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Y4 Obs & Gynae > Menstrual disorders and HMB > Flashcards

Menstrual disorders and HMB Flashcards

1
Q

What is the length of a normal cycle?

A

24-32 days

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2
Q

What is the average menstrual blood loss?

A

37-43ml/cycle

Mostly in first 48h

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3
Q

Factors affecting MBL

A
  1. Age - heavier post 4th decade of life
  2. Genetics - correlation in twins
  3. Parity - positive correlation
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4
Q

What is the difference between menorrhagia vs. metrorrhagia?

A

Menorrhagia - heavy regular periods

Metrorrhagia - heavy irregular bleeding

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5
Q

Oligomenorrhoea

A

Infrequent bleeding

Cycle > 35 days but less than 6 months

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6
Q

What is DUB?

A

Dysfunction uterine bleeding

HMB with no recognisable pelvic pathology, pregnancy or general bleeding disorders.

Also known as primary menorrhagia.

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7
Q

What is primary amenorrhoea?

A

No menarche by age 16

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8
Q

What is secondary amenorrhoea?

A

Absent periods for at least 3 months if cycles previously regular

Absent periods for at least 6 months if previously had oligomenorrhoea

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9
Q

Causes of oligomenorrhoea?

A

‘Constitutional’

Anovulation:
PCOS
Thyroid disease
Prolactinoma
CAH

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10
Q

Causes of primary amenorrhoea?

A

Delayed puberty
Imperforate hymen/ transverse septum
Absent vagina
Mullerian agenesis
Gonadal dysgenesis (Turner’s)
PCOS (less common in primary)
CAH

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11
Q

Causes of secondary amenorrhoea?

A

Pregnancy
PCOS
Premature menopause
Prolactinoma
Thyroid disease
Cushing’s
Eating disorder
Exercise induced
Asherman’s syndrome
Sheehan’s syndrome

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12
Q

Investigations for primary amenorrhoea?

A
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13
Q

Investigations for secondary amenorrhoea?

A
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14
Q

Physiological causes of amenorrhoea?

A

Prepubertal
Pregnancy
Menopause

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15
Q

Causes of HMB?

A

Pathology:
Fibroids
Adenomyosis/ endometriosis
IUCD
PID
Polyps

Medical disorders:
Hypothyroidism
Liver disease

Abnormal clotting:
Von Willebrand’s
Thrombocytopenia
Platelet disorders
Coagulation disorders
Leukaemia

Other:
Cancer/ hyperplasia

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16
Q

How does IUCD cause HMB?

A

IUCD causes inflammation in the endometrium due to copper toxicity.

16
Q
A
17
Q

How to quantify HMB?

A

Measure impact on QoL (plus things like anaemia)

Impact on work/social life
Bleeding through clothes/bedding
Disrupted sleep due to heavy bleeding
How many tampons/pads used per day

18
Q

Who is low risk/ high risk with HMB?

A
19
Q

Medical treatments of HMB:

A

Symptomatic - tranexamic acid (plus Mefenamic acid - NSAID)

Fibroids - GnRH analogues, Esmya (ulipristal acetate)

Hormonal control (Progesterone only):
POP
LARC - Mirena, Implant, Depo-Provera

Hormonal control (combined):
COCP

20
Q

What is tranexamic acid?

A

Antifibrinolytic drug (pro-coagulant)

Inhibit plasminogen activation (inhibit tPA, and uPA) - thus reduce fibrinolysis.

Only taken on the days of the heavy period.

SE: Nausea, dizziness, tinnitus, rash, abdo cramps

21
Q

What is Mefenamic acid?

A

NSAID

Inhibits PG production, and inhibits the binding of PGE2 to its receptor.

SE: GI (usually mild), dizziness, headaches, deranged liver function, asthma, renal disease

22
Q

Surgical treatments of HMB:

A

Polyps - Myosure (Hysteroscopic removal of polyps)

Fibroids -
Myomectomy for fibroids
Uterine artery embolisation

Family complete (conservative surgery) -
Novasure (endometrial ablation)

Family complete (definitive surgery) -
Hysterectomy

23
Q

Short term emergency control of HMB:

A

Tranexamic acid

Norethisterone - 5mg po tds for up to 7 days. Can be used in a 3 weeks on, 1 week off pattern for 3/4 months.

GnRH analogues - Monthly injection to downregulate cycle and induce temporary ‘medical menopause’. Often used to stop very heavy periods in the presence of fibroids, to allow for correction of anaemia and iron stores in preparation for another intervention

24
Q

What is PCOS?

A

Heterogenous endocrine disorder with unknown aetiology.

Causes metabolic and reproductive problems in women.

Triad:
Anovulation
Hyperandrogenism
Polycystic ovaries on ultrasound.

25
Q

Characteristics of hyperandrogegism?

A

Acne
Hirsutism
Obesity

26
Q

Presentation of anovulation?

A

Oligo/amenorrhoea
Multiple ovarian follicules on ultrasound (must be 12 or more in either one or both ovaries) ‘string of pearls’
Increased ovarian volume > 10cm^3

27
Q

How do you diagnose PCOS?

A

Rotterdam criteria - at least 2/3 must be present:

1.Clinical/biochemical signs of hyperandrogenism

  1. Oligo/amenorrhoea
  2. Polycystic ovaries on ultrasound
28
Q

Differential diagnosis for PCOS?

A

Simple obesity
Premature ovarian failure
Thyroid disease
Hyperprolactinaemia
CAH
Androgen secreting tumours
Cushing’s syndrome

29
Q

Investigations for PCOS?

A

Sex hormone binding globulin (SHBG)
Total testosterone
Free androgen index (FAI)
FSH,LH
TFT
Prolactin

30
Q

PCOS management

A

Weight loss is primary prevention
Low glycemic index, calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications where required
Statins where indicated (QRISK >10%)

Specific treatment is dependent on patient and their wants/needs:
If they want regular periods
If they want to conceive
If they want treatment for acne and/or hirsutism

31
Q

Management for PCOS patients who want regular periods?

A

COCP
Cyclical progestogens

32
Q

Management for PCOS patients who want to conceive?

A

Reduce BMI <30
Start folic acid
Baseline fertility assessment, incl semen analysis on partner
Refer to fertility services
May require ovulation induction
Metformin (controversial)

33
Q

Management for PCOS patients who want treatment for acne/hirsutism?

A

COCP
Acne treatment - retinoids, abx etc
Hair removal methods - waxing, laser treatment

34
Q

Long term complications of PCOS?

A

Metabolic disorders e.g. impaired glucose tolerance and T2DM
CVD
Obstructive sleep apnoea
Infertility
Recurrent miscarriages
Pregnancy complications e.g. pre-eclampsia, gestational diabetes
Endometrial cancer
Psychological disorders e.g. anxiety and depression

Y4 Obs & Gynae (2 decks)

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