Menstrual disorders (unfinished) Flashcards
What is the menstrual cycle?
´The menstrual cycle is the time from the first day of a woman’s period to the day before her next period
How much blood do women tend to lose over their periods?
a) what is the average?
b) what is the normal range?
Average loss = 30-40mls
<80 mls over 7 days is normal
When is menarche?
10-16 years
average is 12 years old
When does menopause tend to occur?
50-55 years
How can distrubances of menstruation be categorised?
Problems with frequency - infrequent or frequent
Problems with regularity - absent or irregular
Abnormal duration of flow - prolonged or shortened
Abnormal mestrual volume - heavy or light
In terms of menstrual frequency - what is considered:
- frequent
- normal
- infrequent
Frequent = <24 days
Normal = 24-38 days
Infrequent = >38 days
In terms of regularity, what is considered to be:
- Absent / amenorrhoea (bet youll struggle with this one)
- Normal
- Irregular
Amenorrhoea - no bleeding
Regular/normal:
- < 20 days variation over 12 months
Irregular:
- > 20 days variation over 12 months
In terms of menstrual duration, what is considered:
- Prolonged
- Normal
- Shortened
Prolonged = >8 days
Normal = 2-7 days
Shortened = <2 days
In terms of menstrual volume - what is considered:
- Heavy
- Normal
- Light
Heavy = >80 mls
Normal = 5-80 mls
Light = <5 mls
It is difficult to directly measure if a woman has a heavy period. What features in a history could help you identify this as a problem?
>80 ml over 7 days
+/-´the need to change menstrual products every one to two hours
+/- passage of clots >2.5cm
+/- bleeding through clothes - and social implications of this (will not go out/see friends/go to work on period etc)
What are some common causes of HMB?
Use the pneumonic PALMCOIN to remember the most common causes…
Polyps
Adenomyosis
Leiomyoma (fibroids)
Malignancy (cervical, endometrial)
Coagulopathy (Von Willebrand)
Ovulation dysfunction
Iatrogenic
Not yet classified
What are fibroids? (leiomyoma/myoma)
How do they present?
Non cancerous growths made of muscle and fibrous tissue
May be asymp. but can present with:
- HMB
- Dysmenorrhoea
- Pelvic pain
- urinary symptoms
- pressure symptoms
- backache
- infertility
- miscarriage
How are fibroids managed?
Management is symptom based:
HMB with small fibroids can be managed using medication:
- COCP - combined contraceptive pill
- POP - progestogen only pill
- Mirena coil
HMB with larger fibroids (also if fertility concerns):
- Fibroid embolisation
- Myomectomy
If all fails - hysterectomy
How are submucosal fibroids managed?
Hysteroscopic fibroid resection
What is endometriosis and how does it present?
Defined as endometrial tissue present outside the lining of uterus. During menstruation this ectopic tissue behaves the same as endometrium and bleeds
Symptoms of endometriosis:
- Dysmenorrhoea
- HMB (less common than ^ however)
- Pain during/after sex
- Lower back pain
- Painful bowel movements
- Abnormal bleeding between periods
- Diarrhoea, nausea, blotting
