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Reproductive > Menstrual problems > Flashcards

Menstrual problems Flashcards

1
Q

What is the normal age range for menstruation?

A

13-51yrs

Menarche-menopauce

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2
Q

How is menstruation triggered?

A

Fall in progesterone 2wks after ovulation if not pregnant

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3
Q

What is the mean volume of blood lost during menstruation?

A

30-40ml

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4
Q

What is menorrhagia and typically what volume?

A

Heavy periods (>80ml/cycle)

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5
Q

What is dysmenorrhoea?

A

Painful periods

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6
Q

What is inter-menstrual bleeding (IMB)?

A

Bleeding between periods

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7
Q

What is postcoital bleeding (PCB)?

A

Bleeding after intercourse

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8
Q

What is oligomenorrhoea?

A

Infrequent periods

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9
Q

What do you ask in history of menstrual problems?

A

PAtient’s perception
Clots/flooding/pads/tampons
Pain
Effect on lifestyle

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10
Q

What do you exam in history of menstrual problems?

A

General
Abdo
Speculum
Bimanual

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11
Q

What are the investigations for those with menstrual problems?

A

Heavy periods: FBC, thyroid function, coag, endometrial biopsy

IMB and PCB: chlamydia

Pregnancy test
TV US
Hysteroscopy

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12
Q

When would you do hysteroscopy?

A

Persistent IMB

Suspected endometrial pathology on US

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13
Q

If early teens, what are likely menstrual problem?

A

Anovulatory cycles

Coagulation problems

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14
Q

If teens-40, what are likely menstrual problems?

A 
Chlamydia
Contraception related
Endometriosis/adenomyosis
Fibroids
Endometrial/cervical polps
Dysfunctional bleeding
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15
Q

If 40-menopause, what are likely menstrual problems?

A

Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction

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16
Q

What is the mneumonic for the FIGO classification of abnormal uterine bleeding?

A

PALM-COEIN

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17
Q

What is PALM-COEIN (FIGO classification of abnormal uterine bleeding)?

A 
P - polyp
A - adenomyosis
L - leiomyoma
M - malignancy/hyperplasia
C - coagulation
O - ovarian (PCOS/anovulatory)
E - endocrine (thyroid)
I - iatrogenic (warfarin)
N - not yet classified
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18
Q

What is DUB?

A

Dysfunctional uterine bleeding

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19
Q

What is dysfunctional uterine bleeding (DUB)?

A

Abnormal bleeding but no structural/endocrine/neoplastic/infectious cause found

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20
Q

What is endometriosis?

A

Endometrial type tissue outside the uterine cavity

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21
Q

What is endometriosis dependent on?

A

Oestrogen

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22
Q

Where does endometriosis usually affect?

A

Ovary, pouch of Douglas, pelvic peritoneum

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23
Q

What are the signs/symptoms of endometriosis?

A

Premenstrual pelvic pain
Dysmenorrhoea
Deep dyspareunia
Subfertility

May be no signs
Tender nodules in rectovaginal septum
Limited uterine mobility
Adnexal mass

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24
Q

What is the gold standard for diagnosing endometriosis?

A

Laparoscopy

25
Q

What can be seen on laparoscopy for endometriosis?

A

Clear, red, bluish black or white lesions

26
Q

What is the diagnostic technique for deep endometriosis?

A

MRI

27
Q

What can be used to diagnose endometrioma?

A

US

28
Q

What are the investigations for endometriosis?

A

Laparoscopy

MRI

29
Q

What are chocolate cysts?

A

Noncancerous, fluid-filled cysts that typically form deep within the ovaries

30
Q

What are the treatment options for endometriosis?

A

Medical

Surgical

31
Q

What are the medical treatments for endometriosis?

A

Progesterone: oral/injection/Levonorgesterel IUD
CHC pill
GnFH analogues (e.g. leuprorelin)

32
Q

What are the surgical treatments for endometriosis?

A

Excision of deposits from peritoneum/ovary
Diathermy/laser ablation of deposits
Removal of ovaries with/without hysterectomy

33
Q

What is adenomyosis?

A

Presence of endometrial tissue in the myometrium

34
Q

What are the symptoms/signs of adenomyosis?

A

Heavy painful periods
Bulky tender uterus
Usually parous women
May co-exist with endometriosis

35
Q

How is adenomyosis diagnosed?

A

MRI

Histology (post-hysterectomy)

36
Q

What is the treatment for adenomyosis?

A

Hormonal contraception for painful/heavy periods: LNHIUS (Mirena), progestogens, combined OCP

37
Q

What are fibroids?

A

Smooth muscle growths (leiomyoma)

38
Q

What are the symptoms of fibroids?

A 
Usually asymptomatic
Large = pressure symptoms
Menorrhagia
IMB
In pregnancy: pain, malpresentation, obstruction in labour
39
Q

What group have a higher incidence of fibroids?

A

Afro-Caribbean women

40
Q

What are the investigations for fibroids?

A

Clinical exam = irregularly enlarged uterus
US
Hysteroscopy

41
Q

What are the 3 types of fibroids?

A 
Submucous = protrude into uterine cavity
Intramural = within uterine wall
Subserous = project out of uterus into peritoneal cavity
42
Q

What is the treatment for fibroids?

A 
Only symptomatic
GnRH analogues or Ulipristal acetate - shrink fibroids
Transcervical resection
Myomectomy
Uterine artery embolisation
Hysterectomy
43
Q

What is the treatment for submucous fibroids?

A

Transcervical resection hysteroscopically

44
Q

What are treatments options for DUB?

A

Reassurance not sinister
Medical
Surgical

45
Q

What are the medical treatments for DUB?

A

Non-hormonal: tranexamic acid or mefanamic acid

Hormonal: POP, injection (Depo Provera), LNG IUS, CHC pill

46
Q

What are the surgical treatments for DUB?

A

Endometrial ablation

Hysterectomy

47
Q

What does tranexamic acid do in DUB?

A

Reduces blood loss

48
Q

What does Mefenamic acid do in DUB?

A

Reduces blood loss and pain

49
Q

When are tranexamic acid and Mefenamic acid taken for DUB?

A

At time of periods

50
Q

What approaches are there to hysterectomy?

A

Abdominal
Vaginal
Laparoscopic

51
Q

What is removed in a total hysterectomy?

A

Cervix and uterus

52
Q

What is removed in subtotal hysterectomy?

A

Uterus removed

Cervix left

53
Q

What are the risks for hysterectomy?

A

Infection, DVT, bladder/bowel/vessel injury, altered bladder function, adhesions

54
Q

What does hysterectomy guarantee?

A

Amenorrhoea

55
Q

What is removal of the ovaries with uterus called?

A

Total hysterectomy with bilateral salpingo-oophrorectomy

56
Q

What are disadvantages of oophroectomy?

A

Immediate menopause, recommended HRT till age 50

57
Q

What are advantages of oophorectomy?

A

Reduces risk of ovarian cancer

58
Q

Why is there a high risk of menopause 2yrs post-hysterectomy?

A

Compromised blood supply

Reproductive (20 decks)

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