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Adele Obs and Gynae > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

When does the menstrual cycle begin and end?

A

From the first day of a woman’s period until the day before her next period

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2
Q

What is considered a normal amount of period blood loss?

A

less than 80ml over 7 days (16tsp)

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3
Q

What is the average period blood loss?

A

30-40ml (6-8 tsp)

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4
Q

What is the average period duration?

A

2-7 days

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5
Q

How long does a menstrual cycle last?

A

28 days (average 24-35 days)

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6
Q

When does menarche occur?

A

10-16 years old (average 12)

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7
Q

At what age does menopause occur?

A

50-55

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8
Q

What are the different types of menstrual disturbance?

A

disturbance of menstrual frequency - infrequent or frequent
irregular menstrual bleeding - absent or irregular
abnormal duration of flow - prolonged or shortened
abnormal menstrual volume - heavy or light

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9
Q

What are the criteria for a diagnosis of heavy menstrual bleeding?

A

Bleeding >80ml over 7 days, regular cycle
AND/OR
The need to change menstrual products every one to two hours
AND/OR
Passage of clots greater than 2.5cm
AND/OR
Bleeding through clothes
AND/OR
‘Very heavy’ periods as reported by the woman/affecting quality of life

Can occur alone or in combination with symptoms like dysmenorrhoea

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10
Q

Which uterine and ovarian pathologies can cause heavy menstrual bleeding?

A 
Uterine fibroids (HMB/dysmenorrhoea, pelvic pain)
Endometrial polyps (HMB/intermenstrual bleeding)
Enometriosis and adenomyosis (HMB/dysmenorrhoea, dyspareunia, pelvic pain, difficulty conceiving)
Pelvic inflammatory disease and pelvic infection (for example chlamydia - may also present with vaginal discharge, pelvic pain, intermenstrual and postcoital bleeding, and fever)
Endometrial hyperplasia or carcinoma (postcoital bleeding, intermenstrual bleeding, pelvic pain)
Polycystic ovary syndrome (causes anovulatory menorrhagia and irregular bleeding)
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11
Q

Which systemic diseases and disorders can cause heavy menstrual bleeding?

A

Coagulation disorders (for example von Willebrand disease)
Hypothyroidism
Liver or renal disease

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12
Q

What are some iatrogenic causes of heavy menstrual bleeding?

A

Anticoagulant treatment
Herbal supplements (ginseng, ginkgo, soya) - these may cause menstrual irregularities by altering oestrogen levels or coagulation parameters
Intrauterine contraceptive device (Cu IUD)

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13
Q

What does PALM-COEIN stand for and what is it used for?

A

Causes of abnormal menstrual bleeding

Polyps
Adenomyosis
Leiomyoma/fibroid
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometrium/hyperplasia
Iatrogenic
Not yet classified
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14
Q

What are fibroids?

A

Non cancerous growths made of muscle and fibrous tissue, also called myoma or lieoyoma

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15
Q

What are some of the symptoms of fibroids?

A

May be asymptomatic

Can cause:
HMB
Pelvic pain
Urinary symptoms
Pressure symptoms
Backache
Infertility
Miscarriage
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16
Q

How is a diagnosis of fibroids made?

A

Ultrasound

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17
Q

How is HMB +/- small fibroids treated?

A

COCP
POP
Mirena

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18
Q

How are large fibroids treated in a patient who wishes to preserve their fertility?

A

Fibroid embolisation

Myomectomy

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19
Q

How are submucosal fibroids treated?

A

Hysteroscopic fibroid resection

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20
Q

How do you treat fibroids in a patient who has declined or failed medical treatment and fertility preservation is not required?

A

Hysterectomy

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21
Q

What is endometriosis?

A

Endometrial tissue present outside the lining of the uterus. During menstruation this ectopic tissue behaves the same as endometrium and bleeds.

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22
Q

How many women in the UK are affected by endometriosis?

A

1.5 million

23
Q

What are some of the symptoms of endometriosis?

A

Painful menstrual cramps that get worse over time
Pain during and after sexual intercourse
Lower back pain
Painful bowel movements or urination
Abnormal bleeding or spotting between menstrual periods
Diarrhoea, nausea and blotting

24
Q

What are some possible sites for endometriosis?

A 
Ovary
Pouch of Douglas
Bladder
Colon
Small intestine
Fallopian tube
Rectum
25
Q

How many stages of endometriosis are there?

