Menstrual problems Flashcards
What is the average age of menarche?
13-14
What is the average age of menopause?
51
What is a period triggered by?
Fall in progesterone 2 weeks after ovulation if not pregnant
What is the average blood loss during a period?
30-40ml
What is a subtotal hysterectomy?
Take uterus, but leave cervix
What is a total hysterectomy?
Take entire uterus
What is a total hysterectomy with BSO?
Take uterus, fallopian tubes and ovaries
What is a Wertheim’s hysterectomy?
Take uterus with margins, fallopian tubes and ovaries
What is recommended if removing the ovaries?
HRT until age 50
What are the risks of a hysterectomy?
Infection DVT Bladder, bowel or vessel injury Altered bladder function Adhesions
What should be asked in abhistory with menstrual problems?
Clots, flooding, how often changing
Pain
Effect on lifestyle and quality of life
What examinations should be done with menstrual problems?
General
Abdo
Bimaual
Speculum
What investigations should be done for heavy periods?
FBC
Thyroid function and coagulation if history suggestive
Endometrial biopsy if >45, persistent IMB or obesity
What should be tested for with inter menstrual bleeding and post coital bleeding?
Chlamydia
When should a hysteroscopy be carried out?
Persistent IMB
Suspected endometrial pathology on US
What are the common causes of menstrual problems in early teens?
Anovulatory cycles
Coagulation problems
What are the common causes of menstrual problems in teens-40 yo?
Chlamydia Contraception related Endometriosis Adenomyosis Fibroids Endometrial/cervical polyps Dysfunctional bleeding
What are the common causes of menstrual problems from 40 to the menopause?
Chlamydia Contraception related Endometriosis Adenomyosis Fibroids Endometrial/cervical polyps Dysfunctional bleeding Perimenopausal an ovulation Endometrial cancer Warfarin Thyroid dysfunction
What is dysfunctional uterine bleeding?
Abnormal bleeding without known structural, endocrine, neoplastic or infectious cause
What is the treatment of dysfunctional uterine bleeding?
Reassure
Hormonal- progestogen, Mirena, combined OCP
Non hormonal- tranexamic acid, medanamic acid
Surgical- endometrial ablation, hysterectomy
What does tranexamic acid do?
Reduces blood loss
What does medanamic acid do?
Reduced blood loss and pain
What is endometriosis?
Endometrial type tissue outside uterine cavity
Oestrogen dependent chronic condition
Where is endometriosis usually found?
Ovary
Pouch of Douglas, pelvic peritoneum
What are the signs and symptoms of endometriosis?
Asymptomatic Premenstrual pelvic pain Dysmennorhoea Deep dyspareunia Subfertility Tender nodules in rectovaginal septum Limited uterine mobility Adnexal mass
What investigations are done for endometriosis?
Laprascopy
MRI for deep disease
US
What is the medical treatment of endometriosis?
Progestogen
Combined OCP
GnRH analogues
What are the surgical treatment options of endometriosis?
Excision of deposits
Diathermy/laserablation of deposits
Removal of ovaries with or without hysterectomy
What is adenomyosis?
Endometrial tissue in myometrium
Who is adenomyosis usually sen in?
Parous women
What are the signs and symptoms of adenomyosis?
Heavy, painful periods
Bulky, tender uterus
What investigations are done for adenomyosis?
MRI
Histology of uterine muscle
What is the treatment of adenomyosis?
Hormonal- Mirena, progestogens, combined OCP
Hysterectomy
What are the types of fibroids?
Submucosal- protrude into uterine cavity
Intramural- within uterine wall
Sub serous- project unto peritoneal cavity
What are the signs and symptoms of fibroids?
Asymptomatic
Pressure symptoms
Menorrhagia
Intermenstrual bleeding
What are the signs and symptoms of fibroids in pregnancy?
Pain
Malpresentation
Obstruction
What investigations are done for fibroids?
EXamination
US
Hysteroscopy if inside uterine cavity
When are fibroids treated?
If symptomatic
What are the treatment options for fibroids?
Hormonal GnRH analogues or ulipristal acetate Transcervical resection Myomectomy Uterine artery embolisation Hysterectomy
WHt is the use of GnRH analogues and ulipristal acetate in fibroids?
Shrink fibroids preoperatively
Ammonorrhea causes
Life change (stress, eating disorders, obesity, intense exercise) Hormonal issues Primary ovarian insufficiency Polycystic ovarian syndrome Hyperprolactineamia Prolactinomas Thyroid disorders Uterine, cervical and/or vaginal blockages
What is PALM COEIN?
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy Ovulatory disorder Endometrial dysfunction Iatrogenic Not known
Mesonephric duct cyst names
Epoophoron - under ovary
Paraoophoron - next to ovary
Gartners cyst - close to vagina
Paramesonephric duct abnormalities
Duplication Improper fusion Bicornate uterus Septate uterus Arcuate uterus
