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Year 3: Reproduction > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

What is a menstrual cycle?

A

the time from the first day of a woman’s period to the day before her next period

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2
Q

normal blood loss in a period?

A

80ml over 7 days (16 tsp)

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3
Q

average duration of a period?

A

2-7 days

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4
Q

length of a cycle?

A

28 days ( average 24-35)

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5
Q

disturbances of menstruation - what are the 4 categories?

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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6
Q

when is a cycle considered frequent/ infrequent

A

< 24 days

> 38 days

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7
Q

when is a cycle considered regular/irregular

A

< 20 days variation in 12 months

>20 days variation in 12 months

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8
Q

what volume of blood loss in one menstrual cycle is considered heavy, normal and light?

A

> 80 ml
5-80ml
<5ml

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9
Q
  • when is it considered heavy?
A
  • Bleeding>8dysmenorrhea0 ml over 7 days, regular cycle

AND/OR the need to change menstrual products every one to two hours

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10
Q

Features of heavy menstrual bleeding?

A

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

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11
Q

Common causes of HMB - UTERINE AND OVARIAN pathologies

A
  • 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).
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12
Q

Sytemic diseases and disorders causing HMB? (4)

A
  • 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.
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13
Q

Iatrogenic causes of HMB? (3)

A
  • 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).
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14
Q

MNEMONIC to remember HMB?

A

P - polyp
A - adenomyosis
L - leiomyoma/fibroid
M - malignancy

C - coagulopathy 
O - ovulation 
E - Endometrium/ hyperplaia
L - latrogenic
N - not yet classified
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15
Q

What are fibroids?

A

Non cancerous growths made of muscle and fibrous tissue. also called myoma or lieomyoma

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16
Q

What can fibroids cause symptom wise? (9)

A

HMB, pelvic pain, urinary symptoms, pressure symptoms, backache , Infertility, miscarriage

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17
Q

diagnosis of fibroids?

A

ultrasound

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18
Q

For HMB +/- small fibroids- what can they be controlled by? (3)

A

COCP
POP
Mirena

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19
Q

options for large fibroids?

A

desired Fibroid embolisation myomectomy

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20
Q

submucosal fibroids - what can be carried out?

A

Hysteroscopic fibroid resection

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21
Q

Declined or failed medical treatment & fertility preservation not required - what is the next step?

A

-Hysterectomy

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22
Q

what is endometriosis?

A

tissue present outside the lining of uterus

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23
Q

what does the tissue do during menstruation if you have endometriosis?

A

ectopic tissue behaves the same as endometrium and bleeds

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24
Q

who does endometriosis effect ?

A

women of reproductive age. 1.5 million women in UK affected.

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25
Q

how may endometriosis present?

  • what involvement does it have?
  • what can it cause?
A

with HMB
- pelvic pain

  • multi system
  • infertility, fatigue and systemic symptoms
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26
Q

symptoms of endometriosis?

A

Lowe back pain
painful cramps that get worse - dysmenorrhoea
- abnormal bleeding or spotting doing period
- painful urination/ pooing
- pain during/ after intercourse

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27
Q

endometriosis is often misdiagnosed as it is hard to diagnose with the vague symptoms - what may it be mistaken for?

A
  • IBS
  • anxiety/depression
  • stress
  • fatigue
28
Q

Endometriosis stages - briefly describe them

A

stage 1 - minimal, may be small patches of surface lesions on or around organs in pelvic cavity

stage 2 - mild , begins to infiltrate pelvic organs

stage 3 - moderate - peritoneum pelvic side walls and other structures are involved

stage 4 - severe - infiltrated and affecting pelvic organs and ovaries - adhesions present

29
Q

diagnosis of endometriosis

A
  • Pelvic examination

- Ultrasound scan, Diagnostic laparoscopy

30
Q

management of endometriosis - medical and surgical

A

Management Options: Analgesia, Medical, Surgical
Medical — COCP, POP, Mirena IUS , Depot provera, GnRH Analogues

Surgical- Ablation,Hysterectomy endometrioma excision, pelvic clearance, Hysterectomy
Surgical management may be required as part of fe

31
Q

What is Adenomyosis?

A

condition where endometrium becomes embedded in myometrium .

32
Q

what does Adenomyosis cause?

A

HMB

33
Q

You may have significant ….? with Adenomyosis

A

dysmenorrhea.

34
Q

treatment and definitive treatment for adenomyosis?

A

May respond to hormones partially

- Definitive treatment is hysterectomy

35
Q

Endometrial polyps - overgrowth of endometrial lining can lead to?

  • polyps are mostly ?
A
  • to formation of pediculated structures called polyps which extend into endometrium
  • benign
36
Q

mamagement for Endometrial polyps?

