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Gynaecology > Menstrual Problems > Flashcards

Menstrual Problems Flashcards

1
Q

Symptoms of PMS?

A 
abdo bloating
breast tenderness (cyclical mastalgia)
headaches
oedema
mood changes
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2
Q

when should PMS symptoms resolve?

A

within 4 days of onset of menses

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3
Q

Possible treatments for PMS?

A
  1. Effective- SSRIs, supression of ovulation, oophrectomy
  2. May be effective- diet, exercie, psychological approaches, vit b6 (pyridoxine)
  3. not effective- progesterone, evening primrose oil, vit E, st john’s wort
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4
Q

Definition of menorrhagia?

A

Heavy periods
blood loss >80mls per month
(60% develop anaemia)

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5
Q

causes of menorrhagia?

A
  1. uterine pathology (common)
  2. dysfunctional uterine bleeding- DUB (very common)
  3. medical disorders/clotting (very rare)
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6
Q

Benign uterine causes of menorrhagia?

A
  1. uterine fibroids (leimyomas)- benign tumours of myometrium, well circumcised whorls of smooth muscle cells with collagen
  2. endometrial polyps- localised growths of endometrium, contain fibrous tissue, covered by columnar epithelium
    3, adenomyosis
  3. PID
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7
Q

Malignant uterine cause of menorrhagia?

A

endometrial cancer

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8
Q

What is DUB?

A

Diagnosis of exclusion
menorrhagia in the absence of recognisable pelvic pathology or complications of pregnancy/systemic disease
commonly occurs around menarche and menopause

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9
Q

Investigations of Menorrhagia?

A

FBC, Coag Screen and TFT
USS
endometrial assessment (biopsy, hysterectomy in >40yrs)
cervical smear

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10
Q

Treatment of polyps?

A

polypectomy under LA or GA

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11
Q

Treatment of fibroids?

A
  1. Medical- GnRH used to shrink

2. Surgical- hysteroscopic resection, hysterectoy, myomectomy, uteine artery embolisation

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12
Q

Medical treatment of DUB?

A
  1. Prostaglandin synthesis inhibitors
    (NSAIDs can reduce by upto 25%- reduction of endometrial prostaglandin conc)
  2. Antifibronolytics eg. tranexamic acid- reduce upto 50%
  3. COCP- reduce upto 50%
  4. Systemic Progesterones (noriestherone 5mg from day 5 of cycle)- upto 80%
  5. Levonorgesterol IUS- blood loss reduction upto 95%
  6. GnRH analogues- brings menopause
  7. Danazol
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13
Q

How does danazol work?

A

synthetic androgen with anti-oestrogenic and anti-progesteronic activity
inhibits pituitary gonadotrophons and supresses endometrium

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14
Q

Surgical treatment of DUB?

A

endometrial ablation

hysterectomy (removal of the uterus)- subtotal, total, TAH BSO

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15
Q

Pros of TAH?

A

cervix is removed, no further smears or risk of cervical malignancies

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16
Q

cons of TAH?

A

increased surgical morbidity

conservation of cervix may be associated with better sexual funtion

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17
Q

Pros of Subtotal hysterectomy?

A

fewer complications than TAH (less bleeding, infection, bladder injury and ureteric damage)

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18
Q

Cons of subtotal hysterectomy?

A

risk of cervical cancer remains same as before

19
Q

pros of vaginal hysterectomy?

A

may be lower incidence of bladder and bowel injury

no abdo wound

20
Q

cons of vaginal hysterectomy?

A

limited ovarian access
contraindicated if- large uterus, restricted uterine mobility, limited vaginal space, adnexal patholgy, cervix flush with vagina

21
Q

When does primary dysmenorrhoea usually start?

A

typically within first 2 years of menarche

22
Q

Treatment of primary dysmenorrhoea?

A
  1. Prostaglandin synthesis inhibitors- NSAIDs
  2. COCP- supresses ovulation
  3. depot progesterones
  4. Mirena
23
Q

what is secondary dysmenorrhoea?

A

Associated with underlying patholgy- treat the pathologu

24
Q

What is primary amenorrhoea(reduced/absent menstrual bleeding)?

A

menstruation has never occurred

most girls start menses before 15

25
Q

what is secondary amenorrhoea?

A

established menstruation ceases

no mentstruation for 6 months (or 3x previous cycle length) in the absence of pregnancy

26
Q

Commonest cause of primary amenorrhoea?

A

Imperforate hymen
mestrual blood retained withing vagina (haematocolpos)
causes cyclical lower abdo pain

27
Q

investigations and treatment for imperforate hymen?

A

inspect vulva- distended hymenal membrane may be seen + dark blood
Treatment- incision under GA

28
Q

chromosomal causes of primary amenorrhoea?

A

XO- turners
XY- testicular feminization 5-alpha-reductase deficiency
XX/XY- true hermaphrodite

29
Q

hypothalamic causes of primary amennorrhoea?

A 
physiological delay
weight loss/ anorexia/ heavy exercise
isolated GnRH deficiency
congenital CNS defects
intracranial tumours
30
Q

pituitary causes of primary amenorrhoea?

A 
partial/total hypopituitarism
hyperprolactinaemia
pituitary adenoma
empty sella syndrome
trauma/surgery
31
Q

ovarian causes of primary amenorrhoea?

A 
true agenesis
premature ovarian failure
radiation/chemo/autoimmune
PCOS
virillizing ovarian tumours
32
Q

Phsyiological causes of secondary amenorrhoea?

A

pregnancy
lactation
menopause

33
Q

hypothalamic causes of secondary amenorrhoea?

A

weight loss/anorexia
heavy exercise
stress

34
Q

pituitary causes of secondary amenorrhoea?

A

partial/total hypopituitatism
hyperproteinlactinaemia
trauma/surgery

35
Q

ovarian causes of secondary amenorrhoea?

A 
PCOS
resistant ovary syndrome
premature ovarian failure
radiation/ chemo/ surgery
virilizing ovarian tumours
36
Q

Causes of hyperprolactinaemia?

A 
Pituitary adenomas (microadenomas, macroadenomas)
Secondary to other causes- primary hypothyroidism, Chronic renal failure, stalk compression, PCOS, drugs
37
Q

What drugs may cause hyperprolactinaemia?

A

phenothiazides, haloperidol, metoclopramide, cimetidine, methyldopa, antihistamines and morphine

38
Q

Management of amenorrhoea

A
  1. exclude pregnancy
  2. ask about menopausal sx
  3. hx- wt changes, drugs, medical conditions
  4. exam- ht, wt, visual fields, presence of hirtuism or virilisation
  5. serum LH, FSH, prolactin, testosterone, thyroxine and TH
  6. TV USS (looking for PCOS)
39
Q

Average age of menopause in UK?

A

50.8 yrs

supply of oocytes become exhausted

40
Q

Short term problems of oestrogen deficiency?

A

Vasomotor- headache, hot flush, night sweats, palpitations, insomnia
Psychological- irritability, poor concentration, poor short-term memory, depression, lethargy, loss of libido, generalised aches

41
Q

Urogential problems of oestrogen deficiency?

A 
urethral symptoms
uterine prolapse
stress/urge incontinence
dysparenuria
atrophic vaginitis
42
Q

Treatment of menopause?

A

Hormones- oral, transdermal patches, S/c implants, vaginal preparations

43
Q

side effects of HRT?

A

nausea and breast tenderness
endometrial cancer (mirena can be used with unopposed oestrogen to protect against cancer)
breast cancer
thromboembolic disease

44
Q

contraindications of HRT?

A 
pregnancy
thromboembolic disease
hx of recurrebt thromboembolism
liver disease
undiagnosed vaginal bleeding

Gynaecology (3 decks)

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