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REPRODUCTION & GYNAECOLOGY > Menstrual Disorders (Menorrhagia) > Flashcards

Menstrual Disorders (Menorrhagia) Flashcards

1
Q

What occurs during the follicular ovarian phase?

A

FSH from anterior pituitary:

  • stimulates follicle(s) development
  • stimulates granulosa cells to produce oestrogens
  • Negative feedback on FSH production by oestrogen
  • Declining FSH levels cause atresia of ALL BUT dominant follicle
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2
Q

What hormone is involved in ovulation?

A
  • LH surge 12 hours prior to ovulation

- Dominant follicle then ruptures and releases oocyte

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3
Q

What happens during the luteal ovarian phase?

A
  • Formation of corpus luteum
  • Progesterone production
  • Luteolysis (breakdown of CL) 14 days post-ovulation
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4
Q

Aside from the shedding of the endometrial layer, what else occurs during the menstrual phase?

A
  • Arteriolar constriction to allow shedding to take place

- Fibrinolysis inhibits scar tissue formation

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5
Q

What is considered to be a normal menstrual cycle and normal menstrual bleeding?

A
  • Cycle lasts between 21-35 days (av. 28)
  • Menstrual loss usually lasting 4-6 days
  • Flows peaks day 1-2
  • < 80 ml lost per menstruation
  • No clots passed
  • No bleeding between periods or after intercourse
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6
Q

If a patient is complaining of amenorrhoea (no period for >6 months) what must you check?

A

HCG to check they are not pregnant

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7
Q

What local organic pathology can cause menorrhagia?

A
  • Fibroids (leiomyomas)
  • Adenomyosis
  • Polyp
  • Some forms of IUD
  • Pelvic inflammatory disease (PID)
  • Endometriosis
  • Cervical Eversion
  • Malignancy
  • Hormone producing tumours
  • Trauma
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8
Q

What is an ovarian endometrioma?

A
  • benign oestrogen-dependent endometrial tissue (cyst) on ovary
  • most common form of endometriosis
  • can cause infertility
  • can cause menorrhagia
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9
Q

What systemic organic disorders can cause menorrhagia?

A

Endocrine:

  • Hyper/ hypothyroidism
  • Diabetes Mellitus
  • Adrenal disease

Disorders of haemostasis

  • Von Willebrand’s disease (low vW Factor causes bleeding)
  • Idiopathic Thrombocytopenic Purpura (low platelets)
  • Clotting Factor II, V, VII and XI deficiency
  • Liver/Renal disorder
  • Anticoagulant drugs
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10
Q

What organic disorders of pregnancy can cause menorrhagia?

A

Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Postpartum haemorrhage

DO A PREGNANCY TEST IN THESE PATIENTS

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11
Q

What are the 2 main causes of DUB?

A

Anovulatory:

  • Occurs at extremes of reproductive life
  • Irregular cycle
  • More common in obese women

Ovulatory

  • More common in women aged 35-45 years
  • Regular heavy periods
  • Due to inadequate progesterone production by corpus luteum
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12
Q

How is DUB investigated?

A
  • Full blood count (Hb, serum ferritin)
  • TSH levels
  • Cervical smear
  • Coagulation screen
  • Renal/Liver function tests
  • Transvaginal ultrasound scan
  • Endometrial sampling
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13
Q

Heavy periods can cause a normal Hb but low iron stores in a patient. TRUE/FALSE?

A

TRUE

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14
Q

What is TVUS used to investigate?

A
  • Endometrial thickness

- Presence of fibroids/other pelvic masses potentially palpated on abdominal exam

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15
Q

How can endometrial sampling be carried out?

A

Pipelle biopsies
Hysteroscopic directed
Dilatation and curettage (D + C)

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16
Q

What side effects can a pipelle biopsy cause during the procedure?

A

Patient may experience abdominal cramps

17
Q

Endometrial thickness can also be measured using a trans-abdominal US. TRUE/FALSE?

A

FALSE - must be transvaginal

18
Q

Why is hysteroscopy potentially unsuitable as an outpatient treatment?

A
  • uncomfortable for patient
  • time consuming
  • messy as fluid needs to be used for visualisation
19
Q

Hysteroscopies can be completed under general anaesthetic. TRUE/FALSE?

A

TRUE

20
Q

What pharmacological treatments are currently used for Dysfunctional Uterine Bleeding?

A
  • Progestogens - e.g. Norehisterone (synthetic progesterone => longer 1/2 life)
  • Combined Oral Contraceptive Pill
  • Progestogen releasing Mirena Coil (IUD)
  • Antifibrinolytics - e.g. Tranexamic acid
  • NSAIDs - e.g. Mefenamic Acid
  • GnRH analogue - e.g. Zoladex - down regulates receptors in anterior pituitary
21
Q

What other treatments have previously been used for DUB, but are not widely used now?

A
  • Danazol (testosterone analogue)

- Capillary wall stabilisers

22
Q

What drug treatments would be used in DUB if patients have regular period cycles?

A

Non-hormonal

e.g. antifibrinolytics

23
Q

If patients had an irregular period cycle, what drug treatments should be used as first line in DUB?

A

Hormonal

=> Progestogens OR the Combined Oral Contraceptive Pill

24
Q

Why do many perimenopausal patients not use hormonal treatments for DUB?

A
  • Averse to taking contraception

- GP reluctant to prescribe them due to increased clotting risk (DVT/PE)

25
Q

If drug treatment is unsuccessful in DUB, what other form of treatment can be used?

A

Surgery

  • endometrial resection/ ablation
  • hysterectomy
26
Q

What happens during endometrial resection or ablation?

A
  • Endometrium is burnt away to prevent growth and bleeding

- 10-15% failure rate means bleeding can sometimes remain unchanged

27
Q

How can a hysterectomy be carried out?

A

Removal of uterus via vagina OR abdomen

- can be done laparoscopically

28
Q

What is a Subtotal hysterectomy?

A

Cervix is left behind

if it is removed there is a high rate of vaginal prolapse

29
Q

Why can spotting occur after a subtotal hysterectomy?

A

Some endometrium still attached to top of cervix will bleed slightly

30
Q

Can patients get pregnant after either endometrial ablation OR a hysterectomy?

A
  • NO but patients with ablation can conceive but embryo implants into myometrium instead as endometrium is no longer there

REPRODUCTION & GYNAECOLOGY (58 decks)

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