A

polypectomy

37
Q

Management of Heavy menstrual bleeding (lots)

  • what profile needs to be done
A 
- Thorough history
Pelvic examination (Speculum,Bimanual) remember to look at cervix
- Clotting profile, thyroid function 
Pelvic Ultrasound scan 
Laparoscopy if endometriosis suspected
Management  options depend on:
Impact on quality of life
Underlying pathology
Desire for further fertility
Women’s preferences
  • Endometrial Biopsy from all women aged 44 or above with HMB, refractory to medical treatment
38
Q

with endometrial polyps - what is it always important to look at?

A

the cervix

39
Q

non hormonal treatment for polyps? (3)

A

mefenamic acid
transexemic acid
GnRH analogues

40
Q

what does transexemic acid do?

A

reduces blood loss 60%

antifibrinolytic)

41
Q

what does mefenamic acid do?

A

(prostaglandin inhibitor) reduces blood loss 30% and pain

42
Q

when are transexemic acid and mefenamic acid taken?

who are they suitable for?

A
  • at the time of periods , Do not regulate cycles

Suitable for those trying to conceive or avoiding hormones

43
Q

What does LNG IUS (Mirena) and depo-provera do?

A

reduces bleeding – may cause irregular bleeding, some women will be amenorrhoeic

44
Q

oral progestogens eg provera 10mg - when can it be given?

A

day 5-25 cycle reduce bleeding +regulate

  • day 15-25 may regulate cycle but does not reduce amount of bleeding
45
Q

Surgical Treatments - endometrial ablation

A

Permanent destruction of endometrium using different energy sources

46
Q

what does first generation ablation under hysteroscopic vision use?

A

diathermy

47
Q

what does second generation ablation use?

A

thermal balloon, radio frequency

48
Q

cervix removed or reserved in hysterectomy - what are they called?

A

Total hysterectomy: cervix and uterus removed

Subtotal hysterectomy: uterus removed, cervix left

49
Q

ovaries and tubes removed called?

A

sapling-oophorectomy

50
Q

risks of hysterectomy?

A

infection, DVT BLADDER/BOWEL/ VESSEL INJURY

- altered bladder function / adhesions

51
Q

Ovaries may be removed with uterus in women with?

A

endometriosis or presence of ovarian pathology

52
Q

Disadvantages of oophorectomy?

A

immediate menopause – recommended HRT till age 50

53
Q

Advantages of oophorectomy?

A

Reduces risk of subsequent ovarian cancer

54
Q

Oligo/amennorhea?

A

infrequent, absent or abnormally light menstruation

55
Q

causes of amennorhea?

A

Life changes:stress, eating disorders/malnourishment, obesity, Intense exercise

56
Q

hormones that may cause amennorhoea

  • what may they have?
A

POP, mirena , depot injection

prim ovarian insufficiency

57
Q

what to look for with amennorhoea - underlying causes (4)

A
  • Hyperprolactinemia (elevated levels of prolactin in the blood)
  • Prolactinomas (adenomas on the anterior pituitary gland)
  • Thyroid disorders (Graves’s disease)
  • Obstructions of the uterus, cervix, and/or vagina
    Investigate and treat the cause
58
Q

Polycystic Ovary Syndrome is a ?

A

Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria met

59
Q

criteria for Polycystic Ovary Syndrome? (3)

A
  • Ultrasound appearance of ovary
  • Biochemical hyperandrogenism
  • Clinical hyperandrogenism with oligomenorrhoea ,hirsuitism, acne, infertility and obesity
60
Q

Polycystic Ovary Syndrome? can result in?

A

oligo menorrhea /amenorrhea

61
Q

management of Polycystic Ovary Syndrome?

A

includes lifestyle adjustment with aim to achieve normal BMI

62
Q

Polycystic Ovary Syndrome? - how man withdrawal bleeds do they need and why?

  • how is this achieved ?
A

3

  • to prevent hyperplasia or endometrial protection

COCP,POP, mirena IUS or norethisterone

63
Q

What is Dysfunctional Uterine bleeding?

A

excessive uterine bleeding

- affects premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases.

64
Q

Dysfunctional Uterine bleeding - the underlying pathophysiology is believed to be due to?

A

ovarian hormonal dysfunction

65
Q

Dysfunctional Uterine bleeding - GnRh analogues are good for?

A

bridging for patients who are nearly menopausal - the have declined other options

66
Q

How do GnRh analogues work?

A

ant estrogen and produce a pseudo menopause .

67
Q

6 month therapy is needed for?

A

dysfunctional uterine bleeding

- should get add back HRT until they are confirmed menopausal

Year 3: Reproduction (40 decks)

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