Menstrual disorders and gynaecological cancers Flashcards
What are the menstrual disorders?
- Dsymenorrhea
- Amenorrhea
- Abnormal uterine bleeding
- Menopause and Climacteric
- Premenstrual syndrome
What is dysmenorrhea?
- Painful menstruation
- Common in women who haven’t give birth and in women who are not having intercourse
What are the types of dysmenorrhea?
- Primary : no pelvic pathology
2. Secondary : due to endometriosis, PID, fibroid tumours, ovarian cancer
What are the manifestations?
- Subjective: headache, backache, abdominal pain, chills, nausea
- Objective: fever, vomiting
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
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
What are the common presenting complaints for endometriosis?
Dysmenorrhea and infertility
What is endometriosis-associated infertility?
related to
scar formation & anatomical distortions
What is large endometriotic cysts?
‘chocolate’ cysts
(ovaries) can cause acute abdomen requiring
emergency surgery, peritoneal lavage &
cystectomy
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
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
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)
What are the diagnostic tests for endometriosis?
Investigation – pelvic sonography, laparoscopy
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)
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
What is amenorrhea?
It is the absence of menstruation
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
