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Reproductive System > Menstrual Disorders, Menopause and Secondary Amenorrhea > Flashcards

Menstrual Disorders, Menopause and Secondary Amenorrhea Flashcards

1
Q

what is the normal amount of menstrual loss over the duration of menstruation?

A

less than 80ml over 7 days

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2
Q

what are the four aspects of menstruation which can lead to a menstrual disorder?

A
  • abnormal frequency
  • abnormal duration
  • irregularity
  • abnormal volume
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3
Q

what does amenorrhea mean?

A

absent periods

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4
Q

what does dysmenorrhea mean?

A

painful periods

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5
Q

what does menorrhagia mean?

A

Heavy periods

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6
Q

what volume of menstrual loss is classified as menorrhagia?

A

> 80ml in 7 days

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7
Q

name a few causes of heavy periods related to abnormalities in the uterus/ovaries

A
  • polyps
  • endometriosis
  • malignancy
  • fibroids
  • infection (PID/STI)
  • polycystic ovaries
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8
Q

name a few causes of heavy periods related to systemic problems

A
  • bleeding disorders
  • liver or renal disease
  • hypothyroidism
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9
Q

name a few iatrogenic causes of heavy periods

A
  • anticoagulation drugs

- copper IUD

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10
Q

what is another term for fibroids?

A

leiomyoma

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11
Q

what is the treatment for fibroids?

A
  • symptom management (COCP or coil for HMB)
  • resection
  • hysterectomy
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12
Q

how does endometriosis present?

A 
heavy menstrual bleeding
severe pelvic pain
anaemia/fatigue
dyspaerunia (pain during sex)
nausea
intermenstrual bleeding
painful urination/bowel movement
lower back pain
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13
Q

how can endometriosis be diagnosed?

A

pelvic examination
transvaginal ultrasound
diagnostic laparoscopy

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14
Q

what is an important complication of endometriosis in women of reproductive age?

A

infertility

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15
Q

what is the medical management of endometriosis?

A
  • pain relief
  • COCP
  • intrauterine device
  • progesterone-only methods
  • gonadotropin releasing hormone agonists
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16
Q

what is the surgical management of endometriosis?

A
  • ablation
  • excision (if endometrioma)
  • hysterectomy
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17
Q

what is adenomyosis?

A

it’s embedding of the endometrium into the myometrium

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18
Q

what is endometriosis?

A

it’s presence of endometrial tissue in abnormal areas outwith the uterus

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19
Q

what is the management of adenomyosis?

A

hysterectomy

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20
Q

what is the management of endometrial polyps?

A

resection (polypectomy)

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21
Q

when is an endometrial biopsy taken for heavy period bleeding?

A

if patient older than 44 and not responded to medical treatment

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22
Q

what investigations can be done to diagnose a cause for heavy mentrual bleeding?

A
  • history and examination
  • bloods - thyroid function and clotting profile
  • liver and kidney tests
  • pelvic ultrasound scan
  • laparoscopy if endometriosis suspected
  • hysteroscopy for polyps
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23
Q

what are the hormonal treatment options for heavy menstrual bleeding?

A
  • combined oral contraceptive pill
  • progesterone-only pill
  • progestogen injection
  • Mirena IUS
24
Q

what are the surgical treatment options for heavy menstrual bleeding?

A
  • ablation
  • resection
  • hysterectomy
25
Q

what management for heavy menstrual bleeding is given to women trying to conceive?

A

mefenamic acid

tranexamic acid

26
Q

define subtotal vs total hysterectomy

A

subtotal: cervix not removed
total: cervix removed too

27
Q

what is salpingo-oophorectomy?

A

removal of fallopian tubes and ovaries

28
Q

what is an immediate result of an oophorectomy?

A

menopause

29
Q

name a few causes of amenorrhea

A
  • stress
  • malnutrition
  • intense exercise
  • obesity
  • primary ovarian insuffiency
  • polycystic ovarian syndrome
  • abnormal prolactin levels
  • hormonal treatment
  • hyperthyroidism
  • obstruction
30
Q

what causes polycystic ovaries syndrome?

