Menstrual Problems Flashcards
what constitutes a normal menstrual cycle?
> blood loss of 30-40 mls
4.5 days/21-35
age 13-51
what hormone change triggers menstruation?
decrease in progesterone 2 weeks after ovulation
what causes menstrual problems in the early teens?
> coagulation problems
> anovulatory cycles
what cause menstrual problems from the teens to 40yrs?
> chlamydia > fibroids > endometriosis > contraception related > polyps (cervical/endometrial) > dysfunctional bleeding
what causes menstrual problems from 40 yrs to menopause?
> warfarin
perimenopausal anovulation
thyroid dysfunction
endometrial cancer
what is the classification of causes of abnormal uterine bleeding?
> polyp > adenomyosis > leiomyoma > malignancy > coagulation > ovarian > endocrine > iatrogenic > not yet classified
what are fibroids?
smooth muscle growth
what are the 3 types of fibroids?
> submucous (protrude into uterine cavity)
intramural (within uterine wall)
subserous (project out of the uterus into the peritoneal cavity)
what are the symptoms of fibroids?
> pressure symptoms
menorrhagia
intermenstrual bleeding (submucosal)
asymptomatic
what features can fibroids have in pregnancy?
rapid increase in size causing
- pain
- obstruction in labour
- malpresentation
how are fibroids managed?
> only if symptomatic > GhRH to decrease size preoperatively > hysterectomy > uterine artery embolization > myomectomy > submucosal fibroids: trans cervical resection hysteroscopically
how are fibroids diagnosed?
> clinical exam
ultrasound
hysteroscopy
what is endometriosis?
endometrial type tissue outside the uterine cavity
where is endometrial tissue often found in endometriosis?
> pelvic peritoneum
ovary
pouch of douglas
true or false
the endometrial tissue found outside the uterine cavity in endometriosis is not oestrogen dependent
false it is oestrogen dependent
how does endometriosis present?
> dysmenorrhoea > premenstrual pelvic pain > deep dyspareunia > subfertility > tender nodules in rectovaginal septum > limited uterine mobility > adnexal mass
how is endometriosis diagnosed?
> LAPAROSCOPY
MRI for deep
ultrasound
what is the medical treatment of endometriosis?
> GhRH analogue
progesterone
combined oral contraceptive
what is the surgical treatment of endometriosis?
> excision of deposits from peritoneum/ovary
diathermy/laser ablation of deposits
removal of ovaries plus or minus hysterectomy
what is dysfunctional uterine bleeding?
abnormal bleeding bit no structural/endocrine/neoplastic/infectious cause found
what surgical treatment is available for dysfunctional uterine bleeding?
> endometrial ablation
> hysterectomy
what is endometrial ablation?
permanent destruction of the endometrium
what pre-requisites do you need for endometrial ablation?
> uterine cavity length of more than 11 cm
submucous fibroids less than 3 cm
previous normal endometrial biopsy
what are the risks of a hysterectomy?
> infection > DVT > injury - bladder - bowel - adhesions
what medical treatment is there for dysfunctional uterine bleeding?
> hormonal contraception
mefenamic acid
tranexamic acid
what is the action of mefenamic acid?
> prostaglandin inhibitor
> reduces blood loss 30%
what is the action of tranexamic acid?
> antifibrinolytic
reduces blood loss by 60%
doesn’t regulate cycle
what is adenomyosis?
characterised by endometrial tissue in the myometrium
how does adenomyosis present?
> heavy painful periods
bulky tender uterus
parous women
may coexist with endometriosis
how is adenomyosis diagnosed?
> CLINICALLY
> histology of uterine muscle (generally post hysterectomy)
how is adenomyosis treated?
> hormonal contraception
