endometrial ablation
- Removal of fibroids or polyps
- Hysterectomy
- Mefanamic acid (prostaglandin inhibitor)
- TXA
- GnRH analogues
What are the causes of oligo/amennorrhoea?
- Life changes
- Hormones: POP, mirena and depo
- Primary ovarian insufficiency
- Polycystic ovaries
- Hyperprolactinemia
- Prolactinomas
- Thyroid disorders
- Obstructions of the uterus, cervix and/or vagina
