Menstrual disorders Flashcards
What is the menstrual cycle?
From first day of period to day before next period
What is normal for blood loss during period?
Less than 80 ml over 7 days
What is menarche?
The first menstrual cycle
What considered abnormal menstruation?
Outwith: 24-38 days frequency 20 days variation in regularity in a 12 month period 2-8 days duration 5-80ml volume
What are some systemic causes of HMB?
Coagulation disorders like Willebrand disease
Hypothyroidism
Liver or renal disease
What are some iatrogenic causes of HMB?
Anticoagulant treatment
Ginseng, gingko, soya
IUD
How do herbal remedies like ginseng, gingko, soya affect menstruation?
Can cause irregularities by altering oestrogen levels
What are some uterine causes of HMB?
Uterine fibroids Endometrial polyps Endometriosis Adenomyosis Pelvic inflammatory disease Endometrial hyperplasia
Name an ovarian cause of HMB?
Polycystic ovary syndrome
How might fibroids present?
May be asymptomatic HMB Pelvic pain Urinary symptoms Pressure Backache Infertility Miscarriage
How are fibroids usually diagnosed?
Ultrasound
How are fibroids treated?
Fibroid embolisation or myomectomy for fertility preservation
Hysterectomy if fertility not a factor or medical treatment has declined
What is endometriosis?
Endometrial tissue present outside the lining of uterus
What are some symptoms of endometriosis?
Painful menstrual cramps Lower back pain Pain during sex Painful bowel movements and urination Abnormal bleeding pattern Diarrhoea, nausea, blotting
How is endometriosis diagnosed?
Pelvic exam
US
Diagnostic laparoscopy
What are some medical options to treat endometriosis?
Combined contraceptive pill
POP
Mirena IUS
GnRH analogues
What are some surgical treatments for endometriosis?
Ablation
Hysterectomy
Endometrioma excision
Pelvic clearance
What is adenomyosis?
Endometrium becomes embedded in myometrium
How do endometrial polyps occur?
Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
How are endometrial polyps diagnosed?
Ultrasound
Hysteroscopy
What are some key tests to perform for management of HMB?
Clotting profile
Thyroid function
Laparoscopy
What does tranexamic
acid do?
Antifibrinolytic
Reduces blood loss by 60%
What does mefenamic acid do?
Prostaglandin inhibitor
Reduces blood loss 30% and pain
Is mefenamic acid safe to use for those trying to conceive?
Yes
How do LNG IUS and depo-provera affect menstruation?
Reduce bleeding
May cause irregular bleeding
What are some pre-requisites for endometrial ablation?
Uterine cavity <11 cm long
Sub mucous fibroids <3cm
Normal endometrial biopsy
What are the different degrees of hysterectomy?
Subtotal hysterectomy
Total hysterectomy
Total hysterectomy with bilateral salpingo-oophorectomy
Wertheim’s hysterectomy
What is salpingo-oophorectomy?
Removal of tubes and ovaries
What is a drawback of salpingo-oophorectomy?
Immediate menopause
What is oligomenorrhoea?
Irregular and inconsistent menstruation
What is dysfunctional uterine bleeding?
Excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases
