menustrual disorders Flashcards
menorrhagia
heavy period (above 80ml per month) can cause iron deficiency 3 days menorrhagia = 1 month of reduced QOL
endometriosis
growth of endometrium outside of uterus
PCOS
polycystic ovary syndrome - follicles in which eggs develop but aren’t released
primary dysmenorrhea
peak incidence teens to twenties\pelvic pain and cramping
Gi symptoms
headaches, fatigue ,faintness
secondary dysmenorrhea
Consequences of other pelvic pathology,
pain may begin before menstruation (3-5 days before)
what causes dysmenorrhea ?
Prostaglandins PGF and PGE
myometrial contractility
endothelins - vasoactive peptides -regulates local PR production
vasopressin - stimulates uterine activity
decreases uterine blood flow (leads to myometrial ischaemia)
what causes dysmenorrhea ?
the drop in progesterone that causes the period also stimulates the production of
Prostaglandins PGF and PGE
myometrial contractility
endothelins - vasoactive peptides -regulates local PR production
vasopressin - stimulates uterine activity
decreases uterine blood flow (leads to myometrial ischaemia)
how are prostaglandins and leukotrienes produced?
the withdrawal of progestins causes cell wall phospholipids to be converted to arachidonic acid
COX enzyme convertes this to cyclic endoperoxieds- the pre cursor for PGs
or arachidonic acid can be converted to leukotrines
how is primary dysmenorrhea managed?
treat symptoms
NSAIDs - 1st line unless C/I
C/I - asthma, hiatus hernia, GI
ibuprofen, methanamic acid
alt: paracetamol (feminax express) feminax ultra
Antispasmodic: hyoscine butylpromide (unliscened OTC )
poor oral bioavailability
oral contraceptive : aim to regulate hormone cycle inhibits ovulation prevents increased PG synth in luteal phase decreased uterine contractility
what are the causes of secondary dysmenorrhea?
PG invovlement
PID - pelvic inflammatory Disease - diagnosis - antibiotic treatment needed
endometriosis
menorrhagia
fibroids
uterine polyps
uterine hyperplasia (endometrium overgrowth)
how is secondary dysmenorrhea managed?
treat according to cause
surgery: ablation reeve thin uppermost layer of endometrium using hot speculum
symptomatic pain relief
non analgesic relief
what questions to ask if patient complain about period pain
location, duration,before and after
additional symptoms, irregular period
other meds or conditions
OTC
co- codamol, ibuprofen, naproxen , heat wraps, hyoscine
hot water bottles (causes vasodilation), excercise
Endometriosis
benign
endometrial tissue found outside uterus (lung, GI tract)
caused by retrograde menstruation
increased prevalence with outflow obstruction
found even in embryos
how is endometriosis treated?(surgical and medical)
surgical treatment
laparoscopy - restore pelvic anatomy, divide adhesions, ablate endometrial tissue, reduced pain
hysterectomy (for those not wanting children)
medication : NSAIDS shrinkers( anti oestrogen ) contraceptives - CHC,POC,LNG-IUS progesterons GnRH analogues antiprogestogens (bad side effects so last resort) Selective androgen receptor modulator (SARM) target steroid bisynthetic pathway - new so not licensed
symptoms of endometriosis
dyspareunia (painful intercourse)
dyschezia (difficulty defecating)
dysuria ( similar to UTI , blood in urine)
chronic pelvic pain and menstrual irregularities
rarer :
cyclic haematuria _ bleeding in bladder
cyclical haemopytsis - bleeding in lungs
cyclical tenesmus - constant need to open bowel
diagnosis of endometriosis
pelvic exam (for masses or reduced organ mobility due to masses ‘gluing organs together))
pelvic ultrasound (transabdominal or transvaginal) to identify masses MRI and bloods not recommended
stage 1-4
1-2 - minimal to mild, poorly visualised common implantation site uterine and ovarian
stage 3-4
mod to severe , associated with adhesions
rectovaginal endometriosis, bowel invasion
diagnosing menorrhagia
flooding, large clots, double sanitary protection, frequent sanitary changes
cause of menorrhagia
most no underlining pelvic pathology :
DUB - dysfunctional uterine 60%bleeding (no pathology, pregnancy )
Gynaecological causes 35%:
menopause, fibroids,PID,miscarriage,ectopic pregnancy,adenomyosis,
endocrine and haemo causes,5%:
hepatic, renal or thyroid disease,PCOS
blood thinning meds
symptoms suggestive of underlying pelvic pathology menorrhagia
irregular bleeding sudden change in blood loss, intermenstrual bleeding, dyspareunia post coital bleeding pelvic pain premenstrual pain
diagnosing menorhagia
blood tests: iron, ferritin (thyroid) physical exam (tummy, cervix, enlarged tender ovaries, uterus) cervical smear endometrial biopsy ultrasound sonohysterography (fluid imagiing) hysterscopy (camera )
treating dysmenorrhea
symptomatic relief:
surgical treatment:
uterine artery embolisation (shutdown certain blood vessels)
myomectomy (fibroid removal)
hysterectomy)
Pharmalogical treatment:
NSAID
paracetamol
oral cyclical progestogen (high dose 5mg)
anti- progestogen gestrinone/danazol
hormonal contraceptive :
CHC,POC, IUS /parenteral progesterone , Mirena
local application of heat
TENS - Transcutaneous electrical nerve stimulation
treating dysmenorrhea
symptomatic relief:
surgical treatment:
uterine artery embolisation (shutdown certain blood vessels)
myomectomy (fibroid removal)
hysterectomy)
Pharmalogical treatment:
NSAID
paracetamol
oral cyclical progestogen (high dose 5mg)
anti- progestogen e.g. gestrinone/danazol
hormonal contraceptive :
CHC,POC, IUS /parenteral progesterone , Mirena
local application of heat
TENS - Transcutaneous electrical nerve stimulation
oligomenorhoea
infrequent (or, in occasional usage, very light) menstruation.[1] More strictly, it is menstrual periods occurring at intervals of greater than 35 days,
treating dysmenorrhea
symptomatic relief:
surgical treatment:
uterine artery embolisation (shutdown certain blood vessels)
myomectomy (fibroid removal)
hysterectomy)
Pharmalogical treatment:
NSAID
paracetamol
oral cyclical progestogen (low dose 5mg)
anti- progestogen e.g. gestrinone/danazol
hormonal contraceptive :
CHC,POC, IUS /parenteral progesterone , Mirena
local application of heat
TENS - Transcutaneous electrical nerve stimulation
oligomenorhoea
infrequent (or, in occasional usage, very light) menstruation. More strictly, it is menstrual periods occurring at intervals of greater than 35 days,
polymenorrhea
abnormally frequent, last excessively long, is more than normal, or is irregular.
