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Menstrual Disorders Flashcards

1
Q

What is the menstrual cycle?

A

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

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2
Q

For the menstrual cycle what is: normal loss, average loss, average duration, length of cycle?

A
  • Normal loss less than 80ml over 7 days
  • Average loss 30-40ml
  • Average duration 2-7 days
  • Length of cycle 28 days (average 24-35 days)
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3
Q

What is menarche?

A

A womans first period

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4
Q

What is the average age for menarche and menopause?

A
  • Menarche 10-16 years (average 12 years)
  • Menopause 50-55 years
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5
Q

What are some examples of disturbances of menstruation?

A
  • Disturbances 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

What terminology is used for describe frequency and what are the normal and abnormal limits?

A
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7
Q

What terminology is used for describe regularity and what are the normal and abnormal limits?

A
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8
Q

What terminology is used for describe duration and what are the normal and abnormal limits?

A
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9
Q

What terminology is used for describe volume and what are the normal and abnormal limits?

A
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10
Q

What are some indicators for heavy menstrual bleeding?

A
  • Bleeding > 8 days
  • And/or need to change menstrual products every one to two hours
  • And/or passage of clots greater than 2.5cm
  • Bleeding through clothes
  • And/or very heavy periods as reported by woman –affecting quality of life
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11
Q

What is the aetiology of heavy menstrual bleeding?

A
  • Uterine and ovarian pathologies
    • Uterine fibroids
    • Endometrial polyps
    • Pelvic inflammatory disease and pelvic infection
    • Endometrial hyperplasia or carcinoma
    • Polycystic ovary syndrome
  • Systemic diseases
    • Coagulative disorders
    • Hypothyroidism
    • Liver or renal disease
  • Iatrogenic causes
    • Anticoagulant treatments
    • Herbal supplements
    • Intrauterine contraceptive device
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12
Q

What investigations should be done for heavy menstrual bleeding?

A
  • Pelvic USS
  • Examination
  • Blood tests
    • Clotting profile, thyroid function
  • Endometrial biopsy
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13
Q

What blood tests should be done for heavy menstrual bleeding?

A
  • Blood tests
    • Clotting profile, thyroid function
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14
Q

Describe the management for heavy menstrual bleeding?

A
  • Laparoscopy if endometriosis suspected – gold standard
  • Hysterectomy (surgical removal of uterus)
  • Options depend on
    • Impact on QoL, underlying pathology, desire for future fertility and woman’s preferences
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15
Q

What is a possible complication of heavy menstrual bleeding?

A

Anaemia

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16
Q

What is a hysterectomy?

A

Surgical removal of uterus

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17
Q

What are fibroids?

A

Non-cancerous growths made of muscle and fibrous tissue, also called myoma or leiomyoma

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18
Q

What is the presentation of fibroids?

A
  • May be asymptomatic
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19
Q

What investigations should be done for fibroids?

A
  • USS
    • Used to diagnose
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20
Q

Describe the management for fibroids?

A
  • Symptom based
  • For large fibroids
    • Fibroid embolization or myomectomy
  • For submucosal fibroids
    • Hysteroscopic fibroid resection
  • If all else has failed and fertility not required
    • Hysterectomy
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21
Q

What are possible complications of fibroids?

A
  • Can cause HMB, pelvic pain, urinary symptoms, pressure symptoms, backache, infertility, miscarriage
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22
Q

What is endometriosis?

A

Endometrial tissue present outside the lining of uterus, during menstruation this ectopic tissue behaves the same as endometrium and bleeds

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23
Q

What are the 4 stages of endometriosis?

A
  • Minimal
    • Small patches, surface lesions or inflammation on or around organs in pelvic cavity
  • Mild
    • More widespread and starting to infiltrate pelvic organs
  • Moderate
    • Peritoneum (pelvic side walls) or other structures, sometimes scarring
  • Severe
    • Infiltrative and affecting many pelvic organs, often with distortion of anatomy
24
Q

What sites are often affected by endometriosis?

