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Menstrual Disorders Flashcards

Fibroids Endometriosis Endometrial Polyps Adenomyosis Oligo/Amenorrhea PCOS Dysfunctional Uterine Bleeding

1
Q

2 phases of menstrual cycle

A

Follicular

Luteal

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2
Q

Define ‘heavy menstrual bleeding’

A 
Bleeding >80mls over a period of 7 days
\+/ need to change menstrual products every 1-2 hours
\+/ passage of clots greater than 2.5cm
\+/ bleeding through clothes
\+/ very heavy periods
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3
Q

What symptom can occur alongside heavy menstrual bleeding?

A

Dysmenorrhea

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4
Q

What implications can Heavy menstrual bleeding have?

A

Anaemia

Hysterectomy at young age

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5
Q

4 origins of causes of heavy menstrual bleeding

A

Uterus
Ovaries
Systemic disorders
Iatrogenic

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6
Q

Uterine and Ovarian causes of Heavy Menstrual Bleeding

A 
Fibroids
Endometrial Polyps
Endometriosis
Adenomyosis
Pelvic Inflammatory Disease & Infection
Endometrial hyperplasia and carcinoma
PCOS
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7
Q

Which infection can also present with pelvic pain, intermenstrual and postcoital bleeding, fever and vaginal discharge?

A

Chlamydia

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8
Q

3 symptoms of endometrial hyperplasia or carcinoma

A

IM or PC bleeding, pelvic pain,

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9
Q

Systemic diseases and disorders that cause heavy menstrual bleeding

A

Coagulation - VW
Hypothyroidism
Liver or Renal disease

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10
Q

Iatrogenic causes of heavy menstrual bleeding

A

Anticoagulant treatment
Herbal supplements
Intrauterine Device

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11
Q

PALM COEIN is the mnemonic for causes of what menstrual symptom/disorder?

A

Heavy Menstrual Bleeding

Polyps
Adenomyosis
Leiomyoma/Fibroma
Malignancy

Coagulopathy
Ovulation Dysfunction
Endometrium/Hyperplasia
Iatrogenic
Not Yet Classified
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12
Q

Name 2 types of fibroid

A

Myoma

Leiomyoma

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13
Q

What are fibroids?

A

Non cancerous growth of muscular and fibrous tissue

Benign smooth muscle tumours arising from myometrium of uterus

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14
Q

Symptoms of fibroids

A 
Asymptomatic
Heavy Menstrual Bleeding
Dysmenorrhea
Back ache
Pelvic pain
Urinary Symptoms
Pressure Symptoms
Infertility
Miscarriage
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15
Q

How are fibroids diagnosed?

A

Ultrasound

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16
Q

Name 4 symptom based courses of management of fibroids

A

HMB and small fibroids
Large fibroids & fertility preservation required
Submucosal fibroids
Declined/Failed medical treatment & fertility preservation not required

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17
Q

Surgical management of fibroids when fertility preservation not required

A

Hysterectomy

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18
Q

Management of small fibroids with HMB

A

COCP
POP
Mirena

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19
Q

Management of large fibroids, fertility needs preserved

A

Fibroid embolization

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20
Q

Management of submucosal fibroids

A

Hysteroscopic fibroid resection

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21
Q

Describe the condition endometriosis

A

Endometrial tissue is present outwith the uterus

Ectopic tissue behaves as endometrial tissue and will bleed during menstruation

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22
Q

Which group of women are affected by endometriosis>

A

Those of Reproductive Age

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23
Q

Presenting symptoms of Endometriosis

A 
Pelvic pain
Painful, worsening menstrual cramps
Lower Back pain
Pain during or after intercourse
Abnormal bleeding or spotting between periods
Diarrhoea 
Nausea
Bloating
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24
Q

