Menstrual problems Flashcards
Define amenorrhoea
Absence of periods
Define oligomenorrhoea
Infrequent periods
Define polymenorrhoea
Menstrual cycle that is shorter than 21 days
Define menorrhagia
Heavy flow in period
Outline the pathophysiology of dysmenorrhoea
Cell wall of phospholipids are converted to arachidonic acid by phospholipase. This ends up being one of two precursors: leukotrienes or cyclic endoperoxides
This whole process and production of phospholipase is triggered by withdrawal of progesterone at end of menstrual cycle
How is endometriosis diagnosed?
Pelvic exam
Pelvic ultrasound
Diagnostic laparoscopy
What’s the difference between primary and secondary dysmenorrhoea?
Primary - peak incidence teens to twenties - secondary peak incidence thirties to forties
Secondary is a consequence of other pelvic pathology
How can primary dysmenorrhoea be managed pharmacologically?
NSAIDs
OTC - feminax
Oral contraceptive pill
Antispasmodics e.g. hyoscine butylbromide
What is primary dysmenorrhoea caused by?
Pain due to higher concentrations of prostaglandins in menstrual fluid
What is secondary dysmenorrhoea caused by?
Pain due to prostaglandin involvement but also due to underlying pelvic pathology
How is secondary dysmenorrhoea managed pharmacologically?
Investigate and ascertain underlying cause and treat accordingly
Options include:
- surgery
- symptomatic relief
What is endometriosis?
Where endometrial tissue is found outside the uterus
How is endometriosis pharmacologically managed?
1st line - analgesia
2nd line - shrinkers to get rid of excess endometrial tissue
What type of shrinkers can be given for the management of endometriosis?
Contraceptives
Progestogens
Gonadotropin releasing hormone analogues
Anti-progestogens
What are the causes of menorrhagia?
Dysfunctional uterine bleeding
Other gynaecological causes - menopause, fibroids
Endocrine and haematological causes - PCOS, blood thinning meds
