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Reproductive System > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is the 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

How much blood is lost in menstruation?

A
  • Normal loss:less than 80 ml over 7 days

* Average loss: 30-40 ml

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3
Q

How long does a period last?

A

2-7 days

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4
Q

What is the length of a menstrual cycle?

A

28 days (average 24-35 days)

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5
Q

When is menarche?

A
  • 10-16 years

* Average - 12 years

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6
Q

When is menopause?

A

50-55 years

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7
Q

How may menstruation be disturbed?

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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8
Q

How may menstruation be disturbed?

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

MENSTRUAL PARAMETERS

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9
Q

What defines heavy menstrual bleeding?

A

•Difficult to measure quantity
•AND/OR the need to change menstrual products every one to two hours
•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
•5% of women aged 30-49 in UK consult GP each year due to HMB
•Health Implications e.g. anaemia
•20%women in UK have hysterectomy aged <60 due to HMB

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10
Q

What are the uterine and ovarian pathologies that can cause HMB?

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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11
Q

What are the systemic diseases and disorders that can cause HMB?

A
  • Coagulation disorders (for example von Willebrand disease)
  • Hypothyroidism (which may also present with fatigue, constipation, intolerance of cold, and hair and skin changes)
  • Liver or renal disease
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12
Q

What are the iatrogenic causes of HMB?

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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13
Q

What is PALM COEIN?

A

•Pneumonic to remember the causes of HMB

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

C - coagulopathy
O - ovulation dysfunction
E - endometrium/hyperplasia
I - iatrogenic
N - not yet classified
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14
Q

What are fibroids?

A
  • Non cancerous growths made of muscle and fibrous tissue

* Also called myoma or lieomyoma

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15
Q

What are the signs and symptoms of fibroids?

A
  • May be asymptomatic

* Can cause HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility, miscarriage

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16
Q

How are fibroids managed?

A
  • Management: Symptom based
  • For HMB +/- small fibroids -COCP, POP, Mirena
  • Large fibroids & fertility preservation desired - Fibroid embolisation, myomectomy
  • Submucosal fibroids - Hysteroscopic fibroid resection (still myomectomy)
  • Declined or failed medical treatment & fertility preservation not required -Hysterectomy

Fibroid embolisation - blocks off arteries to fibroid making them shrink

BASICALLLY: Hormones, fibroid embolisation, myomectomy or hysterectomy

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17
Q

What is endometriosis?

A
  • Defined as endometrial tissue present outside the lining of uterus
  • During menstruation this ectopic tissue behaves the same as endometrium and bleeds
  • Affects women of reproductive age
  • 1.5 million women in UK affected
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18
Q

How does endometriosis present?

A
  • May present with HMB
  • Most often pelvic pain
  • Multi-system involvement
  • Severely affects quality of life - can be devastating.
  • In addition to pelvic symptoms, can cause infertility, fatigue and systemic symptoms
  • Severity of deposits may not correspond with symptoms
  • Painful menstrual cramps - worsening
  • Lower back pain
  • Abnormal bleeding/spotting between period
  • Pain during and after sexual intercourse
  • Painful bowel movements or urination
  • Diarrhoea, nausea and bloating
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19
Q

What are the stages of endometriosis?

A

•Stage 1 (minimal)

  • few superficial implants
  • surface lesions or inflammation on or around organs in the pelvic cavity

•Stage 2 (mild)
-more widespread and starting to infiltrate pelvic organs

•Stage 3 (moderate)

  • peritoneum or other structures
  • sometimes also scarring and adhesion

•Stage 4 (severe)

  • infiltrative and affecting many pelvic organs inc. ovaries
  • often with distortion of the anatomy and adhesions
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20
Q

How is endometriosis diagnosed?

A
  • Pelvic examination
  • Ultrasound scan
  • Diagnostic laparoscopy
21
Q

How is endometriosis managed?

A
  • Analgesia
  • Medical
  • Surgical
22
Q

How is endometriosis managed medically?

A
  • COCP
  • POP
  • Mirena IUS
  • Depot provera - contraception injection
  • GnRH Analogues
23
Q

How is endometriosis managed surgically?

A
  • Ablation - only if no intent for children
  • Hysterectomy endometrioma excision - only affected tissue
  • Pelvic clearance
  • Hysterectomy

•Surgical management may be required as part of fertility treatment

24
Q

What is adenomyosis?

A

A condition where endometrium becomes embedded in myometrium

25
Q

How does adenomyosis present?

A
  • Heavy menstrual bleed

* May have significant dysmenorrhea

26
Q

How is adenomyosis treated?

A
  • May respond to hormones partially

* Definitive treatment is hysterectomy

27
Q

What are endometrial polyps?

A
  • Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
  • Mostly benign
28
Q

How are endometrial polyps diagnosed?

A
  • USS

* Hysteroscopy

29
Q

How are are endometrial polyps managed?

