Menstrual disorders Flashcards
What is a menstrual cycle?
the time from the first day of a woman’s period to the day before her next period
normal blood loss in a period?
80ml over 7 days (16 tsp)
average duration of a period?
2-7 days
length of a cycle?
28 days ( average 24-35)
disturbances of menstruation - what are the 4 categories?
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.
when is a cycle considered frequent/ infrequent
< 24 days
> 38 days
when is a cycle considered regular/irregular
< 20 days variation in 12 months
>20 days variation in 12 months
what volume of blood loss in one menstrual cycle is considered heavy, normal and light?
> 80 ml
5-80ml
<5ml
- when is it considered heavy?
- Bleeding>8dysmenorrhea0 ml over 7 days, regular cycle
AND/OR the need to change menstrual products every one to two hours
Features of heavy menstrual bleeding?
AND/OR passage of clots greater than 2.5 cm
Bleeding through the clothes
AND/OR ‘very heavy’ periods as reported by the woman/affecting quality of life
Can occur alone or in combination with symptoms like dysmenorrhea.
Health Implications e.g. anaemia
20%women in UK have hysterectomy aged <60 due to HMB
Common causes of HMB - UTERINE AND OVARIAN pathologies
- Uterine fibroids (HMB/dysmenorrhoea, pelvic pain)
- Endometrial polyps (HMB/ intermenstrual bleeding).
- Endometriosis 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).
Sytemic diseases and disorders causing HMB? (4)
- Coagulation disorders (for example von Willebrand disease).
- history of dental bleeding or prolonged injury should be sorted, especially in those with younger age
- Hypothyroidism (which may also present with fatigue, constipation, intolerance of cold, and hair and skin changes)
- Liver or renal disease.
Iatrogenic causes of HMB? (3)
- Anticoagulant treatment
- Herbal supplements (for example ginseng, ginkgo, and soya) — these may cause menstrual irregularities by altering oestrogen levels or coagulation parameters.
- Intrauterine contraceptive device(CU IUD).
MNEMONIC to remember HMB?
P - polyp
A - adenomyosis
L - leiomyoma/fibroid
M - malignancy
C - coagulopathy O - ovulation E - Endometrium/ hyperplaia L - latrogenic N - not yet classified
What are fibroids?
Non cancerous growths made of muscle and fibrous tissue. also called myoma or lieomyoma
What can fibroids cause symptom wise? (9)
HMB, pelvic pain, urinary symptoms, pressure symptoms, backache , Infertility, miscarriage
diagnosis of fibroids?
ultrasound
For HMB +/- small fibroids- what can they be controlled by? (3)
COCP
POP
Mirena
options for large fibroids?
desired Fibroid embolisation myomectomy
submucosal fibroids - what can be carried out?
Hysteroscopic fibroid resection
Declined or failed medical treatment & fertility preservation not required - what is the next step?
-Hysterectomy
what is endometriosis?
tissue present outside the lining of uterus
what does the tissue do during menstruation if you have endometriosis?
ectopic tissue behaves the same as endometrium and bleeds
who does endometriosis effect ?
women of reproductive age. 1.5 million women in UK affected.
