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Women's health > Menstrual disorders and gynaecological cancers > Flashcards

Menstrual disorders and gynaecological cancers Flashcards

1
Q

What are the menstrual disorders?

A
  • Dsymenorrhea
  • Amenorrhea
  • Abnormal uterine bleeding
  • Menopause and Climacteric
  • Premenstrual syndrome
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2
Q

What is dysmenorrhea?

A
  • Painful menstruation

- Common in women who haven’t give birth and in women who are not having intercourse

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3
Q

What are the types of dysmenorrhea?

A
  1. Primary : no pelvic pathology

2. Secondary : due to endometriosis, PID, fibroid tumours, ovarian cancer

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4
Q

What are the manifestations?

A
  • Subjective: headache, backache, abdominal pain, chills, nausea
  • Objective: fever, vomiting
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5
Q

What is the treatment for primary dysmenorrhea?

A
  • Analgesics, such as NSAIDs
  • Oral contraceptives
  • Local heat application
  • Psychotherapy
  • Hypnotherapy

Patient Education:

  • Avoidance of fatigue and overexertion
  • Ingest oral analgesia as prescribed
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6
Q

What is endometriosis?

A

• Increased risk in nulliparous > 30-40 years of age
• Benign disease but tends to infiltrate and spread to
adjacent tissues
• Presence of endometrial tissues outside the lining of
uterine cavity

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7
Q

What are the common presenting complaints for endometriosis?

A

Dysmenorrhea and infertility

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8
Q

What is endometriosis-associated infertility?

A

related to

scar formation & anatomical distortions

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9
Q

What is large endometriotic cysts?

A

‘chocolate’ cysts
(ovaries) can cause acute abdomen requiring
emergency surgery, peritoneal lavage &
cystectomy

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10
Q

What are the subjective manifestations for endometriosis?

A

• Dysmenorrhea – discomfort or pain before menses, worse during
menstrual flow and diminishing as flow ceases
• Dyspareunia – if vagina and supporting ligaments affected by adhesions
• Fatigue

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11
Q

What are the objective manifestations for endometriosis?

A

• Infertility – results from adhesions pulling uterus out of normal position and
blockage of Fallopian tubes
• ‘Chocolate cysts – develops on ovary – fibrous sac containing thick
viscid brown-coloured altered blood

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12
Q

What is the physical examination for endometriosis?

A
  • vaginal and rectal examination -> may reveal thickened and tender
    utero-sacral ligaments
  • abdominal examination -> pelvic abdominal masses palpable (large
    endometriotic cysts)
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13
Q

What are the diagnostic tests for endometriosis?

A

Investigation – pelvic sonography, laparoscopy

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14
Q

What is the medical treatment for endometriosis?

A

Pain management for primary and secondary dysmenorrhea
– Hormonal suppression of endometrial tissues using oral contraceptives or progesterone to induce pseudo-pregnancy (amenorrhea)

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15
Q

What is the surgical treatment for endometriosis?

A
  • Surgical ablation and excision of endometriosis (laparoscopic/ open)
  • For cysts > 5cm in diameter (unlikely to
    respond to conservative therapy
  • Hysterectomy to prevent recurrence
  • Pelvic clearance for frozen pelvis associated with intractable chronic pelvic pain
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16
Q

What is amenorrhea?

A

It is the absence of menstruation

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17
Q

What is primary amenorrhea?

A

absence of menstruation by age of 16 years due to anatomical/
genetic abnormalities or hormonal imbalances.

18
Q

What is secondary amenorrhea?

A

absence of menstruation for at least 6 months.

19
Q

What are the types of secondary amenorrhea?

A
  • anatomic abnormalities/hormonal imbalances
  • nutritional deficits (anorexia nervosa)
  • excessive exercise/emotional disturbances
  • endocrine dysfunction (Secondary amenorrhea: pregnancy,
    lactation, menopause)
20
Q

What is abnormal uterine bleeding?

A

bleeding from the uterus that is longer than usual or that occurs at an irregular time

21
Q

What are the types of abnormal uterine bleeding?

A
  1. Menorrhagia ( menstrual bleeding that lasts more than 7 days )
  2. Metrorrhagia ( Bleeding from the uterus between menstrual periods )
  3. Oligomenorrhoea ( medical term for infrequent menstrual periods )
  4. Postmenopausal
    bleeding.
22
Q

What are the diagnostic tests for abnormal uterine bleeding?

A
  1. Blood tests: CBC, Pituitary and Adrenal function test, Thyroid function studies,
  2. Pap smear, Pelvic ultrasound, Hysteroscopy, Endometrial biopsy
23
Q

What is the treatment for abnormal uterine bleeding?

A
  1. Medications: Anovulatory/ Ovulatory Abnormal Uterine Bleeding
  2. Surgery: Therapeutic D & C, Endometrial ablation (Laser surgery), Hysterectomy
24
Q

What is the climacteric ( peri-menopausal period )?

A

reproductive function gradually ceases

-Lasts for several years, from oestrogen decline- 1y after the last menstrual
period.
- Hormone changes: oestrogen and progesterone decrease- FSH, LH
increase

25
Q

What is menopause?

A

permanent cessation of menses.

26
Q

What is the manifestation of climacteric & menopause ?

A

most common vasomotor symptoms -> night sweats and hot flashes

27
Q

What is the treatment for climacteric & menopause ?

A

Hormone Replacement Therapy (HRT), selective oestrogen receptor
Climacteric & Menopause
modulators (e.g. Raloxifene) for those who cannot take HRT.

28
Q

What is the Premenstrual Syndrome ( PMS ) ?

A

Cyclical symptoms leading up to menstruation and completely relieved by
the end of menstruation

29
Q

What is mild PMS?

A

No interference with personal/ social and professional life

30
Q

What is moderate PMS?

A

Sup-optimal performance in personal/ social/ professional life

31
Q

What is severe PMS?

A

Withdrawal from performance in personal/ social/ professional life

32
Q

What is epidomiology of PMS?

A 
- Affects 50%-75% of
women with regular
menstrual cycles
- Significant PMS
affects up to 50% of
women
33
Q

What is the premenstrual dsyphoric ( PMDD )?

A 
Severe form of PMS in which symptoms of
anger, irritability and internal tension are
prominent
Affects 5% of women in
this group
34
Q

What are the clinical features of PMS?

A

• Symptoms – start after ovulation, worsens as menstruation approaches &
resolves within first few days of bleeding until at least day 12 of cycle
• Physical – breast swelling & discomfort, abdominal bloating, oedema,
weight gain, headaches, extreme fatigue, deterioration in asthma,
migraine or epilepsy
• Emotional & behavioural – aggression, anger, irritablity, tearfulness, low
mood, anxiety, altered eating habits, disturbed sleep, relationship
difficulties, occupational problems

35
Q

What is the diagnosis of PMS?

A

• Prospective recording of symptoms at least over 2 cycles – using a
symptom diary
• Symptom free interval from day 4 to 12 of the idealized 28 day menstrual
cycle
• If symptoms persist throughout menstrual cycle, an alternative diagnosis is
likely e.g. mood or anxiety disorder

36
Q

What is the assessment of PMS?

A

• History:
 focus on regularity of menstrual cycles
 prospective symptoms inventories e.g.
Calendar of premenstrual experiences ( COPE )

  • Physical examination
  • Blood Tests: not necessary
37
Q

What is the first line of treatment for PMS?

A

Exercise, diet, stress reduction

Cognitive behavioural therapy, vitamin B6 dose (110mg om)
Combined new generation pill
Continuous or luteal phase (day 15-28) lose dose SSRI

38
Q

What is the second line of treatment for PMS?

A 
Oestradiol patches (100mcg) with progestogens day 17-28
Higher dose SSRI continuously or in luteal phase
39
Q

What is the third line of treatment for PMS?

A

GnRH analogues with addback HRT (continuous combined

oestrogen and progesterone of tibolone)(if used for > than 6 months)

40
Q

What is the fourth line of treatment for PMS?

A

Hysterectomy and bilateral oophorectomy with addback HRT

including testosterone

Women's health (9 decks)

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