Mentruation Flashcards
Normal and Abnormal
What is classified as ‘normal menstruation’?
Lasting 4-6 days with heaviest days being 1 and 2.
<80ml per day and no clots passed
no intermenstrual or post-coital bleeding
What is menorrhagia and metrorrhagia?
Menorrhagia - increased menstrual bleeding
Metrorrhagia - regular intermenstrual bleeding
What is polymenorrhoea and polymenorrhagia?
Polymenorrhoea - cycle lasting <21 days
polymenorrhagia - increased frequency and menstrual bleeding
What is menometrorrhagia?
increased menstrual loss with regular intermenstrual bleeding
What is amenorrhoea and oligomenorrhoea?
Absensce of menstruation
Menstruation cycle lasting >35 days
What is DUB?
Dysfunctional uterine bleeding (menorrhagia in the absence of pathology - 50% of cases)
When does puberty usually start in females?
ages 9-11 with the start of breast development and pubic hair growth.
What is the average age of menarche in the UK?
12.9 years
What does LH act on in the ovary?
the thecal cells - to increase androgen production (and maturation of oocytes)
What are the four structures involved in the regulation of ovulation and menstruation?
Hypothalamus
Anterior pituitary gland
ovary
uterus
What is the definition of primary amenorrhoea?
No periods experienced before the age of 16 if no secondary characteristic present
if secondary characteristics present then investigate at 18
List some causes of primary amenorrhoea
Hypothalmic (lack of GnRH) or hypogonadotrophic (lack of LH or FSH)
List some organic causes of menorrhagia
tumours, fibroids, endometriosis, adenomyosis, IUCD, PID
List some systemic causes of menorrhagia
hypothyroidism/hyperthyroidism, diabetes, adrenal disease, prolactin disorders and coagulopathies (VWF deficiency, ITP, factor deficiency) or on anti-coagulant
List some causes of bleeding during pregnancy
Ectopic or miscarriage
What investigations would you consider in someone with menorrhagia?
FBC Coag screen TSH Endometrial sampling transvag USS cervical smear
What are the different types of DUB? Explain.
Anovulatory - 85% and will occur in the extremes of age
Ovulatory - 15% and due to insufficient secretion of hormone by the corpus luteum
What is the first line treatment of DUB?
IUD (mirena)
What is the second line treatment of DUB?
OCP
Antifibrinolytic e.g. transexamic acid
Antiprostaglanding e.g. mefanamic acid
What is the third line treatment of DUB?
GnRH analogues
What is the surgical treatment of DUB?
endometrial ablation/resection
hysterectomy
What are some physiological causes of amenorrhoea?
pre-menstrual
pregnancy
lactation
post-menopausal
What are some pituitary causes of amenorrhoea?
pituitary adenoma (non-functioning) prolactinoma (prolactin will inhibit GnRH production from hypothalamus and causes downstream decrease in FSH and LH levels)
What are some ovarian causes of amenorrhoea?
Premature ovarian failure
PCOS - ineffective LH so ovum never released from ovary. must have 2 of: cystic ovaries on pelvic USS, evidence of androgen excess (hirsuitism, acne) and amenorrhoea
What is menopause?
This is the normal cessation of menstruation due to reduced oestrogen production by the ovaries
When does menopause usually occur?
> 45
When is menopause abnormal?
<40 as this may signify POF
surgery, radiotherapy and chemotherapy all increase risk of this
What are the symptoms of menopause?
hot flushes, night sweats, vaginal dryness, low mood/anxiety, decreased libido, difficulty sleeping
If symptoms of menopause are severe what can be give (medical management)?
HRT - oestrogen +/- progesterone
When is combine HRT (oestrogen and progesterone) given and why?
Given to women with symptoms of menopause who still have a uterus. If oestrogen is unopposed then this increases risk of uterine cancer.
What other therapies can be used (apart from HRT) to treat menopause?
CBT
healthy diet and exercise
antidepressants
What does FSH act on and what does this result in?
Acts on the granulosa cells of the ovary to increase the conversion of androgens (secreted by the thecal cells) into oestrogen via aromatase enzymes
What happens to hormone axis during the menopause?
FSH levels are high - increased conversion of androgens to oestrogen by granulosa cells
LH low due to no formation of a leading follicle, so no ovum to be released (ovulation does not occur)
Progesterone low as no corpus luteum formation - increased FSH further to stimulate oocyte follicular development.
