Menstrual Dysfunction Flashcards
How long does a normal menstrual cycle typically last? What is the duration of menstrual loss? How much blood is lost per menstruation?
28 days +/- 7 days
4-6 days
<80ml per menstruation
What are the 3 stages of the menstrual cycle?
Proliferative/follicular phase
Luteal phase
Menstrual phase
Which layer of the uterus is shed during menstruation, causing bleeding?
Endometrium
Define “menorrhagia”
Prolonged and increased menstrual flow
Define “metrorrhagia”
Regular menstrual bleeding between menstrual periods
Define “polymenorrhoea”
Menstrual bleeding occurring at <21 day interval of cycle
Define “polymenorrhagia”
Increased bleeding and increased frequency of cycles
Define “menometrorrhagia”
Prolonged menstrual cycle and bleeding between cycles
Define “amenorrhoea”
Absence of menstrual cycle for more than 6 months
What is the difference between organic and non-organic causes of menorrhagia?
Organic - pathology present
Non-organic - no obvious/observable pathology identified (dysfunctional uterine bleeding)
List some local organic causes of menorrhagia
Fibroids Adenomyosis Polyps Cervical eversion Hyperplasia, carcinoma Pelvic inflammatory disease Contraceptive devices Endometriosis Trauma e.g. intercourse AV malformations
What is adenomyosis?
Endometrium present in myometrium, causing irritant blood to pool and intense pain
List some systemic organic causes of menorrhagia
ENDOCRINE: Hyper/hypothyroidism, DM, Adrenal disease, Prolactin disorders
HAEMOSTASIS: Von Willebrand’s disease, ITP, coag factor disorders
LIVER
RENAL
DRUGS: Anticoagulants
Non-organic (dysfunctional) menstrual bleeding makes up 50% of cases. True/False?
True
List the types of DUB. Which type of dysfunctional menstrual bleeding (DUB) is more common?
Anovulatory (85%)
Ovulatory
What can be assessed on a transvaginal ultrasound scan?
Endometrial thickness
Presence of fibroids + pelvic masses
How can endometrial sampling be done?
Pipelle biopsy
Hysteroscopy
Dilate and curettage
How can dysfunctional menstrual bleeding be managed medically? What is first line
Progestogens Combined OCP Danazol GnRH analogues NSAIDs Anti-fibrinolytics Capillary stabilisers Progesterone-releasing intra-uterine contraceptive (MIRENA IUS COIL = FIRST LINE)
What are the main surgical interventions for dysfunctional menstrual bleeding? Which is first line?
Endometrial resection/ablation (1ST LINE)
Hysterectomy
At what endometrial thickness is biopsy indicated?
Greater than 4mm in postmenopausal
16mm in premenopausal
Describe the follicular phase of the menstrual cycle
FSH stimulates ovarian follicle and granulosa cells to produce oestrogen from the dominant follicle
Rising oestrogen inhibits FSH production
Low FSH levels causes atresia of the dominant follicle
Describe the proliferative phase of the menstrual cycle
Oestrogen-induced growth of endometrial glands and stroma
Describe ovulation within the menstrual cycle
Prior LH surge
Dominant follicle ruptures and releases oocyte
Describe the luteal phase of the menstrual cycle
Formation of the corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation
Endometrial apoptosis leads to menstruation
Describe menstruation during the menstrual cycle
Arteriolar constriction shedding functional endometrial layer
Fibrinolysis inhibits scar tissue formation
Define “oligoamenorrhea”
Menses at intervals of >35 days
What is a fibroid?
Benign growths that develop in or around the womb (uterus)
What is the main aetiology behind PID?
Chronic CHLAMYDIA infection of fallopian tubes
What is endometriosis? How does it appear?
Ectopic endometrium found within the pelvis
Starts as a red lesion and turns black
Cervical malignancy is most common in…
Young women
Uteral malignancy is most common in…
Post-menopausal woman with bleeding
What are the three main causes of painful menstrual bleeding?
Adenomyosis
Pelvic inflammatory disease
Endometriosis
Name another organic cause of menorrhagia and give some examples
PREGNANCY
Miscarriage, ectopic pregnancy, gestational trophoblastic disease, postpartum haemorrhage
Describe the common features of anovulatory DUB
Occurs at extremes of reproductive life
Irregular cycle
Typically obese women
Describe the common features of ovulatory DUB. What is the pathogenesis behind it?
Women aged 35-45 years
Regular heavy periods
Due to inadequate progesterone production by corpus luteum
List investigations used in DUB
FBC, coag screen, TSH, renal/liver function tests Cervical smear Transvaginal US scan Endometrial sampling
What is the classical presentation of endometrioma?
Post menopausal woman (>40) with menorrhagia
Thick endometrium
What is the first and second line line investigation for endometrioma respectively?
Pipelle biopsy
Transvaginal US scan
What is the first line NSAID commonly used in menorrhagia?
Mefenamic acid
What is NICE recommendation for the management of DUB?
2 non-surgical treatments first before surgery
