Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

JCU Obstetrics & Gynaecology > Menstrual dysfunction > Flashcards

Menstrual dysfunction Flashcards

1
Q

What are considered ‘red flag’ situations in GP requring urgent referral to secondary care?

A

Age >40 years

Age >35 years plus:

  • Unopposed oestrogen use
  • Nulliparity
  • PCOS
  • Weight >90kg
  • Familial uterine cancer syndrome

Association with high grade Pap smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the important questions to focus on in the history of a patient with menstrual disturbance?

A

LMP, LMP, always LMP

Length of symptoms, days bleeding, presence of clots

Contraception

Menstrual diary

Symptoms of anaemia

Reproductive history

Med/Surg history, FHx, drugs, etc.

Fertility wishes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are you looking for on examination?

A

General: ?anaemia, thyroid status

Abdominal: masses, e.g. fibroid uterus

Speculum: cervical lesion, e.g. cancer, ectropion, fibroid polyp

Bimanual: size, a/v or r/v, mobile or fixed, uterine masses, adnexal masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which investigations are relevant for menstrual disorders?

A

Haemoglobin

Iron studies

TFTs if indicated

Serum testosterone if PCOS suspected

Transvaginal scan of the pelvis - ?fibroids, endometrial thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can you stop the bleeding for someone with a dysunctional beed?

A

High dose continuous progestogens

Medroxyprogesterone acetate (Provera) 30mg daily - continue for a month

If cycles anovulatory, may need subsequently need cyclical progestogens to control menses if COC contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are non-hormonal approaches to managing menorrhagia?

A

Tranexamic acid (antifibrinolytic): 500mg - 1.5g TDS to QID. Start on the first day of the period (or the day before if immediate premenstrual symptoms reliable). Take only while menstruating

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the hormonal options for treating menorrhagia?

A

Combined oral contraceptive pill - consider tri-cycle

Mirena

Cyclical progestogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What if the endometrium is abnormal on ultrasound - e.g. >15mm

A

Repeat scan early follicular phase, when it should be thinnest

Pipelle in select cases

Hysteroscopy if polyp suspected or high risk for endometrial hyperplasia/cancer

Hysteroscopy can be outpatient or under GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the surgical options for the management of menorrhagia?

A

Endometrial ablation - most successful in >45y, may need repeat in younger women after 5-7 years. Aim is eumenorrhea not amenorrhoea

Myomectomy if fertility desired:

  • submucous - hysteroscopic
  • intramural/subserosal - open/laparoscopic

Hysterectomy - abdominal, vaginal, laparoscopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define the types of dysmenorrhoea

A

Primary: menstrual pain without an underlying pathology

Secondary: menstrual pain with an underlying pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give four differential diagnoses of secondary dysmenorrhoea.

A
  • Endometriosis
  • Adenomyosis
  • Uterine polyps
  • Uterine anomalies (e.g. non-communicating uterine horn)
  • Fibroids/leiomyoma
  • Intrauterine synechiae
  • Ovarian cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the commonest cause of secondary dysmenorrhoea?

A

Endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give four differential diagnoses of menorrhagia

A

Fibroids/Leiomyoma

Adenomyosis

Anovulation

Idiopathic

Endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give four non-gynaecological differential diagnoses of menorrhagia

A

Endocrine: hyper/hypothyroidism, hyperprolactinaemia

Haematological: coagulopaties (vWD), PLT abnormalities (ITP)

Renal failure: impairs oestrogen excretion

Liver disease: ↓ clotting factors

Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Give and justify 5 blood tests that may be done when working up menorrhagia.

A

FBC: ?anaemia, ?quantitative PLT abnormality

Iron studies: ?iron deficient from bleeding

TFTs: ?hyper/hypothyroidism

Prolactin: ?hyperprolactinaemia

PCOS bloods: testosterone

Coagulation profile: e.g. vWF activity assay if primary menorrhagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give three medical treatment options for menorrhagia.

A

Tranexamic acid: antifibrinolytic

NSAIDs: anti-prostaglandin

Hormonal (COCP, DepoProvera): cycle control

17
Q

What is the red flag condition to consider in a post-menopausal woman with PV bleeding?

A

Endometrial cancer

18
Q

Give two hypothalamic, two pituitary and two ovarian causes of anovulation.

A

Hypothalamus: excessive exercise, ↓ BMI

Pituitary: Hypopituitarism, SOL e.g pituitary adenoma + hyperprolactinaemia

Ovarian: PCOS, premature ovarian failure

19
Q

Give two hormonal blood tests that may aid in diagnosing anovulation.

A

Day 3 FSH: FSH should be low in the early follicular phase of the cycle. A high FSH at this time could mean premature ovarian failure (premature menopause)

Progesterone 7 days before expected menses (e.g. day 21 in 28 day cycle): corpus luteum should have formed and be producing progesterone

20
Q

Define the types of amenorrhoea.

A

Primary: lack of menstruation by the age of 16 in the presence of secondary sexual characteristic or 14 in their absence.

Secondary: absence of menstruation for 6 months

21
Q

Name two physiological causes of amenorrhoea.

A

Lactation

Menopause

Pregnancy

22
Q

Name three pathological causes of amenorrhoea.

A
  1. Stress
  2. Anorexia
  3. Excessive exercise
  4. SOL
  5. Micro or macroadenoma
  6. Sheehan’s syndrome
  7. PCOS
  8. Premature ovarian failure
  9. Asherman’s syndrome
  10. Hyperprolactinaemia
  11. Cushing’s syndrome
  12. Congenital adrenal hyperplasia
23
Q

Give four blood tests you would consider in patients with amenorrhoea.

A
  1. Pregnancy test
  2. FSH/LH
    1. in premature ovarian failure
    2. in hypothalamic causes
  3. Testosterone ?diagnosis of PCOS
  4. Prolactin
  5. TFTs
24
Q

What is oligomenorrhoea?

A

Infrequent menstrual periods

  • Cycles are longer than 32 days
  • Usually represent anovulation or intermittent ovulation
25
Q

Name three causes of oligomenorrhoea.

A
  1. PCOS - most common cause
  2. Borderline or low BMI
  3. Obesity (without PCOS)
  4. Ovarian resistance / premature ovarian failure
  5. Mild hyperprolactinaemia
  6. Mild thyroid disease
26
Q

What can be used to regulate cycles in patients with oligomenorrhoea?

A
  1. COCP
  2. Cyclical progestagens
27
Q

Name three causes of intermenstrual bleeding.

A
  1. Uterine fibroids - submucosal
  2. Uterine polyps
  3. Cervicitis
  4. IUD
  5. Ectopic pregnancy or miscarriage
  6. Hypothyroidism
  7. Cervical or uterine cancer
28
Q

Name three investigations you would perform on a patient with intermenstrual bleeding.

A
  1. PAP smear
  2. vaginal swabs for chlamydia and gonorrhoea
  3. FBC - may be anaemic
  4. TFTs - may have hypothyroidism
  5. ßhCG to exclude ectopic/miscarriage
  6. USS - assess endometrium/investigate for masses
29
Q

When does menarche typically occur?

A
  • Mean age is 12.5 years
  • Puberty onset can be anywhere from 8 - 13y
30
Q
A

JCU Obstetrics & Gynaecology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions