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Repro > Menstrual Problems > Flashcards

Menstrual Problems Flashcards

1
Q

what constitutes a normal menstrual cycle?

A

> blood loss of 30-40 mls
4.5 days/21-35
age 13-51

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2
Q

what hormone change triggers menstruation?

A

decrease in progesterone 2 weeks after ovulation

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3
Q

what causes menstrual problems in the early teens?

A

> coagulation problems

> anovulatory cycles

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4
Q

what cause menstrual problems from the teens to 40yrs?

A 
> chlamydia
> fibroids
> endometriosis
> contraception related
> polyps (cervical/endometrial)
> dysfunctional bleeding
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5
Q

what causes menstrual problems from 40 yrs to menopause?

A

> warfarin
perimenopausal anovulation
thyroid dysfunction
endometrial cancer

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6
Q

what is the classification of causes of abnormal uterine bleeding?

A 
> polyp
> adenomyosis
> leiomyoma
> malignancy
> coagulation
> ovarian
> endocrine
> iatrogenic
> not yet classified
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7
Q

what are fibroids?

A

smooth muscle growth

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8
Q

what are the 3 types of fibroids?

A

> submucous (protrude into uterine cavity)
intramural (within uterine wall)
subserous (project out of the uterus into the peritoneal cavity)

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9
Q

what are the symptoms of fibroids?

A

> pressure symptoms
menorrhagia
intermenstrual bleeding (submucosal)
asymptomatic

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10
Q

what features can fibroids have in pregnancy?

A

rapid increase in size causing

  • pain
  • obstruction in labour
  • malpresentation
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11
Q

how are fibroids managed?

A 
> only if symptomatic
> GhRH to decrease size preoperatively
> hysterectomy
> uterine artery embolization
> myomectomy
> submucosal fibroids: trans cervical resection hysteroscopically
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12
Q

how are fibroids diagnosed?

A

> clinical exam
ultrasound
hysteroscopy

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13
Q

what is endometriosis?

A

endometrial type tissue outside the uterine cavity

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14
Q

where is endometrial tissue often found in endometriosis?

A

> pelvic peritoneum
ovary
pouch of douglas

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15
Q

true or false

the endometrial tissue found outside the uterine cavity in endometriosis is not oestrogen dependent

A

false it is oestrogen dependent

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16
Q

how does endometriosis present?

A 
> dysmenorrhoea
> premenstrual pelvic pain
> deep dyspareunia
> subfertility
> tender nodules in rectovaginal septum
> limited uterine mobility
> adnexal mass
17
Q

how is endometriosis diagnosed?

A

> LAPAROSCOPY
MRI for deep
ultrasound

18
Q

what is the medical treatment of endometriosis?

A

> GhRH analogue
progesterone
combined oral contraceptive

19
Q

what is the surgical treatment of endometriosis?

A

> excision of deposits from peritoneum/ovary
diathermy/laser ablation of deposits
removal of ovaries plus or minus hysterectomy

20
Q

what is dysfunctional uterine bleeding?

A

abnormal bleeding bit no structural/endocrine/neoplastic/infectious cause found

21
Q

what surgical treatment is available for dysfunctional uterine bleeding?

A

> endometrial ablation

> hysterectomy

22
Q

what is endometrial ablation?

A

permanent destruction of the endometrium

23
Q

what pre-requisites do you need for endometrial ablation?

A

> uterine cavity length of more than 11 cm
submucous fibroids less than 3 cm
previous normal endometrial biopsy

24
Q

what are the risks of a hysterectomy?

A 
> infection
> DVT
> injury
 - bladder
 - bowel
 - adhesions
25
Q

what medical treatment is there for dysfunctional uterine bleeding?

A

> hormonal contraception
mefenamic acid
tranexamic acid

26
Q

what is the action of mefenamic acid?

A

> prostaglandin inhibitor

> reduces blood loss 30%

27
Q

what is the action of tranexamic acid?

A

> antifibrinolytic
reduces blood loss by 60%
doesn’t regulate cycle

28
Q

what is adenomyosis?

A

characterised by endometrial tissue in the myometrium

29
Q

how does adenomyosis present?

A

> heavy painful periods
bulky tender uterus
parous women
may coexist with endometriosis

30
Q

how is adenomyosis diagnosed?

A

> CLINICALLY

> histology of uterine muscle (generally post hysterectomy)

31
Q

how is adenomyosis treated?

A

> hormonal contraception

Repro (22 decks)

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