Common misdiagnoses and conditions linked to endometriosis

A 
Depression
Stress, anxiety
Fatigue
Thyroid issues
PCOS
Period Pain
'Normal' 
IBS
Overactive imagination/ low pain threshold
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25
Sites of ectopic tissue in Endometriosis
``` Outer wall of uterus Fallopian tube Ovary Rectum Colon Bladder Pouch of Douglas Small intestine ```
26
Stages of Endometriosis - Minimal, Mild, Moderate, Severe
Stage 1 - Minimal - patches/surface lesions on/around organs of pelvic cavity Stage 2 - Mild - More widespread, infiltrate organs Stage 3- Moderate - Peritoneum, scarring and adhesions Stage 4- Severe - Infiltrative, many organs and ovaries affected. Distorts anatomy. Adhesions present
27
Diagnosis of Endometriosis
Pelvic examination Ultrasound Diagnostic laparoscopy
28
Management of Endometriosis
Analagesia Medical - COCP, POP, Mirena, Depot provera, GnRH analogues Surgical - Ablation, Hysterectomy, Endometrioma excision, Pelvic clearance
29
Describe adenomyosis
Endometrium becomes embedded in myometrium
30
Symptoms of adenomyosis
HMB | Dysmenorrhea
31
Treatment of adenomyosis
May respond to hormones | Hysterectomy
32
Diagnosis of endometrial polyps
Ultrasound | Hysteroscopy
33
Treatment of polyps
Polypectomy
34
Overall Management of HMB
``` History Pelvic Examination Clotting and thyroid tests Pelvic Ultrasound Laparoscopy if suspected endometriosis Appropriate treatment Endometrial biopsy if age 44 and above, refractive to medical treatment ```
35
6 Medical Treatments for Heavy Menstrual Bleeding
``` Tranexamic acid Mefenamic acid Hormonal contraception Combined Contraceptive Pill LNG IUS and Provera Oral progestrogens - Provera ```
36
How does tranexamic acid treat HMB?
Reduces blood loss - Antifibrinolytic
37
How does mefenamic acid treat HMB?
Reduces blood loss and pain | Prostaglandin inhibitor
38
Which 2 medical treatments of HMB are suitable if trying to conceive?
Tranexamic acid and Mefenamic acid | Can take both at time of period - don't regulate cycles
39
Effect of Oral progestrogen on HMB during day 5-15 of menstrual cycle
Reduces bleeding and regulates cycle
40
Effect of Oral progestrogen on HMB during day15-25 of menstrual cycle
Regulates cycle
41
Types of Endometrial Ablation
First generation - diathermy, under hysteroscopic vision | 2nd generation - thermal balloon, radiofrequency
42
3 Pre-requisites for treatment by Endometrial Ablation
Uterine cavity length < 11cm Submucosal fibroids < 3cm Previous normal endometrial biopsy
43
3 Methods of Hysterectomy
Abdominal Vaginal Laparascopic
44
Types of Laparascopic Hysterectomy
Total Laparascopic Hysterectomy Laparascopically assisted Vaginal Hysterectomy (LAVH) Laparascopically Assisted Subtotal Hysterectomy
45
What is a total hysterectomy?
Cervix and uterus removed
46
What is a subtotal hysterectomy?
Uterus removed, cervix spared
47
How long for recovery after hysterectomy?
2-3 months
48
Risks invovled with hysterectomy
``` Infection DVT Bladder/Bowel/Vessel injury Altered bladder function Adhesions ```
49
Guaranteed outcome of hysterectomy
Amenorrhea
50
What is a salpingoophorectomy?
Removal of tubes and ovaries
51
What conditons may require salpingoophorectomy?
Endometriosis | Ovarian pathologies
52
Disadvantage of salpingoophorectomy
Immediate menopause | Require HRT
53
Advantage of salpingoophorectomy
Reduced risk of subsequent ovarian cancer
54
Risk of removing uterus /salpingoophorectomy where ovaries preserved?
Menopause within 2 years - blood supply compromised
55
Define Oligo/Amenorrhea
Infrequent/Absent/Abnormally light menstruation
56
Causes of amenorrhea
``` Life changes - stress, eating disorders/malnourishment, obesity, intense exercise Hormonal - POP, Mirena, Depot injections Primary ovarian insufficiency Hyperprolactinaemia Prolactinoma Thyroid disease (Grave's) Obstruction of uterus, cervix or vagina ```
57
Symptoms of Polycystic Ovarian Syndrome
``` Weight gain Acne Depression Hair Loss Excessive facial and body hair Irregular periods High blood pressure Skin discolourance ```
58
Diagnostic criteria of PCOS
2 from Ultrasound appearance of ovary Biochemical hyperandrogegism Clinical hyperandrogegism
59
What conditions is PCOS associated with?
Obesity | Infertility
60
Management of PCOS
Lifestyle - achieve normal BMI Symptoms treated At least 3 withdraw bleeds per year to prevent hyperplasia - COCP, POP, Mirena
61
Define Dysfunctional Uterine Bleeding
Excessive bleeding in a premenopausal woman that is not due to pregnancy or recognisable uterine or systemic diseases Ovarian hormonal dysfunction
62
Management
``` Exclude other causes - PALM COEIN Conservative/Medical based on severity GnRH Analaogues Up to 6 months of treatment Should be given add back HRT until confirmed menopausal unless contraindicated ```

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