Menstrual Disorders

Question 1

What is the normal and so abnormal menstrual cycle?

Answer 1

Normal cycle: 28 days. Menses last 2-7 days. Begins averagely age 12, ends 50-55yo.

Menstruation (follicle develops) into follicular phase and then oestrogen, LH and FSH peak to release egg from ovum in ovulation phase, corpus luteum release progesterone to maintain lining of uterus in luteal before regressing and shedding in menstruation.

Abnormal menstruation can be within:

• disturbance of menstrual frequency
• irregular menstrual bleeding
• abnormal duration of flow
• abnormal menstrual volume

Question 2

How would you investigate abnormal bleeding?

Answer 2

History eg Volume of blood eg changing products, passing clots, through clothes 
Clotting profile, thyroid function 
Ultrasound 
Pelvic examination 
Hysteroscopy 
Endometrial biopsy if HMB >44yo

Question 3

What are the common menstrual disorders?

Answer 3

Heavy menstrual bleeding caused by fibroids, polyps, endometriosis, PID and pelvic infection, PCOS, endometrial hyperplasia or carcinoma, coagulation disorders, hypothyroidism, liver or renal disease, anticoagulation treatment, herbal supplemented, IUD (think PALM COEIN)

Fibroids (non cancerous growths)

Endometriosis (endometrial tissue outside uterus) - painful cramps, lower back pain, abnormal bleeding, pain during and after intercourse, painful bowel movements or urination, diarrhoea, nausea, blotting

Adenomyosis (endometrium becomes embedded in myometrium)

Polyps: overgrowth of endometrial lining

Olive/amenorrhea can be caused by: life changes, hormones, primary ovarian insufficiency, PCOS, hyperprolactinaemia, thyroid disorders, obstructions

PCOS: metabolic syndrome with 2/3 of 1) polycystic USS of ovaries, 2) biochemical hyperandrogenism / clinical hyperandrogenism 3) oligo/amenorrhea

Question 4

How are the common menstrual disorders treated?

Answer 4

Heavy bleeding depends on cause: medical options include tranexamic acid, mefenamic acid, hormonal contraception

Fibroids is symptom based: small and HMB may just need ctrx, large and wants fertility = embolism, mtomectomy, fertility not required = hysterectomy

Endometriosis: analgesia, medical (cocp, mirena IUS, GnRH analogues, depot provera), surgical (ablation, hysterectomy, pelvic clearance, hysterectomy endometrioma excision)

Adenomyosis: hysterectomy

Polyps: polypectomy

Oligo/amenorrhea: investigate and treat cause

PCOS: symptom based