menstrual disorders Flashcards
menstrual cycle
time from first day of period to day before her next period
normal blood loss
<80ml over 7 days (16 tbsp)
average loss 30-40ml (6-8tbsp)
average duration of period
2-7 days
average length of cyle
~28days (avg 24-35 days)
menarche age
10-16yrs
avg 12years
menopause age
50-55 yrs
changes during menstrual cycle on going at 3 levels
hormonal
ovarian
endometrial lining
possible disturbances of mentruation
frequency: infrequent or frequent
irregular bleeding: absent or irregular
abnormal duration of flow: prolonged or shortened
abnormal menstrual volume: heavy or light
heavy menstrual bleeding
bleeding >80ml over 7 days
and/or needing to change menstrual products every 1-2hrs
and/or passage clots >2.5cm
and/or bleeding through clothes
and/or v heavy periods affecting her QOL e.g. having to leave work
causes of heavy menstrual bleeding: uterine and ovarian pathologies
uterine fibroids endometrial polyps endometriosis and adenomyosis PID and pelvic infection endometrial hyperplasia/carcinoma PCOS
causes of heavy menstrual bleeding: systemic diseases and disorders
coagulation disorders e.g. vW factor disease
hypothyroidism
liver or renal disease
causes of heavy menstrual bleeding: iatrogenic causes
anticoag Rx
herbal supplements e.g. ginseng
IUD
fibroids
non-cancerous growths made of muscle and fibrous tissue
can cause HMB, pelvic pain, urinary + pressure symptoms, infertility, backache, misscarriage
management of small fibroids
COCP
POP
mirena
management of large fibroids
fibroid embolisation and myomectomy
management of submucosal fibroids
hysteroscopic fibroid resection
failed medical treatment of fibroids and fertility preservation not reqiured
hysterectomy
endometriosis
endometrial tissue present outside the lining of the uterus
during menstruation, this ectopic tissue behaves the same as endometrium and bleeds
endometriosis presentation
HMB pelvic main multi-system involvement affecting QOL infertiilty lower back pain diarrhoea, nausea, painful bowel movements pain during and after sex
diagnosis of endometriosis
pelvic examintion
USS
diagnostic laparoscopy
medical management of endometriosis
suppress ovulation and ovaries to prevent endometrial shedding
COCP POP mirena IUD depor provera GnRH analogues
surgical management of endometriosis
ablation
hysterectomy endometrioma excision
pelvic clearance
hysterectomy
anednomyosis
condition where endometrium becomes embedded in myometrium
HMB and dysmenorrhoea
endometrial polyps
overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium
HMB
irregular menstrual bleeding e.g. post-coital
diagnosis and management of endometrial polyps
USS or hysteroscopy
polypectomy
investigation of HMB
through history pelvic exam - speculum and bimanual clotting profile, thyroid function pelvic USS laparoscopy if endometriosis suspected
management options for HMB depend on
impact on QOL
underlying pathology
desire for further fertility
woman’s preferences
HMB treatments: hormonal
mirena IUS
COCP
POP
depot provera
HMB treatments: non-hormonal
mefenamic acid tranexamic acid GnRH analogues endometrial ablation fibroid embolisation hysterectomy
oligo-/ameno-rrheoa
infrequent, absent or abnormally light menstruation
causes of amenorrhoea
life change, stress, ED/malnourishment, obesity, intense exercise hormones: POP, mirena primary ovarian insufficiency PCOS hyperprolactinaemia prolactinomas thyroid disorders (Grave's) obstructions of uterus, cervix and/or vagina
polycystic ovarian syndrome
metabolic syndrome with diagnosis confirmed if 2/3 criteria met:
- ultrasound appearance ovary
- bichemical hyperandrogenism
- clinical hyerpandrogenism, with oligomenorrhoea, hirautusms, acne, infertility+ obesity
management of PCOS
lifestyle adjustment with aim to acheive normal BMI
symptom based Rx
PCOS: how many withdrawal bleeds are required to prevent hyperplasia or endometrial protection and how are they achieved
at least 3
either COCP, POP, mirena IUD or norethistreone
dysfunctional uterine bleeding
common disorder of excessive uterine bleeding afffecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases
underlying pathophysiology believed to be due to ovarian hormonal dysfunction
Rx options for dysfunctional uterine bleeding
conservative, medical, surgical Rx based on severity of symptoms and patient’s wishes
GnRh analogues?
menstrual parameters: frequency
frequent <24 days
normal 24-30 days
infrequent >38 days
menstrual parameters: regularity
absent/amenorrhoea - no bleeding
regular <20days variation in 12mo
irregular >20 days variation in 12mo
menstrual parameters: duration
prolonged >7days
normal 2-7days
shortened <2 days
menstrual parameters: volume
heavy >80ml
normal 5-80ml
light <5ml
