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
What is DUB?
Irregular intrauterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to endometrial lining (no organic cause for bleeding)
Most cases of DUB happen because of?
Anovolutary cycles
Organic causes of AUB?
Enodmetrium: Endometriosis, polyps, miscarraige
Myometrium: Adenomyosis, leiomyoma
