Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a Women's health > Menstruation > Flashcards

Menstruation Flashcards

1
Q

What is menopause

A

permanent end of menstruation resulting from loss of ovarian follicular activity
* 12 consecutive months of amenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the normal age range for menopause

A

usually occurs between 45-55
average is 51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is considered early menopause

A

before the age of 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes premature menopause

A

premature ovarian insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give 5 menopause symptoms

A
  • vasomotor Sx: hot flushes/ night sweats
  • change in periods: cycle length, dysfunctional bleeding
  • irritability and mood swings
  • Urogenital: vaginal dryness and atrophy, frequency
  • disturbed sleep
  • anxiety and depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes menopause

A

a lack of ovarian follicular function resulting in:
* low oestrogen and progesterone
* high LH and FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the perimenopause time period

A

starts with the first features of approaching menopause and ends 12m after the last period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is perimenopause managed with HRT

A
  • Uterus: topical/ oral cyclical combined HRT
  • No uterus: oral/ topical oestrogen only HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A lack of oestrogen increases the risk of certain conditions. State 4

A
  • cardiovascular disease
  • osteoporosis
  • pelvic organ prolapse
  • urinary incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When prescribing hormone replacement therapy, what is an important question to ask

A

if she has a uterus/ has had a hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is HRT used to manage menopause in a woman with a uterus

A
  • continuous combined regimen: oestrogen AND progestogen
  • oral / transdermal (estradiol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is transdermal HRT offered to woman in menopause

A
  • BMI >30
  • risk of gallstones
  • high triglycerides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is HRT used to manage menopause in a woman without a uterus

A

transdermal/ oral oestrogen (ONLY) therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why are progestogens added to oestrogens when managing menopause

A

reduce the increased risk of endometrial hyperplasia and carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Contraindication to HRT

A
  • Current or past breast cancer
  • Any oestrogen-sensitive cancer
  • Undiagnosed vaginal bleeding
  • Untreated endometrial hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Apart from HRT, how are menopausal symptoms managed

A
  • Vasomotor symptoms: fluoxetine, citalopram or venlafaxine
  • Vaginal dryness: vaginal lubricant or moisturiser
  • Psychological symptoms: self-help groups, CBT, antidepressants
  • urogenital atrophy: vaginal oestrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What kind of HRT does not increase the risk of VTE

A

Transdermal HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How long should effective contraception be used after the last period based on age?

A
  • 12 months after the last period for women over 50 years old.
  • 24 months after the last period for women under 50 years old.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the two phases of the menstrual cycle?

A

follicular phase and the luteal phase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the follicular phase?

A

The phase from the start of menstruation to the moment of ovulation (approximately the first 14 days in a 28-day cycle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the luteal phase?

A

From the moment of ovulation to the start of menstruation (the final 14 days of the cycle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What marks the start of the menstrual cycle

A
  • first day of menstruation
  • endometrium is shed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the follicular phase of the menstrual cycle

A
  • pulses of GnRH from the hypothalamus stimulate LH and FSH release which induce follicular growth
  • follicles secrete oestradiol and inhibin which suppress FSH secretion in a ‘negative feedback’
  • only one follicle and oocyte mature (dominant follicle)
  • dominant follicle continues to secrete oestradiol
  • rising oestradiol levels become a +ve feedback signal on hypothalamus and pituitary causing LH levels to rise sharply: ovulation follows 36hrs later
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the luteal phase of the menstrual cycle

A
  • after ovulation, the follicle that released the ovum becomes the corpus luteum
  • corpus luteum secretes high levels of progesterone and a small amount of oestrogen
  • towards the end of the phase, the corpus luteum degenerates and stops producing oestrogen and progesterone
  • This fall in oestrogen and progesterone causes the endometrium to break down and menstruation to occur.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe the changes to the endometrium during the menstrual cycle

A
  • shedding of the endometrium (menstruation)
  • proliferative phase - high oestrogen levels stimulate thickening of the endometrium. cervical mucus more permeable
  • secretory phase - cervical mucus thickens. stromal cells release prostaglandins which encourage the endometrium to break down and the uterus to contract
26
Q

What is abnormal uterine bleeding

A

any variation from the normal menstrual cycle
* changes in regularity and frequency
* changes in duration of flow
* changes in amount of blood loss

27
Q

Give 4 structural causes of abnormal uterine bleeding

A

PALM
* Polyps
* Adenomyosis
* Leiomyomas (fibroids)
* Malignancy and hyperplasia

28
Q

Give 5 non-structural causes of abnormal uterine bleeding

A

COEIN
* Coagulopathy
* Ovulatory dysfunction
* Endometrial hyperplasia/ carcinoma
* Iatrogenic
* Not yet specified

29
Q

What is menorrhagia

A

heavy menstrual bleeding, that the woman considers to be excessive
* prev defined as blood loss >80mL per cycle

30
Q

Give 5 causes of menorrhagia

A
  • dysfunctional uterine bleeding (absence of underlying pathology)
  • uterine fibroids and polyps
  • bleeding disorders ((e.g. Von Willebrand disease)
  • PID
  • Endometrial/ cervical malignancy
31
Q

What clinical features of a menorrhagia history would indicate excess blood loss

A
  • flooding
  • passage of large clots
32
Q

How is menorrhagia investigated

A
  • FBC - may show anaemia
  • pelvic exam - assess for masses
  • transvaginal ultrasound - exclude structural causes
  • coagulation/ thyroid testing if Hx indicates it
33
Q