25
Descibe the epidemiology of endometriosis (prevalence and age group)?
* Affects woman of reproductive age * 3% prevalence of woman
26
What is the presentation of endometriosis?
* Heavy menstrual bleeding (HMB) * Painful menstrual cramps that get worse over time * Abnormal bleeding or spotting between menstrual periods * Pain during and after sexual intercourse * Lower back pain * Pelvic pain * Multi-system involvement * Fatigue and systemic symptoms
27
What investigations should be done for endometriosis?
* Pelvic examination * USS * Diagnostic laparoscopy
28
What is the management of endometriosis?
* Analgesia * Medical * COCP, POP, mirena IUS, depot provera, GnRH analougues * Surgical * Ablation, hysterectomy endometrioma excision, pelvic clearance, hysterectomy
29
What are possible complications of endometriosis?
* Severely effects quality of life, can be devastating * Infertility
30
What is adenomyosis?
Condition where endometrium becomes embedded in myometrium
31
What is the presentation of adenomyosis?
* Heavy menstrual bleed * May have significant dysmenorrhea (painful periods or menstrual cramps)
32
What is the medical term for painful periods or menstrual cramps?
Dysmenorrhea
33
What is the management of adenomyosis?
* May respond to hormones * Definitive treatment is hysterectomy
34
What are endometrial polyps?
Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
35
Are endometrial polyps benign or malignant?
Mostly benign
36
How are endometrial polyps diagnosed?
* By USS or hysteroscopy
37
What is the management of endometrial polyps?
Polypectomy
38
Describe the treatment options for menstrual disorders?
39
Describe the medical treatment options for menstrual disorders?
* **Tranexamic acid** * Mode of action - antifibrinolytic * Effect - reduces blood loss by 60% * **Mefenamic acid** * Mode of action - prostaglandin inhibitor * Effect - reduces blood loss 30% and pain * **Hormonal options** * Combined contraceptive pill (COPC) * Effect – makes periods lighter, regular and less painful * LNG IUS and depo-provera * Effect – reduces bleeding * Side effects – may cause irregular bleeding, anaemia * Oral progestogens * Such as Provera 10mg * Effect – if day 5-25 cycle reduce bleeding and regulates, if day 15-25 cycle may regulated but does not reduce bleeding
40
What are hormonal options as management for menstrual disorders?
* Combined contraceptive pill (COPC) * Effect – makes periods lighter, regular and less painful * LNG IUS and depo-provera * Effect – reduces bleeding * Side effects – may cause irregular bleeding, anaemia * Oral progestogens * Such as Provera 10mg * Effect – if day 5-25 cycle reduce bleeding and regulates, if day 15-25 cycle may regulated but does not reduce bleeding
41
What are surgical options for menstrual disorders?
* **Endometrial ablation** * Permanent destruction of endometrium using different energy sources * First generation ablation – under hysteroscopic vision, uses diathermy * Second generation ablation – thermal balloon, radio frequency * Pre-requisites * Uterine cavity length \< 11cm * Sub mucous fibroids \< 3cm * Previous normal endometrial biopsy * **Hysterectomy** * Surgical removal of uteris * Different kinds – abdominal, vaginal, laparoscopic (laparoscopically assisted vaginal hysterectomy (LAVH), or total laparoscopic hysterectomy (TLH) or laparoscopically assisted subtotal hysterectomy) * Total hysterectomy is cervix and uterus removed, subtotal is only the uterus * Risks – infection, DVT, bladder/bowel/vessel injury, altered bladder function, adhesions * **Salpingo-oophorectomy** * Removal or ovaries with uterus * Indication – ovarian pathology, endometriosis * Advantages – reduces risk of ovarian cancer * Disadvantages – immediate menopause
42
What is endometrial ablation?
* Permanent destruction of endometrium using different energy sources * First generation ablation – under hysteroscopic vision, uses diathermy * Second generation ablation – thermal balloon, radio frequency
43
What are pre-requisites for endometrial ablation?
* Uterine cavity length \< 11cm * Sub mucous fibroids \< 3cm * Previous normal endometrial biopsy
44
What are the different kinds of hysterectomy?
* Different kinds – abdominal, vaginal, laparoscopic (laparoscopically assisted vaginal hysterectomy (LAVH), or total laparoscopic hysterectomy (TLH) or laparoscopically assisted subtotal hysterectomy) * Total hysterectomy is cervix and uterus removed, subtotal is only the uterus
45
What is salpingo-oophorectomy?
* Removal or ovaries with uterus
46
What is oligo/amenorrhea?
Infrequent, absent or abnormally light menstruation
47
What is the aetiology of oligo/amenorrhea?
* Life changes such as stress or eating disorders or obesity or intense exercise * Hormones such as POP, mirena or depot injection * Primary ovarian insuffiency * Polycystic ovarian syndrome * Hyperprolactinaemia (elevated levels of prolactin in the blood) * Prolactinomas (adenomas on the anterior pituitary gland) * Thyroid disorders * Graves disease * Obstruction of uterus, cervix and/or vagina
48
What is polycystic ovarian syndrome?
Metabolic syndrome with diagnosis if 2 of 3 criteria met: * USS appearance of ovary * Biochemical hyperandrogenism * Clinical hyperandogenism with oligomenorrhoea, hirsuitism, acne, infertility and obesity
49
How is polycystic ovarian syndrome diagnosed?
Metabolic syndrome with diagnosis if 2 of 3 criteria met: * USS appearance of ovary * Biochemical hyperandrogenism * Clinical hyperandogenism with oligomenorrhoea, hirsuitism, acne, infertility and obesity
50
What is the presentation of polycystic ovarian syndrome?
* Oligomenorrhoea/amenorrhea
51
What is the management of polycystic ovarian syndrome?
* Lifestyle adjustments, aim of normal BMI * Symptom based treatment * 3 withdrawal bleeds required per year to prevent hyperplasia or endometrial protection * Achieved with either COCP, POP, mirena IUS or norethisterone
52
What does DUB stand for?
Dysfunctional uterine bleeding
53
What is dysfunctional uterine bleeding?
Common disorder of excessive uterine bleeding affecting premenopausal woman that is not due to pregnancy or any recognisable uterine or systemic diseases
54
What is teh aetiology of DUB?
* Underlying pathophysiology due to ovarian hormonal dysfunction
55
What is the management for DUB?
* Exclude common causes of excessive bleeding * Conservative, medical or surgical treatment based on severity of symptoms and patients wishes * GnRH analogues, good for bridging patients who are nearly menopausal and not responded to other medical and surgical treatment * Effect – anti-oestrogen so produce a pseudo-menopause

Reproductive System (34 decks)

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