Menstrual dysfunction Flashcards
Give local organic causes of menorrhagia
polyps fibroids endometriosis adenomyosis endometritis malignancy cervical eversion sexual trauma arteriovenous malformation IUCD PID
Give systemic causes of menorrhagia
Endocrine: hypothyroid, adrenal, DM, ^PRL, Liver and renal disease Bleeding disorders Pregnancy Anticoagulants
What is dysfunctional uterine bleeding DUB
abnormal bleeding in the absence of organic pathology
it is a diagnosis of exclusion
What types of DUB are there
anovulatory - extremes of reproductive age, high BMI, irregular cycles
Ovulatory - regular heavy periods, inadequate progesterone production
List investigation for DUB
FBC - Hb TFT LFT U+E Hormone levels: FSH, LH, oestrogen, progesterone, Cervical smear TVUSS endometrial sampling: pipelle, dilatation and curettage, hysteroscopy
Medical management of DUB
combined hormonal contraception progestogen only GnRH analogues danazol (testosterone analogue) - not used NSAIDs anti fibrinolytics capillary wall stabilisers
Surgical management of DUB
1st line = endometrial ablation
2nd line = sub/total hysterectomy
What is a subtotal hysterectomy
removal of the uterus but cervix remains
what is a total hysterectomy
removal of uterus AND cervix
Do you still need a cervical smear after endometrial ablation
YES
Which type of hysterectomy would you still need a cervical smear screen
subtotal hysterectomy
What type of hormone treatment can you give post menopausal women after endometrial ablation
Combined HRT
What type of hormone treatment can you give post menopausal women after hysterectomy
Oestrogen only