How is menorrhagia pharmacologically managed in women that do not require contracepetion

A
  • Tranexamic acid
  • mefenamic acid (if there’s associated pain)
34
Q

How is menorrhagia pharmacologically managed in women that require contraception

A
  • intrauterine system - Mirena first line
  • combined oral contraceptive pill
  • long-acting progestogens
35
Q

How is menorrhagia managed if medical management has failed

A
  • referral to secondary care
  • endometrial ablation - removal/ destruction of endometrium
  • balloon thermal ablation
  • hysterectomy - last resort
36
Q

What is amenorrhoea

A

absence of menstruation

37
Q

What is primary amenorrhea

A

Failure to establish menstruation by:
* 13 years with no secondary sexual characteristics
* 15 years of age with normal secondary sexual characteristics (such as breast development)

38
Q

Give 5 causes of primary amenorrhoea

A
  • gonadal dysgenesis (e.g. turners syndrome)
  • Androgen insensitivity syndrome
  • imperforate hymen/ FGM
  • congenital adrenal hyperplasia
  • constitutional delay
39
Q

What is secondary amenorrhea

A
  • cessation of menstruation for 3-6 months in women with previously normal and regular menses
    or
  • 6-12 months in women with previous oligomenorrhoea
40
Q

Give 5 causes of secondary amenorrhea

A
  • Pregnancy
  • hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
  • polycystic ovarian syndrome (PCOS)
  • hyperprolactinaemia
  • premature ovarian failure and menopause
  • thyrotoxicosis
  • Sheehan’s syndrome - severe PPH causing pituitary necrosis)
  • Asherman’s syndrome (intrauterine adhesions)
41
Q

How is amenorrhea investigated

A
  • UPT or serum bHCG - exclude pregnancy
  • LH and FSH levels
  • prolactin
  • FBC, U+Es, TFTs,
  • gonadotrophins - secondary: low = hypothalamic cause, high = ovarian problem
42
Q

How is primary amenorrhea managed

A
  • treat underlying cause
  • stress - CBT, healthy weight gain
  • Ovarian causes - COCP
  • hypopituitarism - pulsatile GnRH or COCP
43
Q

How is secondary amenorrhea managed

A
  • exclude pregnancy and menopause
  • treat underlying cause
44
Q

What is dysmenorrhea

A

excessively painful menstruation

45
Q

What is primary dysmenorrhea

A

when there is no underlying pelvic pathology

46
Q

What is thought to be partially responsible for primary dysmenorrhea?

A

Excessive endometrial prostaglandin production

47
Q

What are the typical features of primary dysmenorrhea

A
  • pain typically starts just before or within a few hours of the period starting
  • suprapubic cramping pains which may radiate to the back or down the thigh
48
Q

How is primary dysmenorrhea managed

A
  • 1st line: NSAIDs such as mefenamic acid and ibuprofen - They work by inhibiting prostaglandin production
  • 2nd line: COCP
49
Q

What is secondary dysmenorrhea

A

typically develops many years after the menarche and is the result of an underlying pathology

50
Q

When does the pain usually start in women with secondary dysmenorrhea

A

pain usually starts 3-4 days before the onset of the period

51
Q

Give 4 causes of secondary dysmenorrhea

A
  • fibroids
  • adenomyosis
  • endometriosis
  • pelvic inflammatory disease
52
Q

What should be done for all patients with secondary dysmenorrhea?

A

referral to gynaecology for investigation.

53
Q

What is premenstrual syndrome (PMS)

A

describes the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle

54
Q

Give 4 emotional symptoms of premenstrual syndrome

A
  • anxiety
  • stress
  • fatigue
  • mood swings
55
Q

Give 3 physical symptoms of premenstrual syndrome

A
  • bloating
  • breast pain
  • headaches
56
Q

How is premenstrual syndrome managed

A
  • general lifestyle changes, stress, exercise, alcohol restriction, smoking cessation, sleep etc
  • regular, frequent (2-3 hourly), small, balanced meals rich in complex carbs
  • New generation COCP ( drospirenone)
  • SSRi - continuously or just during the luteal phase
57
Q

What is premature ovarian insufficiency

A

defined as menopause before the age of 40 years
characterised by hypergonadotropic hypogonadism

58
Q

Give 5 causes of premature ovarian sufficiency

A
  • idiopathic - mc
  • iatrogenic - radio/ chemotherapy
  • autoimmune - T1DM, thyroid etc
  • infections - e.g. mumps
  • bilateral oophorectomy
59
Q

How does premature ovarian sufficiency present

A
  • secondary amenorrhea
  • hot flushes
  • night sweats
  • infertility
  • vaginal dryness
60
Q

How is premature ovarian sufficiency diagnosed

A
  • younger than 40 years with typical menopausal symptoms and an elevated FSH (>25 IU/L)
  • elevated FSH levels should be demonstrated on 2 consecutive blood samples taken 4-6 weeks apart
  • low oestradiol
61
Q

What conditions are women with premature ovarian failure at higher risk for due to the lack of oestrogen?

A
  • Cardiovascular disease
  • Stroke
  • Osteoporosis
  • Cognitive impairment
  • Dementia
  • Parkinsonism
62
Q

How is premature ovarian sufficiency managed

A
  • Traditional HRT or COCP until 51
  • should be noted that HRT does not provide contraception

3a Women's health (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions