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Obs & Gynae > Menstruation > Flashcards

Menstruation Flashcards

1
Q

What hormones are responsible for:

  • endometrial proliferation of the stromal cells and elongation of the glands ~day 13
  • endometrial secretory changes (enlarged cells, swollen glands and increased vascularity) ~day 21
  • what happens to cause shedding of endometrium and myometrial contraction?
A
  • oestrogen causes the proliferation
  • relatively more progesterone (from CL) causes the secretory changes
  • the failure of CL -> withdrawal of hormonal support leading to shedding
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2
Q

PALM COEIN is an acronym to remember the 9 main categories of AUB (abnormal uterine bleeding)
PALM = structural causes
COEIN = non-structural causes
-name as many structural as poos:

A

P: Polyps

A: Adenomyosis

L: Leiomyomas (fibroids)

M: Malignancy/Hyperplasia

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3
Q

PALM COEIN is an acronym to remember the 9 main categories of AUB (abnormal uterine bleeding)
PALM = structural causes
COEIN = non-structural causes
-name as many non-structural as poos:

A 
C: Coagulopathy
O: Ovulatory Dysfunction
E: Endometrial (primary disorder of local endometrial haemostasis regulation)
I: Iatrogenic
N: not yet specified
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4
Q

Irregular menstrual bleeding is defined as cycle-cycle variation of > how many days?

A

> 20 days

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5
Q

Amenorrhoea is defined as no bleeding in a how many month interval?

A

> 6 months

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6
Q

What is the normal frequency of menstrual bleeding? (either side of which would be termed infrequent/frequent MB)
clue: range covers 14days

A

-normal is every 24-38days

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7
Q

What is the normal duration for a period to last either side of which is referred to as either prolonged or shortened?

A

-normal 3-8days

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8
Q

Bleeding >1yr after the acknowledged menopause is “post-menopausal bleeding”.
On the other hand, at what age is bleeding termed “precocious menstruation”?

A

-bleeding before the age of 9yrs

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9
Q

Suggest 2 common causes of heavy menstrual bleeding:

A
  • uterine fibroids
  • polyps
  • abnormalities of endometrial haemostasis
  • thyroid disease
  • coagulopathy
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10
Q

A family/personal hx of excessive post-insult bleeding/easy bruising in a women presenting with heavy menstrual bleeding may be suggestive of what?

A

-a coagulopathy such as von Willebrand’s disease

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11
Q

In the investigation of heavy menstrual bleeding,

  • irregular enlargement of the uterus suggests ______
  • adenomyosis is suggested by what? (with or without enlargement)
A
  • enlarged -> fibroids

- adenomyosis -> tenderness

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12
Q

What addition to TVUS can be given to improve dx of intrauterine pathology e.g. polyps, submucosal fibroids..

A

-addition of 5-15ml of saline through cervix into uterus “saline ultrasound”

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13
Q

State 3 risk factors for endometrial cancer in younger women:
clue: history of which conditions predisposes this risk?

A
  • obesity
  • diabetes
  • nulliparity
  • history of PCOS
  • family hx of HNPCC (non-polyposis CRC)
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14
Q

The pathway for management of heavy menstruation varies if women is trying to conceive or not, what are the 2 options initially in these cases?
-what will have been investigated and excluded first?

A
  • tranexamic acid / NSAIDs
  • progestogen IUS
  • will have excluded: anaemia, local causes, malignancy and systemic causes
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15
Q

If the following fails to control heavy menstruation what approach is adopted?

  • tranexamic acid / NSAIDs
  • progestogen IUS
A
  • SURGERY

- hysteroscopic or if not conceiving, hysterectomy

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16
Q 
What class of medications does transexamic acid belong to?
-NB: they are taken during menstruation only and reduce blood loss by ~50%
A

-anti-fibrinolytics

17
Q

What is the mechanism by which NSAIDs work and are able to reduce blood loss by ~30% in women with HMB?
e.g. mefenamic acid

A

-inhibit prostaglandin synthesis

18
Q

Myomectomy (removal of fibroids from myometrium) is done to remove fibroids when fertility is still desired.
Name 1 medication that can be given pre-operatively to reduce the size of the fibroids?

A
  • GnRH Agonists

- or Ulipristal Acetate

19
Q

Suggest 3 reasons to do an endometrial biopsy (usually with Pipelle):

A
  • age >40yrs
  • HMB with intermenstrual bleeding
  • RFs for endometrial cancer
  • HMB unresponsive to medical therapy
  • if US suggests polyp or focal endometrial thickening
  • prior to endometrial ablation (tissue wont be available for pathology)
  • if AUB has resulted in acute admission
20
Q

Give 3 causes of irregular/intermenstrual bleeding

A
  • fibroids
  • uterine/cervical polyps
  • adenomyosis
  • ovarian cysts
  • chronic pelvic infection
  • malignancy
21
Q

Suggest 3 investigations for irregular menstrual bleeding:

A
  • speculum exam (may reveal cervical polyp)
  • check Hb
  • exclude malignancy (TVUS)
  • may do cervical smear
  • endometrial biopsy
22
Q

Give 2 pathological causes of secondary a/oligo-menorrhoea:

NB: physiolog inc: pregnancy, lactation, menopause, drug-related

A
  • PCOS
  • premature menopause
  • hyperprolactinaemia
  • hypo/hyper-thyroidism
  • adrenal tumours
  • cervical stenosis
23
Q

Hypothalamic hypogonadism is a common cause of infrequent menstrual periods, what factors may lead to this?

A

-low weight/anorexia
-excessive exercise
(rarely tumours)

24
Q

What is hyperprolactinaemia treated with (usually caused by pituitary hyperplasia or adenomas)

A
  • DA agonists: e.g. Bromocriptine, -Cabergoline

- surgery

25
Q

Post-coital bleeding (other than 1st time) is always abnormal.
What must you exclude?
What are common causes? name2

A
  • exclude cervical carcinoma

- causes: cervical ectropions, benign polpys, cervicitis, vaginitis

26
Q

How is polyps and how are ectropions causing post-coital bleeding managed?

A
  • polyps are avulsed and sent for histology

- ectropions can be frozen w cryotherapy

27
Q

why must precocious puberty be treated by arresting sexual development? What medication is used to achieve this?

A
  • to allow normal growth (growth spurt will occur early with early fusion of epiphysis so shorter height reached)
  • give GnRH agonists to inhibit sex hormone secretion
28
Q

State 2 fts of McCune-Albright syndrome

-treated with c_____ a_____

A
  • bone cysts, ovarian cysts, cafe au lait spots, precocious puberty
  • cyproterone acetate
29
Q

What is the pattern of inheritance of congenital adrenal hyperplasia (CAH)?

A

-Autosomal Recessive

Obs & Gynae (9 decks)

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