Menstrual Dysfunction & DUB Flashcards
What is menorrhagia?
Prolonged and increased menstrual flow
Metorrhagia?
Regular intermenstrual bleeding
Polymenorrhoea?
Menses occurring at <21 day interval
Polymenorrhagia?
Increased bleeding and frequent cycle
Menometrorrhagia?
Prolonged menses and intermenstrual bleeding
Amenorrhoea?
Absence of menstruation of >6 months in someone who has previously had period (secondary) or if girl hasn’t had period by age 16
Oligomenorrhoea?
Menses at intervals of >35 days
Organic causes of menorrhagia (local)?
- Fibroids
- Adenomyosis
- Polyps
- Cervical eversion
- Endometrial hyperplasia
- IUD
- PID
- Endometriosis
- Malignancy
- Hormone producing tumours
- Trauma
- AVM of endometrium
Systemic organic causes of mennorhagia?
Hypothyroidism Prolactin disorders Adrenal disease Bleeding disorders PCOS
Pregnancy related organic causes of menorrhagia?
- Miscarriage
- Ectopic pregnancy
- Gestational trophoblastic disease
- Post partum haemorrhage
What type of diagnosis is dysfunctional uterine bleeding?
Diagnosis of exclusion and usually caused by hormonal imbalance and disturbed oculation
2 main types of DUB?
Anovulatory
Ovulatory
What is anovulatory DUB?
Irregular cycle | More common in obese women | No ovulation = isn't adequate changes in hormone levels to cause proper menstruation so can get build up
Ovulatory DUB?
- More common in 34-45 y/o
- Regular heavy periods due to inadequate progesterone production by corpus luteum
Investigation of DUB?
- FBC
- Cervical smears
- TSH
- Coagulation screens
- Renal function
- LFTs
- Transvaginal US
- Pipelle biopsies
Medical management of DUB?
- Oral progesterones
- COCP
- Tranexamic acid
- Mefenamic acid
- GnRH analogues
- Mirena coil
What does oral progesterone do?
Taken days 6-26 as progesterone stops bleeding then get withdrawal bleeding
What s tranexamic acid?
Antifibrinolytic- only needs to be taken during menstruation
What is mefenamic acid?
NSAID
Reduces bleeding because inhibits prostaglandins which endometrium produces a lot during menstruation
GnRH is good for reducing risk of?
Osteoporosis
When is surgical treatment considered for DUB?
Only if drug treatment and mirena coil have been tried?
2 main surgical options?
Endometrial ablation
Hysterectomy
Endometrial ablation is 1st line surgical treatment. True or false?
True: fewer complications and shorter recovery
What will patient need for and after endometrial ablation?
Smear tests as cervix remains Combined HRT (microscopic endometrium may be still left)
What would be a risk if combined HRT wasnt taken after endometrial ablation?
Endometrial carcinoma
What HRT can a person take if total hysterectomy?
Oestrogen only
