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REPRO > Menstrual D.O > Flashcards

Menstrual D.O Flashcards

1
Q

What is abnormal bleeding?

A
  • IMB

- PCB

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2
Q

What are indicators of heavy bleeding ?

A
  • too much clotting
  • iron def. anemia
  • leaking onto clothes
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3
Q

What is polymenorrhea?

A

menses occuring <21 day interval

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4
Q

Polymenorrhagia?

A
  • increased bleeding and frequent cycle
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5
Q

Amenorrhoea?

A
  • absent menses >6 months
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6
Q

Oligomenorrhea?

A
  • menses at >35 days

- usually d/t PCOS

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7
Q

wHAT ARE THE 2 GR.S of Menorrhagia?

A

ORGANIC (pathology)

NON-ORGANIC (DUB, 50% of cases, HORMONAL)

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8
Q

LOcal causes of Organic Menorrhagia?

A

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

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9
Q

What endocrine problems cause menorrhagia?

A
  • hypo/hyperthyroidism
  • DM
  • Adrenal Disease
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10
Q

What bleeding disorders cause menorrhagia?

A
  • VWB disease
  • ITP
  • Fctor III, V, VII and XI def
  • anticoagulants
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11
Q

What chronic illnesses cause menorrhagia?

A
  • chronic liver disease
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12
Q

Why may bleeding occur with pregnancy?

A
  • miscarriage
  • ectopic pregnancy
  • Gestational trophoblastic disease
  • postpartum hemorrhage

——TEST WITH PREG. TEST

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13
Q

What is DUB subdivided into?

A

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
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14
Q

How to invx DUB?

A
  • FBC
  • Cervical smear
  • TSH (hypothyroid)
  • Coagulation screen
  • renal /liver function test
    -TVUS (check thickness/ presence of fiboids )
  • Endometrial sampling
    (pipelle biopsy/D&C)
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15
Q

How to manage DUB?

A

Drug rx:

  • progestogens (synthetic anologue)
  • OCP
  • Danazol (testosterone analogue)
  • GnRH analogues
  • NSAIDs
  • Anti-fibrinolytics
  • Capillary wall stabilizers

—–progesterone releasing IUCD (MIRENA IUS)

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16
Q

Diff. between oral and IUCD progesterone

A
  • coil delievrs drug locally in a sustained manner
17
Q

How to manage regular cycles

with heavy period?

A
  • (non-hormonal rx)
  • Tranexamic Acid (3x/day for 4 days)
  • NSAIDs (MEFENAMIC acid)
18
Q

Treatment of irregular cycle?

A
  • OCP
19
Q

What does the GnRH Analogue do?

A

shuts down ovary

20
Q

What is considered to be SURGICAL management of DUB?

A
  1. endometrial ablation- burning of the endometrial lining

2. Hysterectomy

21
Q

Whatare the diff. way s to hysterectomy?

A
  • 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
22
Q

WHyis medical rx more desriable?

A
  • cheaper

- no waiting list

23
Q

What does the NICE guidelines suggest with ablation and hysterectomy ?

A
  • ablation to be done first
24
Q

What is the difference between Hysterectomy and Endometrial ablation?

A

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

25
Q

What does LASH/LAVH and TLH stand for?

A
  • LAPAROSCOPIC procedures
  • LASH= Laparoscopic supracervical hyst.
  • LAVH= laparoscopic vaginal Hysterec.
  • TLH- total laparoscopic hysterec
26
Q

What is involved with endometrial ablation?

A
  • TCRE
  • REA
    —–THERMAL balloon ablation
  • thermal hydroablation
    bipolar MESH endo. ablation
27
Q

What NSAIDs are licensed for dysmennorhoea ?

A
  • Ibuprofen

- Naproxen

28
Q

How are NSAIDs useful to treat menorrhagia?

A
  • 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% !

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