A 
4:
Minimal
Mild
Moderate
Severe
26
Q

How is stage 1 (minimal) endometriosis characterised?

A

Small patches, surface lesions or inflammation on or around organs in the pelvic cavity

27
Q

How is stage 2 (mild) endometriosis characterised?

A

More widespread than stage 1 and starting to infiltrate pelvic organs

28
Q

How is stage 3 (moderate) endometriosis characterised?

A

Peritoneal (pelvic side walls) involvement or other structures, sometimes there is also scarring and adhesions

29
Q

How is stage 4 (severe) endometriosis characterised?

A

Infiltrative and affecting many pelvic organs and ovaries, often with distortion of the anatomy and adhesions

30
Q

How is endometriosis diagnosed?

A

Pelvic examination
Ultrasound scan
Diagnostic laparoscopy

31
Q

How is endometriosis managed?

A

Analgesia / medical / surgical
Medical: COCP, POP, Mirena IUS, depot provera, GnRH analogues
Surgical: ablation, hysterectomy, endometrioma excision, pelvic clearance
Surgical management may be required as part of fertility treatment

32
Q

What is adenomyosis?

A

A condition where endometrium becomes embedded in myometrium

33
Q

What are the symptoms of adenomyosis?

A

HMB

May have significant dysmenorrhoea

34
Q

How is adenomyosis treated?

A

May respond to hormones partially

Definitive treatment is hysterectomy

35
Q

What are endometrial polyps?

A

Overgrowth of endometrial lining can lead to formation of pedunculated structures called polyps which extend into myometrium, mostly benign

36
Q

How is a diagnosis of endometrial polyps made?

A

Ultrasound or hysteroscopy

37
Q

How are endometrial polyps treated?

A

Polypectomy

38
Q

How should heavy menstrual bleeding be investigated?

A 
Thorough history
Pelvic examination (speculum, bimanual)
Clotting profile
Thyroid function
Pelvic ultrasound scan
Laparoscopy if endometriosis suspected
39
Q

What is tranexamic acid and what does it do?

A

Antifibrinolytic - reduced blood loss by 60%

40
Q

What is mefenamic acid and what does it do?

A

Prostaglandin inhibitor - reduces blood less by 30% and reduces pain

41
Q

What are some of the medical treatments for heavy menstrual bleeding?

A 
Tranexamic acid
Mefenamic acid
Hormonal contraception
- COCP
- levonorgestrel IUS
- depo-provera
- oral progestogens
42
Q

What are some of the surgical treatments for heavy menstrual bleeding?

A

Endometrial ablation

  • first gen: under hysteroscopic vision - uses diathermy
  • second gen: thermal balloon, radiofrequency
43
Q

What does a subtotal hysterectomy consist of?

A

Removal of the uterus, sparing the cervix

44
Q

What does a total hysterectomy consist of?

A

Removal of the uterus and cervix

45
Q

What does a total hysterectomy with bilateral salpingo-oopherectomy consist of?

A

Removal of the uterus and cervix, as well as both fallopian tubes and ovaries

46
Q

What are the risks of a hysterectomy?

A

Infection DVT
Bladder/bowel/vessel injury
Altered bladder function
Adhesions

47
Q

What are the advantages and disadvantages of having a bilateral salpingo-oopherectomy alongside a hysterectomy?

A

Advantages: reduces risk of subsequent ovarian cancer
Disadvantages: immediate menopause - recommended HRT til age 50

48
Q

What are the risks of conserving the ovaries in a hysterectomy?

A

High risk of menopause in next 2 years due to compromised blood supply

49
Q

What is oligomenorrhoea?

A

infrequent or abnormally light menstruation

50
Q

What can cause oligo/amennorrhoea?

A 
Life changes: stress, eating disorders/malnourishment, obesity, intense exercise
Hormones: POP, Mirena, depo injection
Primary ovarian insufficiency
PCOS
Hyperprolactinaemia
Prolactinomas
Thyroid disorders (hyperthyroid)
Obstructions of the uterus, cervix and/or vagina
51
Q

What is polycystic ovary syndrome?

A

Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria are met:

  • no ovulation
  • high androgen levels
  • ovarian cysts
52
Q

What are the differential diagnoses for PCOS?

A

Adrenal hyperplasia
Hypothyroidism
Hyperprolactinaemia/prolactinoma

53
Q

How is PCOS treated?

A

Hormonal treatment - COCP, POP, Mirena IUS

Adele Obs and Gynae (22 decks)

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