Menstruation Flashcards
Describe normal menstruation
Normal loss: less than 80ml over 7 days (16tsp)
Average loss: 30-40ml (6-8tsp)
Average duration: 2-7days
What are some potential disturbances of menstruation?
Frequency; frequent or infrequent
Irregular or absent
Abnormal duration of flow
Abnormal volume
Describe heavy menstrual bleeding
Difficult to quantify
May include:
- > 80ml over 7 days
- need to change menstrual products every one to two hours
- passage of clots bigger than 2.5cm
- bleeding through clothes
- affecting quality of life
What are some causes of heavy menstrual bleeding?
Uterine and ovarian pathologies i.e. uterine fibroids, endometrial polyps, endometriosis
Systemic diseases and disorders
- coagulation disorders, hypothyroidism, liver or renal disease
Iatrogenic; anticoag treatment, herbal supplements, IUD
Describe fibroids
Non-cancerous growths made of muscle and fibrous tissue
May be asymptomatic or could have HMB, pelvic pain, urinary symptoms, , backache, infertility, miscarriage
Diagnosis: US
Describe fibroid management
Management: Symptom based
- HMB; pill
- large fibroids and fertility desired; embolisation, myomectomy
- submucosal fibroids; hysteroscopic fibroid resection
Declined/failed medical treatment and fertility preservation not required: hysterectomy
Describe endometriosis
Endometrial tissue present outside lining of uterys
May present with HMB, pelvic pain
Multi-system involvement
Severely affects QoL
Can cause infertility, fatigue, systemic symptoms
Severity of deposits may not correspond with symptoms
What are the four stages of endometriosis?
Stage 1 : Minimal
- mall patches, surface lesions or inflammation around organs in pelvic cavity
Stage 2 : Mild
- more widespread and starting to infiltrate pelvic organs
Stage 3 : Moderate
- peritoneum or other structures, sometimes also scarring and adhesions
Stage 4 : Severe
- infiltrative and affecting many pelvic organs and ovaries, often with distortion of anatomy and adhesions
Describe diagnosis and management of Endometriosis
Pelvic examination
US, diagnostic laparoscopy
Management: analgesia, medical, surgical
Medical: COCP, POP, IUS, GnRH analogues
Surgical: ablation, hysterectomy endometrioma excision, pelvic clearance, hysterectomy
Surgical management may be required as part of fertility treatment
Describe adenomyosis
A condition where endometrium becomes embedded in myometrium
heavy menstrual bleed
May have significant dysmenorrhoea
May partially respond to hormones
Definitive treatment is hysterectomy
Describe endometrial polyps
Overgrowth endometrial lining
Mostly benign
Diagnosis by US or hysteroscopy
Management: polypectomy
Management of heavy menstrual bleeding
Thorough history
Pelvic examination
Clotting profile, thyroid function
PUS
Laparoscopy if endometriosis suspected
options depend on
- impact on QoL
- underlying pathology
- desire for fertility
Treatment options in heavy menstrual bleeding
Hormonal
- mirena IUS
- COCP
- POP
- depot provera
NON-hormonal
- mefenamic acid
- tranexamic acid
- GnRH analogues
Surgical
- endometrial ablation
- fibroid embolisation
- hysterectomy
Describe tranexamic acid and mefenamic acid
Tranexamic: antifibrinolytic reduces blood loss 60%
Mefenamic: prostaglandin inhibitor reduces blood loss 30% as well as reducing pain
Describe endometrial ablation
Permanent destruction of endometrium
First generation ablation: under hysteroscopic vision using diathermy
Second generation: thermal balloon, radiofrequency
Pre-requisites;
- uterine cavity length < 11cm
- submucous fibroids <3cm
- previous normal endometrial biopsy
