Menstrual D.O Flashcards
What is abnormal bleeding?
- IMB
- PCB
What are indicators of heavy bleeding ?
- too much clotting
- iron def. anemia
- leaking onto clothes
What is polymenorrhea?
menses occuring <21 day interval
Polymenorrhagia?
- increased bleeding and frequent cycle
Amenorrhoea?
- absent menses >6 months
Oligomenorrhea?
- menses at >35 days
- usually d/t PCOS
wHAT ARE THE 2 GR.S of Menorrhagia?
ORGANIC (pathology)
NON-ORGANIC (DUB, 50% of cases, HORMONAL)
LOcal causes of Organic Menorrhagia?
fibroids/ adenomyosis (painful) /endocervical polyps/ cervical eversion (glandular cervix outpouches into the ectocervix)/ endometrial hyperplasia/ IUCD (copper ones)./ PID (chlamydia)/ endometriosis/ cervical or uterine cancer/ hormone tumors (granulosa cell tumors- d/t estrogen) / trauma
What endocrine problems cause menorrhagia?
- hypo/hyperthyroidism
- DM
- Adrenal Disease
What bleeding disorders cause menorrhagia?
- VWB disease
- ITP
- Fctor III, V, VII and XI def
- anticoagulants
What chronic illnesses cause menorrhagia?
- chronic liver disease
Why may bleeding occur with pregnancy?
- miscarriage
- ectopic pregnancy
- Gestational trophoblastic disease
- postpartum hemorrhage
——TEST WITH PREG. TEST
What is DUB subdivided into?
ANOVULATORY (85%)
- –occurs at extreme ages (menarche and perimenopause)
- —missed ovulation 2months worth of uterine shedding
- —seen in OBESE women
OVULATORY:
- -35-45 y.o
- –regular heavy period
- d.t inadequate progesterone prodn by C.L
How to invx DUB?
- FBC
- Cervical smear
- TSH (hypothyroid)
- Coagulation screen
- renal /liver function test
-TVUS (check thickness/ presence of fiboids ) - Endometrial sampling
(pipelle biopsy/D&C)
How to manage DUB?
Drug rx:
- progestogens (synthetic anologue)
- OCP
- Danazol (testosterone analogue)
- GnRH analogues
- NSAIDs
- Anti-fibrinolytics
- Capillary wall stabilizers
—–progesterone releasing IUCD (MIRENA IUS)
Diff. between oral and IUCD progesterone
- coil delievrs drug locally in a sustained manner
How to manage regular cycles
with heavy period?
- (non-hormonal rx)
- Tranexamic Acid (3x/day for 4 days)
- NSAIDs (MEFENAMIC acid)
Treatment of irregular cycle?
- OCP
What does the GnRH Analogue do?
shuts down ovary
What is considered to be SURGICAL management of DUB?
- endometrial ablation- burning of the endometrial lining
2. Hysterectomy
Whatare the diff. way s to hysterectomy?
- vaginal hysterectomy (no visible wound sutures; but poor sight into uterus)
- Sub total (leave the cervix —reduced risk of prolapse
- Total abdominal
- LASH/LAVH/TLH
WHyis medical rx more desriable?
- cheaper
- no waiting list
What does the NICE guidelines suggest with ablation and hysterectomy ?
- ablation to be done first
What is the difference between Hysterectomy and Endometrial ablation?
E.ABLATION:
- day case procedure
- shorter time
- quicker recovery
- FEWER complications
- REQUIRES CERVICAL SMEARS
- combined HRT required
Hysterectomy: major op./ longer operating time/longer recovery/ more complications
What does LASH/LAVH and TLH stand for?
- LAPAROSCOPIC procedures
- LASH= Laparoscopic supracervical hyst.
- LAVH= laparoscopic vaginal Hysterec.
- TLH- total laparoscopic hysterec
What is involved with endometrial ablation?
- TCRE
- REA
—–THERMAL balloon ablation - thermal hydroablation
bipolar MESH endo. ablation
What NSAIDs are licensed for dysmennorhoea ?
- Ibuprofen
- Naproxen
How are NSAIDs useful to treat menorrhagia?
- PG E2 prodn is raised
- PG E sites also Incr.
- —therefore useful to be given NSAIDs (Cyclo-oxygenase inhibitor —reduces PG prodn)
——reduces blood loss by 20-50% !
