Period Problems Flashcards
What is Oligomenorrhoea?
Prolonged period cycle, with each period lasting >35 days
What are some causes of Oligomenorrhoea?
Constitutional
Anovulation
What are some conditions that can lead to Anovulation?
PCOS
Thyroid Disease
Prolactinoma
CAH
What is Primary Amenorrhoea?
Patient presents with no menarche by age 16
What are some causes of Primary Amenorrhoea?
Delayed Puberty Imperforate Hymen Absent Vagina Mullerian Agenesis Gonadal Dysgenesis PCOS CAH
What is Secondary Amenorrhoea?
Absent periods for:
3m if regular periods
6m if irregular periods
What are some causes of Secondary Amenorrhoea?
Pregnancy PCOS Premature Menopause Prolactinoma Thyroid disease Cushings Eating Disorder Exercise-Induced Asherman Syndrome Sheehan Syndrome
What is PCOS?
A heterogenous endocrine disorder presenting with multiple ovarian cysts and reduced fertility as a result
What are some features of PCOS?
Hyperandrogenism - Acne, Hirsuitism, Obesity
Anovulation - Oligo/Amenorrhoea, Multiple follicles on USS, increased Ovarian Volume
Infertility
Increased insulin resistance
Which criteria is used to diganose PCOS?
Rotterdam Criteria
What factors are found in the Rotterdam Criteria for PCOS?
Clinical/Biochemical signs of Hyperandrogenism
Oligo/Amenorrhoea
USS Features of PCOS
Which investigations are appropriate for suspected PCOS?
USS Free Androgen index FSH, LH TFTs Prolactin
How should confirmed PCOS be managed?
Weight loss if pregnancy is desired
COCP for regular periods
Acne Treatment
What are some long-term complications of PCOS?
T2DM CV Disease Obstructive sleep apnoea Infertility Recurrent Miscarriage Pregnancy Complications - PET, GDM Endometrial Cancer Anxiety and Depression
What is the median blood loss expected during a period?
37-43ml
What affects the mean blood lost during a Period?
Increasing Age
Genetics
Parity
What is Menorrhagia?
Heavy Regular Bleeds
What is Metrorrhagia?
Irregular Heavy Bleeds
What is Dysfunctional Uterine Bleeding?
Heavy menstrual bleeding in the absence of any uterine pathology
Which Pathologies can contribute to Heavy Menstrual bleeding?
Fibroids Adenomyosis Endometriosis IUCD PID Polyps
Which Medical Disorders can contribute to Heavy Menstrual Bleeding?
Hypothyroidism
Liver Disease
Which clotting disorders can lead to Heavy Menstrual Bleeding?
von Willebrands Thrombocytopenia Platelet disorders Coagulation disorders Leukaemia
How can the impact of HMB on QoL be assessed?
Work and Social life impact
Bleeding through clothing
Bed soiling
Sleep disruption
When should HMB only recieve basic investigations?
<45y
No IMB
No risk factors for Endometrial Cancer
When should HMB receive detailed investigation?
> 45
IMB
Suspected Pathology
Risk Factors for Endometrial Cancer
Which investigations are appropriate for those with HMB at high risk of a pathology?
USS
Hysteroscopy +/- Biopsy
What medical management is available for HMB?
Tranexamic Acid
Mefenamic Acid
Ullipristal Acetate if Fibroids
Hormonal - POP, Mirena
How does Tranexamic Acid work?
Reduces Fibrinolysis
How does Mefenamic Acid work?
NSAID
What surgical management is available for HMB?
Hysteroscopic removal of Polyps
Myomectomy for Fibroids
Hysterectomy if family complete
