Menstrual health 2 Flashcards
What is reproductive endocrinology?
- includes the study of hormones and control mechanisms that regulate sexual development, sexual function and reproduction.
- Includes the analysis of the hypothalamic-pituitary axis and adrenal glands.
What are red flags in reproductive endocrinology?
RED FLAGS:
* Chest pain, acute pelvic pain, abnormal uterine bleeding, excessive leukorrhoea, numbness in hands and/or feet, bleeding after intercourse, breast changes (lumps, colour), bleeding between periods, blood in stools and blood in urine.
What biomedical testing and diagnostic testing is available for Women’s health?
- Reproductive endocrinology: hormonal profile
- Haematology (blood tests): haemoglobin, glucose
- Diagnstic imaging: pelvic ultrasound, MRI, HSG, SIS, laparoscopy
- Useful in women experiencing abnormalities in their menstrual cycle such as: bleeding between periods, pelvic pain, absent or irregular periods, pelvic mass and assessment of fibroids, cyst diagnosis and follow up, fertility issues, post menopausal bleeding.
What is ANTI-MULLERIAN HORMONE (AMH)?
- Produced by granulosa cells of ovarian follicles during the early stages of their development. Anti-mullerian hormone levels indicate the number of eggs remaining in the ovaries.
- AMH test is in indicator of egg quantity but not egg quality
- Low levels <1 nanogram per ml indicate poor ovarian reserve
- High levels >6 nanograms per ml may suggest PCOS
What is Progesterone (P4)?
- Plays a vital role in the reproductive system being the main hormone released by the corpus luteum during the luteal phase of the menstrual cycle
- Progesterone supports the menstrual cycle and prepares the endometrium for implantation of the fertilised ovum during pregnancy
- 6-30 nanograms per ml confirms ovulation (day 21 or 7 days prior to menstruation) which is useful for clients trying to conceieve.
- Low levels indicate anovulation and further testing is required.
What is the luteinising hormone? (LH)
- LH triggers the release of the egg (ovum) from the ovary (ovulation).
- This hormone test is conducted during the early follicular phase (day 3-5 of the menstrual cycle)
- > 10 IU/ml may indicate anovulation and possible PCOS
What is follicle stimulating hormone? FSH?
- Stimulates the follicles on the ovary to grow and prepare eggs (ovum) for ovulation)
- Conducted early during the follicular phase (day 3-5 of the menstrual cycle). Results in >10 IU/ml may indicate anovulation and possible PCOS.
What is haematology?
- Haemoglobin is an iron-containing protein in the blood responsible for transporting oxygen to the tissues
- A haemoglobin test measures iron levels in the blood
- The normal adult range for haemoglobin is 13 – 18 grams per deci-litre
- Low haemoglobin count for women may indicate: iron deficiency, chronic blood loss, fibroids, abnormal uterine bleeding, anemia.
What is the significance of testing blood glucose?
- Testing of blood glucose levels may be necessary for patients at risk of developing type II diabetes, such as someone with a history of diabetes
- Oral glucose tolerance test (OGTT) measures the body’s ability to process glucose
- Normal range of glucose levels = 4 – 7 mmols/L
What is abnormal uterine bleeding?
- Possible causes of abnormal uterine bleeding include structural abnormalities such as fibroids or polyps, hormone changes or even stress.
- Heavy menstrual bleeding (menorrhagia), bleeding at unusual times (between periods, after intercourse), unusually long periods (seven days or longer), inconsistent menstrual cycles.
- Tests: hormone test, blood test, pelvic ultrasound.
What points can be used for Blood xu?
Water points LV8, ST36
SP6, KID3, BL17, CV6 and CV4
What herbal prescription can be used for Blood xu?
Ba Zhen Tang
What points can be used for Blood stagnation?
SP4, PC6, SP8, SP10, KID4, BL17, CV6, ST29, LIV3
What herbal formula can be used for Blood stagnation?
Si Wu tang, Tao hong si qu wan
What points can be used for Heat in the blood?
SP4, PC6, LIV2, LIV3, LI11, BL17, SP10, KID2
What herbal formula can be used for heat in the blood?
An Chong tang
Qing Jing San
What points can be used for cold in the blood?
LU7, KID6, CV4, CV6, ST29, ST28, KID14 + Moxa cones
What herbal formula can be used for cold in the blood?
Wen Jing Tang
Shao Fu Zhu Yu Tang
What are blood xu signs and symptoms?
amenorrhoea or delayed menstruation, dull headache on vertex during or after period (due to Liver channel ascending to the head), dizziness, blurred vision, numbness, poor memory, insomnia, palpitations, dry skin, dry eyes, tiredness, pale complexion, dry hair.
T: pale, thin
P: choppy for fine
Treatment P: nourish blood, strengthen the Liver
Tui Na: kneading - ribs and abdomen routine
What are the S+S of Liver Blood stasis?
Amenorrhoea, long periods (scanty, dark blood and clots), stabbing headaches before period (around temples or eyes), depression, irritable, intense abdominal pain (relieved after passing clots)
T: purple (or purple sides)
P: Wiry or choppy
TP: invigorate blood, eliminate stasis, regulate periods, stop pain
Tui: analgesic techniques to dredge the channels (kneading, pushing, squeezing and chopping to eliminate stasis).
What are the S+S for heat in the blood?
Long periods (profuse, heavy, dark blood), early menstruation or ‘flooding and trickling,” irritable, thirsty, red face, feels hot, dark urine, constipation
T: red with yellow coat (or no coat)
P: rapid, firm (or overflowing)
TP: Clear heat and cool blood, clear liver and heart heat, regulate penetrating vessel.
What are the S+S for cold in the blood?
Delayed (scanty) menstruation, lower central abdominal pain before period (better for warmth, worse for pressure), small dark clots, back ache, tiredness
T: pale-blueish-purple
P: deep, choppy or wiry
TP: warm the uterus, expel cold, invigorate blood
What is the pathology of late menses?
Blood Xu
Cold in uterus
Kidney Yang Xu
Qi Stagnation
How does the oral contraceptive effect menstruation?
Long term use of the oral contraceptive induces blood xu or blood stasis
What is PMS?
Pre-menstrual syndrome which describes emotional and physical symptoms that occur before a period. These may include depression, sadness, anxiety, lethargy, loss of concentration, aggressiveness, changes in libido, changes in bowel habits, skin eruptions, food cravings etc.
What are the causes of PMS?
Emotional strain: anger, worry, guilt, frustration and resentment may cause stagnation of Liver Qi which is a cause of PMS.
Irregular diet: excessive consumption of dairy products and greasy foods leads to the formation of phlegm - phlegm combines with Qi stagnation to cause pre-menstrual symptoms.
Overwork: weakens Kidney and Liver Yin - when deficient can cause stagnation of Liver Qi.