A

excess of androgens

31
Q

how is polycystic ovaries syndrome managed?

A
  • management of symptoms

- advice on lifestyle (eg BMI, diet)

32
Q

two of which three criteria are necessary to diagnose polycystic ovarian syndrome?

A
  • polycystic ovaries (ultrasound)
  • infrequent periods (no ovulation)
  • hyperandrogenism (clinical and biochemical)
33
Q

which acronym can be used to identify causes of heavy menstrual bleeding?

A

PALM COEIN

34
Q

what happens to the levels of oestrogen and FSH in menopause?

A

oestrogen levels drop

FSH levels rise

35
Q

what lab test is carried out to confirm menopause?

A

FSH levels

36
Q

what is the first line treatment of symptoms caused by menopause?

A

hormone replacement therapy

37
Q

what are the systemic options for hormone replacement therapy, and what do they depend on?

A

depends on whether woman still has uterus:

  • uterus = oestrogen + progesterone
  • no uterus = oestrogen only
38
Q

what are the local options for hormone replacement therapy?

A

vaginal oestrogen

39
Q

when is HRT contraindicated?

A
  • if woman has hormone-dependent cancer
  • if woman has liver disease
  • if woman has unexplained bleeding
  • if woman has Hx of VTE/thrombophilia/breast ca
40
Q

if a woman is perimenopausal, what does that mean and what HRT option is offered to her?

A

perimenopausal = still some ovarian function

she will be offered cyclical combined HRT instead of continuous combined HRT

41
Q

name a complication of menopause which can affect bones

A

osteoporosis

42
Q

name a few symptoms experienced during menopause

A 
hot flushes
dyspareunia
vaginal dryness
night sweats
bloating
mood swings
low libido
muscle/joint pain
43
Q

name a few alternative treatments for menopausal symptoms if HRT is contraindicated

A
  • selective estrogen receptor modulators (SERM)
  • SSRI/SNRI
  • natural remedies
  • non-hormonal vaginal lubricants
44
Q

what tool is used to assess for the risk of osteoporosis in menopausal women?

A

FRAX score

45
Q

if a woman presents with premature menopause without previous hysterectomy, what HRT treatment will she be offered and what age will she be advised to take it until?

A

woman still has a uterus = combined HRT

HRT until age 50

46
Q

name a few risks involved in taking HRT

A
  • increased risk of breast/ovarian ca

- increased risk of VTE/CVA

47
Q

name a few benefits involved in taking HRT

A
  • reduces hot flushes
  • reduces night sweats
  • relieves vaginal dryness
  • reduces risk of osteoporosis
48
Q

what is the main purpose of giving oestrogen as a hormone replacement therapy?

A

symptom relief

49
Q

what is primary amenorrhea?

A

never having had a period before

50
Q

name a few causes of secondary amenorrhea

A
  • pregnancy
  • contraception (IUS, depo-provera)
  • PCOS
  • stress/BMI/strenuous exercise/malnutrition
  • premature menopause
  • increased prolactin
  • primary ovarian insufficiency
  • thyroid disease
51
Q

name a few investigations done to identify the cause of amenorrhea

A
  • abdominal/bimanual examination
  • BMI
  • TSH, estrogen, testosterone, FSH/LH, prolactin
  • urine dipstick
  • pelvic ultrasound
52
Q

two of which three criteria are needed to make a diagnosis of PCOS?

A
  • polycystic ovaries on ultrasound
  • anovulation
  • hyperandrogenism (clinical and biochemical)
53
Q

how is PCOS managed?

A
  • lifestyle advice (eg BMI)
  • antiandrogen drugs (combined contraception, spironolactone)
  • endometrium protection (combined hormonal contraception)
  • clomifene/metformin
54
Q

which diabetic medication has been shown to help with ovulation in women with PCOS?

A

metformin

55
Q

what are women with PCOS at risk of if they have very infrequent periods?

A

endometrial hyperplasia

Reproductive System (7 decks)

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