A

Polypectomy

30
Q

How is general HMB investigated?

A
  • Thorough history
  • Pelvic examination (Speculum,Bimanual) - remember to look at cervix
  • Clotting profile, thyroid function
  • Pelvic Ultrasound scan
  • Laparoscopy if endometriosis suspected
31
Q

How is general HMB managed?

A 
•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

32
Q

What are non-hormonal medical treatments for HMB?

A
  • Tranexamic acid (antifibrinolytic) reduces blood loss 60%
  • Mefenamic acid (prostaglandin inhibitor) reduces blood loss 30% and pain
  • Both of them are taken at the time of periods
  • Do not regulate cycles
  • Suitable for those trying to conceive or avoiding hormones
33
Q

What are hormonal medical treatments for HMB?

A
  • Combined contraceptive pill (COCP) - makes periods lighter, regular and less painful
  • LNG IUS and Depo-Provera reduces bleeding – may cause irregular bleeding, some women will be amenorrhoeic
  • Oral progestogens e.g. Provera10mg
  • day 5-25 cycle reduce bleeding +regulate
  • day 15-25 may regulate cycle but does not reduce amount of bleeding
34
Q

What are hormonal medical treatments for HMB?

A
  • Combined contraceptive pill (COCP) - makes periods lighter, regular and less painful
  • LNG IUS and Depo-Provera reduces bleeding – may cause irregular bleeding, some women will be amenorrhoeic
  • Oral progestogens e.g. Provera10mg
  • day 5-25 cycle reduce bleeding +regulate
  • day 15-25 may regulate cycle but does not reduce amount of bleeding
35
Q

What are the surgical treatments for HMB?

A
  • Endometrial ablation
  • Hysterectomy
  • Removal of ovaries with the uterus
36
Q

What is endometrial ablation?

A
  • Permanent destruction of endometrium using different energy sources
  • First generation ablation: under hysteroscopic vision – uses diathermy
  • Second generation ablation: thermal balloon, radio frequency
37
Q

What are the prerequisites for endometrial ablation?

A
  • Uterine cavity length <11 cm
  • Sub mucous fibroids < 3cm
  • Previous normal endometrial biopsy

Mainly used for endometriosis but may be used to treat small fibroids (otherwise embolisation).

38
Q

What is a hysterectomy?

A

•Surgical removal of uterus

  • Abdominal
  • Vaginal
  • Laparoscopic

•Guarantees amenorrhoea

  1. Subtotal (cervix left)
  2. Total (cervix and uterus)
  3. Total with bilateral sapling-oophorectomy
  4. Wertheim’s hysterectomy
39
Q

What are the types of laparoscopic hysterectomy?

A
  • Laporoscopically assisted vaginal hysterectomy (LAVH)
  • Total laparoscopic hysterectomy (TLH)
  • Laparoscopically assisted subtotal hysterectomy
40
Q

Is a hysterectomy a major surgery?

A
  • Yes
  • 3-5 days in hospital (open/vaginal)
  • 1-2 days laparoscopic approach
  • 2-3 months full recovery
41
Q

What are the risks associated with a hysterectomy?

A
  • Infection
  • DVT
  • Bladder, bowel or vessel injury
  • Altered bladder function
  • Adhesions
42
Q

What is the removal of the ovaries with the uterus?

A
  • Salpingo-oophorectomy

* Ovaries may be removed with uterus in women with endometriosis or presence of ovarian pathology

43
Q

What are the disadvantages of oophorectomy?

A

Immediate menopause – recommended HRT till age 50

44
Q

What are the advantages of oophorectomy?

A

Reduces risk of subsequent ovarian cancer

45
Q

What are the causes of oligo/amenorrhoea?

A
  • Life changes:stress, eating disorders/malnourishment, obesity, Intense exercise
  • Hormones: POP, Mirena, depot injection
  • Primary ovarian insufficiency
  • Polycystic ovarian syndrome
  • 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
46
Q

What is dysfunctional uterine bleeding?

A

•Dysfunctional uterine bleeding (DUB) is a common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases

47
Q

What is the pathophysiology of dysfunctional uterine bleeding?

A

Underlying pathophysiology is believed to be due to ovarian hormonal dysfunction

48
Q

How is dysfunctional uterine bleeding managed?

A
  • Conservative/Medical/Surgical treatment based on severity of symptoms and patient’s wishes
  • GnRh analogues could be good bridging for patients who are nearly menopausal and have not responded to or declined other medical treatment and surgical management not desirable
  • GnRH analogues work as ant estrogen and produce a pseudo menopause
  • Up to 6 month therapy
  • If further desired by patient and no contraindication, should be given add back HRT till patient confirmed menopausal.

GnRH REDUCES OESTROGEN CAUSING PSEUDOMENOPAUSE

Reproductive System (31 decks)

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