Menstrual Disorders - Amenorrhea, Dysmenorrhea, PCOS, Endometriosis, PID, Fibroids Flashcards

1
Q

Folliculogenesis
-before birth
-puberty
-fertilization
Arrest points

A

Before birth - primordial follicle pool
-primary oocytes arrest at P1

Puberty
-primary oocytes atrese or mature into antral cells
-antral cells complete meiosis 1 => secondary oocyte + 1 polar body
-secondary oocyte arrest at M2

After ovulation
-secondary oocyte fertilised
-meiosis 2 complete + 2nd polar body

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2
Q

Follicular phase and ovulation
-days
-what happens

Menstrual and proliferative phase
-days
-what happens

A

Follicular phase - 1-10
-FSH and LH stimulate follicle development => O released from follicles

Ovulation - 11-14
-O increase => LH surge triggers ovulation
-basal body temp falls
-O, P, LH receptors increase

Menstrual phase - 1-5
Proliferative - 6-14
-endometrium builds up
-thick mucus plugs cervix
-before ovulation, wet mucus

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3
Q

Luteal phase
-days
-what happens

Secretory phase
-days
-what happens

A

Luteal - 15-28
-corpus hemorhagicum => CL releases P
-no implantation => corpus albicans => fall in P

Secretory - 15-28
- increased P => endometrial glands, spiral arteries build up
- secrete mucus, glycogen
- cervical mucus thickens
- basal body temp increases

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4
Q

Oestrogen function

A

Endometrial proliferation
Follicle growth
LH surge
Upregulates O, PO, LH receptors
Increases TBG levels

Genitalia development
Female fat distribution
Increases hepatic synthesis of transport proteins

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5
Q

Progesterone function

A

Maintain endometrium, pregnancy
Thicken cervical mucous
Decrease myometrial excitiability
Increases body temp
Spiral artery dev

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6
Q

Causes of primary amenorrhea
-definition

A

No period by
-13 + without 2ndary sexual characteristics
-15 + 2ndary sexual characteristics

Gonadal dysgenesis - Turners
Functional hypothalamic
CAH
Imperforate hymen

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7
Q

Causes of secondary amenorrhea
-definition

A

Past normal, regular - no period for 3-6months
Past oligomenorrhea - no period for 6-12months

Hypothalamic amenorrhea
PCOS
High PRL
POI
Thyrotoxicosis
Sheehan’s - postpartum bloodloss affecting pituitary function
Asherman’s - build up of scar tissue in uterus

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8
Q

Amenorrhea
-investigations
-management

A

Exclude pregnancy - urinary/serum bHCG

FBC, U&E, coeliac screen, TFT
FSH, LH
-high if ovarian problem
-low if hypothalamic problem
PRL
Androgens
-high in PCOS
O

For primary and secondary
-find underlying cause

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9
Q

PCOS
-pathophysiology
-presentation
-investigations
-management

A

High LH => high T
Hyperinsulinemia

Triad of
Reproductive disfunction
-sub/infertility
-oligo/amenorrhea
Hyperandrogenism
-hirsutism, acne
Metabolic syndrome
-obesity
-acanthosis nigricans

High LH:FSH ratio
PRL, T normal or high
SGBH low
Impaired glucose tolerance
Pelvic US - cysts

2 of the following 3 needed to make diagnosis
-oligo/amenirrhea
-clinical/biochemical signs of hyperandrogenism
-Polycystic ovaries found on US (12+ follicles in 1 or both ovaries, or increased ovarian volume

Hyperandrogenism
-COCP (co-cyprindol) can also regulate cycle
COCP increases VTE risk

Infertility
-weight reduction
-consider metformin, clomifene

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10
Q

Androgen insensitivity syndrome
-pathophysiology
-presentation

A

End organ resistance to testosterone => 46XY with female phenotype

Primary amenorrhea
Little/no axillary or pubic hair
Undescended testes => groin swellings
Breast development possible

Chromosomal analysis => 46XY
High T

Counselling - raise child as female
Bilateral orchidectomy
Oestrogen therapy

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11
Q

Endometriosis
-pathophysiology
-presentation
-investigations
-management

A

Growth of endometrial-like tissue outside uterine cavity

Pain
-chronic pelvic
-period
-dyspareunia
-dysuria, dyschezia
Subfertility
Hematuria, urgency

Definitive - laparoscopy

Pain relief
1st line - NSAIDS/paracetamol
2nd line - COCP/progesterone
3rd line - refer to specialist
-GnRH analogues
-laparoscopic excision of endo/adhesiolysis to improve conception likelihood

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12
Q

Dysmenorrhoea
-primary presentation and management
-secondary presentation and possible causes

A

Primary - no underlying pelvic pathology
-thought to be related to excess endometrial prostaglandin release

Pain just before/within hours of period starting
Suprapubic cramping => back, thigh

1st line - NSAIDS (mefenamic acid, ibuprofen)
2nd line - COCP

Secondary - many years after menarche
-3-4days before period
=> REFER TO GYNAE

Endo
Adenomyosis
PID
IUDs - copper (IUS Mirena can help)
Fibroids

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13
Q

PID
-pathophysiology
-causative organisms
-presentation
-investigations
-complications

A

Upper pelvic organ infection

Most common - chlamydia trachomatis
NGonorrhea

Lower abdo pain
Fever
Deep dyspareunia
Dysuria menstrual irregularities
Discharge
Cervical excitation

Pregnancy test => exclude ectopic
High vaginal swab
Chlamydia and Gonorrhea screen

1st line - PO ofloxacin + metronidazole OR
IM ceftriaxone + PO doxy and metronidazole

FItz-Hugh-Curtis Syndrome - adhesions between liver and peritoneum
-RUQ pain, cholecystitis-like
Infertility
Chronic pelvic pain
Ectopics

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14
Q

Fibroids
-pathophysiology
-presentation
-investigations
-management

A

Benign smooth muscle tumour in uterus
-develop in response to estrogen

Asymptomatic
Heavy periods
Bulk symptoms
-lower abdo pain, crampy with period
-bloating
-urinary symptoms
Subfertility

TVUS

Asymptomatic - periodic monitoring
Menorrhagia - contraception
LNG-IUS/COCP/PO P/injectable P

Reduce size
Medically - GnRH
Surgically - myomectomy/hysterectomy

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15
Q

Fibroid degeneration
-pathophysiology
-presentation
-management

A

Sensitive to O => grow during pregnancy
Growth outstrips blood supply => fibroid ischemia

Acute pain - local, tender, palpable
Fever

Conservative - self limiting in 1wk
-paracetamol for pain
-AVOID NSAIDS

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16
Q

PMS
-presentation

A

Symptoms in luteal phase of normal menstrual cycle
-anxiety, stress
-mood swings
-fatigue
-bloating
-breast pain

Mild - lifestyle advice
-sleep hygiene, exercise, reduce smoking and alcohol intake
-regular frequent small balanced meals rich in complex carbohydrates

Moderate - COCP

Severe - SSRI
-taken continuously or just during luteal phase