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O&G > Menstruation and its disorders > Flashcards

Menstruation and its disorders Flashcards

1
Q

{ } is a depressive disorder that often follows ovulation and remits within a few days of menses

A

Premenstrual dysphoric disorder

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2
Q

What is the proposed pathophysiology of endometriosis?

A

Retrograde menstruation

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3
Q

What is a uterine leiomyoma?

A

Benign smooth muscle tumours within the myometrium

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4
Q

A uniformly enlarged uterus is characteristic of adenomyosis or leiomyomas?

A

Adenomyosis

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5
Q

An irregularly enlarged uterus is characteristic of adenomyosis or leiomyomas?

A

Leiomyoma

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6
Q

What are two risk factors for adenomyosis?

A

Early menarche

Increased parity

Previous uterine surgery

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7
Q

How do GnRH agonists (leuprolide, goserelin) work to treat leiomyomas?

A

GnRH → pituitary desensitised to overstimulation → reduced LH and FSH → reduced estrogen synthesis → fibroids deprived of growth → volume reduction

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8
Q

Why are GnRH agonists unsuitable as a long term treatment option for leiomyomas?

A

Rebound growth

Osteoporosis

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9
Q

What are 3 treatment options for adenomyosis?

A

COCP - reduced pain and intensity of bleeding

Progestin-only contraception - amenorrhoea

Total hysterectomy

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10
Q

What is adenomyosis?

A

The presence of endometrial glands and stroma within the myometrium

Ectopic endometrial tissue induces hypertrophy and hyperplasia of the surrounding myometrium, resulting in a diffusely enlarged uterus

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11
Q

How does tranexamic acid work?

A

Inhibits activation of plasminogen to plasmin.

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12
Q

When is tranexamic for menorrhagia taken during the menstrual cycle?

A

During menses and 3-5 days following bleeding

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13
Q

What investigations should be done in all women with post-menopausal bleeding?

A

Ultrasound examination of pelvis

Hysteroscopic examination of uterine cavity

Endometrial biopsy

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14
Q

What should the endometrial thickness be in post-menopausal women?

A

Less than 5mm

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15
Q

What proportion of infertile women are found to be affected by endometriosis?

A

Up to 50%

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16
Q

What single investigation effectively diagnoses and assesses the severity of endometriosis?

A

Laparoscopy

17
Q

What are the side effects of gonadotrophin releasing hormone analogues?

A

Hot flushes

Break through bleeding

Vaginal dryness

Headaches

Decreased libido

Bone density loss

18
Q

What are the causes of primary amenorrhoea?

A

Delayed puberty

Genital tract anomaly

Turner syndrome or other gonadal dysgenesis

Androgen insensitivity syndrome

Congenital adrenal hyperplasia

19
Q

What are the causes of premature ovarian failure?

A

Turner syndrome

Fragile X carrier

Post-chemotherapy

Post-radiotherapy

Oophorectomy

20
Q

What investigations should be done for someone with suspected PCOS and what would you expect to find?

A

Testosterone: high

LH: high and LH:FSH ratio > 2:1

DHEA-S: high

Oestrogen: normal or slightly elevated

OGTT

Lipids

TVUS

21
Q

What are the Rotterdam diagnostic criteria for PCOS?

A

Two of:

  1. Oligo/anovulation
  2. Clinical or biochemical signs of hyperandrogenism
  3. Polycystic ovaries (12+ peripheral follicles or increased volume)
22
Q

What are the long term complications of PCOS?

A

Endometrial hyperplasia and cancer

Type II diabetes

Cardiovascular pathology

Hirsutism and acne

23
Q

What is the best intervention for a woman with PCOS who wants to conceive?

A

Weight loss

24
Q

What are the drugs that can cause hyperprolactinaemia?

A

Antipsychotics

TCAs

Metoclopramide/domperidone

Verapamil

Methyldopa

25
Q

What is the karyotype of complete androgen insensitivity syndrome?

A

46XY (male)

Female external genitalia as oestrogen can be produced

26
Q

What menstrual bleeding pattern is seen with anovulatory uterine bleeding?

A

Irregular or infrequent periods

Flow ranging from light to excessively heavy

27
Q

What is the risk of anovulatory uterine bleeding?

A

Endometrial cancer

(high estrogen, low progesterone state)

28
Q

What are the possible clinical features of leiomyomas?

A

Abnormal uterine bleeding

Pressure/bulk symptoms (heaviness, urinary frequency and urgency)

Infertility, recurrent pregnancy loss

29
Q

What interventional radiological procedure can be used for leiomyomas?

A

Uterine artery embolisation

Occlusion of uterine arteries → reduction in fibroid size

Uterus preserved but fertility is not

30
Q

What are the causes of abnormal uterine bleeding?

A

PALM (structural) COEIN (nonstructural)

P - polyp

A - adenomyosis

L - leiomyoma

M - malignancy and hyperplasia

C - coagulopathy

O - ovulatory dysfunction

E - endometrial

I - iatrogenic

N - not yet classified

31
Q

What laboratory test is used to diagnose anovulatory uterine bleeding?

A

Day 21 progesterone

O&G (13 decks)

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