Menstrual disorders and gynaecological cancers Flashcards by sandy ang

What are the menstrual disorders?

Dsymenorrhea
Amenorrhea
Abnormal uterine bleeding
Menopause and Climacteric
Premenstrual syndrome

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What is dysmenorrhea?

Painful menstruation

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

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What are the types of dysmenorrhea?

Primary : no pelvic pathology

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

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What are the manifestations?

Subjective: headache, backache, abdominal pain, chills, nausea
Objective: fever, vomiting

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What is the treatment for primary dysmenorrhea?

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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What is endometriosis?

• 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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What are the common presenting complaints for endometriosis?

Dysmenorrhea and infertility

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What is endometriosis-associated infertility?

related to

scar formation & anatomical distortions

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What is large endometriotic cysts?

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

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What are the subjective manifestations for endometriosis?

• 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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What are the objective manifestations for endometriosis?

• 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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What is the physical examination for endometriosis?

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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What are the diagnostic tests for endometriosis?

Investigation – pelvic sonography, laparoscopy

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What is the medical treatment for endometriosis?

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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What is the surgical treatment for endometriosis?

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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What is amenorrhea?

It is the absence of menstruation

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What is primary amenorrhea?

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

What is secondary amenorrhea?

absence of menstruation for at least 6 months.

What are the types of secondary amenorrhea?

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

What is abnormal uterine bleeding?

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

What are the types of abnormal uterine bleeding?

Menorrhagia ( menstrual bleeding that lasts more than 7 days )
Metrorrhagia ( Bleeding from the uterus between menstrual periods )
Oligomenorrhoea ( medical term for infrequent menstrual periods )
Postmenopausal
bleeding.

What are the diagnostic tests for abnormal uterine bleeding?

Blood tests: CBC, Pituitary and Adrenal function test, Thyroid function studies,
Pap smear, Pelvic ultrasound, Hysteroscopy, Endometrial biopsy

What is the treatment for abnormal uterine bleeding?

Medications: Anovulatory/ Ovulatory Abnormal Uterine Bleeding
Surgery: Therapeutic D & C, Endometrial ablation (Laser surgery), Hysterectomy

What is the climacteric ( peri-menopausal period )?

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

What is menopause?

permanent cessation of menses.

What is the manifestation of climacteric & menopause ?

most common vasomotor symptoms -> night sweats and hot flashes

What is the treatment for climacteric & menopause ?

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

What is the Premenstrual Syndrome ( PMS ) ?

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

What is mild PMS?

No interference with personal/ social and professional life

What is moderate PMS?

Sup-optimal performance in personal/ social/ professional life

What is severe PMS?

Withdrawal from performance in personal/ social/ professional life

What is epidomiology of PMS?

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

What is the premenstrual dsyphoric ( PMDD )?

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

What are the clinical features of PMS?

• 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

What is the diagnosis of PMS?

• 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

What is the assessment of PMS?

• History:  focus on regularity of menstrual cycles  prospective symptoms inventories e.g. Calendar of premenstrual experiences ( COPE ) * Physical examination * Blood Tests: not necessary

What is the first line of treatment for PMS?

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

What is the second line of treatment for PMS?

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

What is the third line of treatment for PMS?

GnRH analogues with addback HRT (continuous combined oestrogen and progesterone of tibolone)(if used for > than 6 months)

What is the fourth line of treatment for PMS?

Hysterectomy and bilateral oophorectomy with addback HRT | including testosterone