Menstrual disorders Flashcards
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The menstrual cycle is the time from the first day of a woman’s period to the day before her next period
What is considered ‘normal’ blood loss during a period?
less than 80ml over 7 days (16tsp) but on average it is 30-40ml
Average duration of a period?
2-7 days
What is Menarche?
The onset of a female’s period
On average they start between 10-16 years
Common disturbances of menstruation
- 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.
What is classed as an infrequent period?
>38 day cycle
What things can you find out about a woman’s periods that indicate heavy menstrual bleeding?
- Do they need to change their menstrual product every 1-2 hours?
- Do they pass blood clots greater than 2.5 cm
- Do they bleed through their clothes?
- Do their periods affect their QOL?
Give an example of a health implication associated with heavy menstrual bleeding?
Anaemia
What are some common causes of heavy menstrual bleeding?
- Ovulatory dysfunction - anovulation means a lack of progesterone production leading to hormone imbalance which can cause menorrhagia
- Bleeding disorders i.e von Willebrand disease (VWD) or platelet function disorder
- Adenomyosis
- Pelvic inflammatory disease e.g chlamydia
- Cervical cancer
- Endometrial cancer
- Uterine polyps
- Uterine fibroids
- Copper IUD
What is the pneumonic used to remember the causes of HMB?
PALM COIE
- What are fibroids? (‘myoma’/’ileomyoma’)
- What symptoms can they cause?
- Non-cancerous growths made of muscle and fibrous tissue
- They can be asymptomatic or they can cause things like
- HMB
- Pelvic pain
- Urinary symptoms
- Pressure symptoms
- Infertility
- Backache
- Miscarriage
How are fibroids diagnosed and managed?
Diagnosis by USS
Management is symptom based.
- If HMB and small fibroids then the combined pill, mini pill or hormone IUD may be enough to control symptoms
- If fibroids are large and fertility preservation is desired then fibroid embolisation (block off arteries) or myomectomy
- If submucosal fibroids then hysteroscopic fibroid resection
- If declined or failed medical treatment and the woman doesn’t want to remain fertile then hysterectomy
What is Endometriosis?
- Where there is endometrial tissue present outside the lining of uterus.
- During menstruation this ectopic tissue behaves the same as the endometrium and bleeds. However, in this case the blood has no way to escape. This can cause inflammation, pain and the formation of scar tissue.
- It is a chronic and debilitating condition that causes painful periods. It is complex and often has multi-system involvement
- Can severely affect QOL of women - potential to cause infertility, fatigue etc
How might Endometriosis present?
- Most often pelvic pain and dysmenorrhoea (cramps/pain)
- May present with HMB
- The severity of symptoms may not correspond with the size of deposit - someone with less peritoneal scarring and smaller deposits may have severe pain and vice versa
Symptoms of Endometriosis
Adenomyosis
- What is it?
- What symptoms does it cause?
- How is it treated?
- A condition where the endometrium becomes embedded in the myometrium
- This results in HMB and patient can have significant dysmenorrhoea
- May respond to hormones partially but definitive treatment is hysterectomy
Endometrial polyps
- What are they?
- How are they diagnosed?
- How are they managed?
- ´Overgrowth of the endometrial lining can lead to formation of pediculated structures called polyps which extend into the endometrium. They are mostly benign.
- Diagnosis is by USS or hysteroscopy
- Management = polypectomy
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Remember women have many options and they should be presented with all the information in order to make an informed decision on their treatment.
