Menstrual Problems Flashcards
What are some investigations you would to in a menorrhagic?
FBC, TFT, Pelvic USS and hCG
Hysteroscopy or endometrial biopsy
What is some medical managements of menorrhagia?
Tranexamic acid/mefenamic acid COCP POP Depot injection Mirena IUD GnRH analogues
What are some surgical managements of menorrhagia?
Transcervical resection if fibroids
Endometrial ablation
Myomectomy
Hysterectomy
What are fibroids/leiomyomas?
These are benign tumours rising from the myometrium
What are some S+S of fibroids?
Menorrhagia
Pressure on bladder and bowel
May be asymptomatic
Uterus may be enlarged and large fibroids may be palpable
Pelvic USS is done to determine size and location
How are fibroids treated?
Treat the menorrhagia
Sometimes surgical is done for submucosal fibroids
Myomectomy
Hysterectomy
Uterine artery embolisation is occasionally done
What is primary amenorrhoea?
The absence of menarche by the age of 14 (with no 2ndry sexual characteristics) or 16 with 2ndry sexual characteristics
What is secondary amenorrhoea?
The absence of menstruation for over 6 months in a woman who has previously menstruated
Oligomenorrhoea?
Over 35 days between periods
What are some causes of amenorrhoea?
Pregnancy PCOS Hypothalamic disorders Hyperprolactinaemia Ovarian failure/menopause Thyroid disease Anatomical disorders
How would you investigate people with amenorrhoea?
hCG, LH, FSH, prolactin, karyotype
Pelvic USS
If oral progesterone is given for 5 days and a withdrawal bleed occurs, this means there is oestrogen and anatomy normal
Treatment of amenorrhoea?
Treat the cause
Primary ovarian failure - COCP and oestrogen
What is PCOS?
2 of the following
Polycystic ovaries on USS
Signs of hyperandrogenism (clinical - hirsutism/acne or biochemical)
Oligo/anovulation
also oligomenorrhoea, obesity, acne, subfertility
How would you test for PCOS?
Pelvic USS, testosterone levels, glucose tolerance test and BP
How would you treat PCOS?
Weight loss and exercise
OCP, progesterone, hair control
