Menstrual Disorders, Menopause and Secondary Amenorrhea Flashcards
what is the normal amount of menstrual loss over the duration of menstruation?
less than 80ml over 7 days
what are the four aspects of menstruation which can lead to a menstrual disorder?
- abnormal frequency
- abnormal duration
- irregularity
- abnormal volume
what does amenorrhea mean?
absent periods
what does dysmenorrhea mean?
painful periods
what does menorrhagia mean?
Heavy periods
what volume of menstrual loss is classified as menorrhagia?
> 80ml in 7 days
name a few causes of heavy periods related to abnormalities in the uterus/ovaries
- polyps
- endometriosis
- malignancy
- fibroids
- infection (PID/STI)
- polycystic ovaries
name a few causes of heavy periods related to systemic problems
- bleeding disorders
- liver or renal disease
- hypothyroidism
name a few iatrogenic causes of heavy periods
- anticoagulation drugs
- copper IUD
what is another term for fibroids?
leiomyoma
what is the treatment for fibroids?
- symptom management (COCP or coil for HMB)
- resection
- hysterectomy
how does endometriosis present?
heavy menstrual bleeding severe pelvic pain anaemia/fatigue dyspaerunia (pain during sex) nausea intermenstrual bleeding painful urination/bowel movement lower back pain
how can endometriosis be diagnosed?
pelvic examination
transvaginal ultrasound
diagnostic laparoscopy
what is an important complication of endometriosis in women of reproductive age?
infertility
what is the medical management of endometriosis?
- pain relief
- COCP
- intrauterine device
- progesterone-only methods
- gonadotropin releasing hormone agonists
what is the surgical management of endometriosis?
- ablation
- excision (if endometrioma)
- hysterectomy
what is adenomyosis?
it’s embedding of the endometrium into the myometrium
what is endometriosis?
it’s presence of endometrial tissue in abnormal areas outwith the uterus
what is the management of adenomyosis?
hysterectomy
what is the management of endometrial polyps?
resection (polypectomy)
when is an endometrial biopsy taken for heavy period bleeding?
if patient older than 44 and not responded to medical treatment
what investigations can be done to diagnose a cause for heavy mentrual bleeding?
- history and examination
- bloods - thyroid function and clotting profile
- liver and kidney tests
- pelvic ultrasound scan
- laparoscopy if endometriosis suspected
- hysteroscopy for polyps
what are the hormonal treatment options for heavy menstrual bleeding?
- combined oral contraceptive pill
- progesterone-only pill
- progestogen injection
- Mirena IUS
what are the surgical treatment options for heavy menstrual bleeding?
- ablation
- resection
- hysterectomy
what management for heavy menstrual bleeding is given to women trying to conceive?
mefenamic acid
tranexamic acid
define subtotal vs total hysterectomy
subtotal: cervix not removed
total: cervix removed too
what is salpingo-oophorectomy?
removal of fallopian tubes and ovaries
what is an immediate result of an oophorectomy?
menopause
name a few causes of amenorrhea
- stress
- malnutrition
- intense exercise
- obesity
- primary ovarian insuffiency
- polycystic ovarian syndrome
- abnormal prolactin levels
- hormonal treatment
- hyperthyroidism
- obstruction
what causes polycystic ovaries syndrome?
excess of androgens
how is polycystic ovaries syndrome managed?
- management of symptoms
- advice on lifestyle (eg BMI, diet)
two of which three criteria are necessary to diagnose polycystic ovarian syndrome?
- polycystic ovaries (ultrasound)
- infrequent periods (no ovulation)
- hyperandrogenism (clinical and biochemical)
which acronym can be used to identify causes of heavy menstrual bleeding?
PALM COEIN
what happens to the levels of oestrogen and FSH in menopause?
oestrogen levels drop
FSH levels rise
what lab test is carried out to confirm menopause?
FSH levels
what is the first line treatment of symptoms caused by menopause?
hormone replacement therapy
what are the systemic options for hormone replacement therapy, and what do they depend on?
depends on whether woman still has uterus:
- uterus = oestrogen + progesterone
- no uterus = oestrogen only
what are the local options for hormone replacement therapy?
vaginal oestrogen
when is HRT contraindicated?
- 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
if a woman is perimenopausal, what does that mean and what HRT option is offered to her?
perimenopausal = still some ovarian function
she will be offered cyclical combined HRT instead of continuous combined HRT
name a complication of menopause which can affect bones
osteoporosis
name a few symptoms experienced during menopause
hot flushes dyspareunia vaginal dryness night sweats bloating mood swings low libido muscle/joint pain
name a few alternative treatments for menopausal symptoms if HRT is contraindicated
- selective estrogen receptor modulators (SERM)
- SSRI/SNRI
- natural remedies
- non-hormonal vaginal lubricants
what tool is used to assess for the risk of osteoporosis in menopausal women?
FRAX score
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?
woman still has a uterus = combined HRT
HRT until age 50
name a few risks involved in taking HRT
- increased risk of breast/ovarian ca
- increased risk of VTE/CVA
name a few benefits involved in taking HRT
- reduces hot flushes
- reduces night sweats
- relieves vaginal dryness
- reduces risk of osteoporosis
what is the main purpose of giving oestrogen as a hormone replacement therapy?
symptom relief
what is primary amenorrhea?
never having had a period before
name a few causes of secondary amenorrhea
- pregnancy
- contraception (IUS, depo-provera)
- PCOS
- stress/BMI/strenuous exercise/malnutrition
- premature menopause
- increased prolactin
- primary ovarian insufficiency
- thyroid disease
name a few investigations done to identify the cause of amenorrhea
- abdominal/bimanual examination
- BMI
- TSH, estrogen, testosterone, FSH/LH, prolactin
- urine dipstick
- pelvic ultrasound
two of which three criteria are needed to make a diagnosis of PCOS?
- polycystic ovaries on ultrasound
- anovulation
- hyperandrogenism (clinical and biochemical)
how is PCOS managed?
- lifestyle advice (eg BMI)
- antiandrogen drugs (combined contraception, spironolactone)
- endometrium protection (combined hormonal contraception)
- clomifene/metformin
which diabetic medication has been shown to help with ovulation in women with PCOS?
metformin
what are women with PCOS at risk of if they have very infrequent periods?
endometrial hyperplasia
