Period problems Flashcards
Symptoms of PMS
Psych: Irritable Tense Dysphoria (unhappy) A severe form of this is premenstrual dysphoric disorder where there's episodes of depression each month that responds to AD treatment
Physical:
Breast tenderness
Bloating
Headache
Behavioural:
Reduced visuospatial and cognitive ability
More frequent accidents.
6x gynaecological causes of menorrrhagia
Fibroids Endometriosis Adenomyosis PID Endometrial polyps Cancer of the womb
Menorrhagia management
IUS is first line One of the acid is first line non hormonal Mefenamic is their is pain Tranexamic if no pain All women should get FBC
Whihc hormones cause increased fibroid growth?
Oestrogen and progesterone
4 types of fibroids (classification)
intramural
subserosal
submucosal
cervical
intramural fibroids definition
within myometrium
subserosal fibroids…
below peritoneal surface of uterus
submucosal fibroids …
beneath endometrial cavity - can distort uterine anatomy -> infertility
Which types of fibroids lead to infertility and recurrent miscarriage
submucosal and intramural
Sx fibroids
cramping, menorrhagia, bladder and bowel disregulation,
pregnancy fibroids Sx
foetal malpresentation, preterm labour, pph
Inidications for treatment in uterine fibroids (4)
excessive menstrual blood loss, pressure Sx, uterine cavity distortion, rapid growth (can be sarcomatous change)
Heavy bleeding in uterine fibroids management
1st - levonorgestrel releasing ius (not if cavity distorted)
Combined pill, tranexamic acid
Surgical management of uterine fibroids
myomectomy (if want kids)
hysterectomy (if not)
Endometriosis
when endometrial cells grow outside uterus
RF endometriosis
FH, oestrogen excess (low parity, early menarchem late menopause)
Sx endometriosis
fluctuate and worsen during menstrual phase.
subfertility, dysmenorrhea, chronic pelvic pain, menorrhagia, deep dyspareunia, pain on defecation (if in pouch of douglas), urinary Sx, abdo pain
endometriosis pelvic examination findings
reduced uterine motility, often fixed retroverted uterus tender nodularity, visible vaginal lesions, tender adnexal mass
Dx endometriosis
laparascopy, confirmed w biopsy
Mx endometriosis pain
NSAIDS, if helps then add hormonal (COCP, progesterone analogues)
if odesn’t help GnRH analogue to surpress growth of existing mass - consider HRT as causes pseudomenopause
adenomyosis - def, sx, mx
endometrial tissue within myometrium
causes painful heavy period and enlarged boggy uterus
managed GnRH agnoists/hysterectomy
PID
ascending infection of upper female genital tract - common complication of lower infections ie chlamydia
RF PID
under 25y, multiple sex partners, unprotected sex, copper IUD insertion recently
PID Sx
severe lower abdo pain - can radiate to back or upper thigh
dyspareunia
menorraghia, IM spotting, irregular periods, pc bleeding
mucopurulent/blood stained discharge
fever
us findings pid
dilated uterine tube or tubo ovarian abscess
Mx PID
broad spec ab for anaerobic and aerobic - oral ofloxacin + metronidazole or IM ceftiaxone +doxycycline +metronidazole
consider removing IUD
surgical removal of abscess if continues to grow despite ab
PID complications
10-20% chance infertility
chronic pelvic pain
pelvic adhesions
increased risk ectopic
8 pathological causes of irregular bleeding and IM spotting
STI, recent miscarriage, hormone dysfunction (PCOS, menopause), vaginal dryness, cervical ectoprion/erosison, cancer (cervical, uterine, vaginal. vulval), polyps, fibroids
charecteristics of PCOS (hormones)
increased LH, suppressed FSH -> suppressed normal menstrual cycle
PCOS: implications of high LH
increased androgen production, converted by aldipose tissue to oestrogen - more commen in obese women with more aldipose tissue
PCOS: implications of high oestrogen
no LH surge or FSH for follicular development -> anovulation and a/oligomenorrhea. Follicle becomes cystic/degenerates
clinical features PCOS
menstual cycle disturbance, hyperandrogenism (hirsutism, acne, alopecia - bitemporal/male pattern baldness), obesity in 50% cases, acanthosis nigricans (increased insulin levels). mood swings/depression
Rotterdam criteria
2 of following present for PCOS diagnosis:
infequent/absent periods
clinical features of hyperandrogenism or raised serum testosterone
USS evidence of >12 ovarian cysts
PCOS Ix
bloods - LH:FSH ratio > 3:1 within first 5 days of menstual cycle. raised serum oestrogen, testosterone, androstenedione.
Imaging - pelvic USS
Mx PCOS
weight loss, for fertility - clomiphene citrate induces ovulation (risk of multiple pregnancies) if not then gonadotrophs, metformin, COCP for hirsutism. surgical - ovarian drilling (less common)
cervical ectropion definition
distal migration of cervical columnar epithelium outside cervix into normal squamous region, resulting in exposure to vagina acid
cervical ectroprion causes
elevated oestrogen - COCP, pregnancy, lots of cycles, commonest cause of bleeding in last stages of pregnancy
sx cervical ectroprion
spotting, vaginal discharge, post coital bleeding and pain
how is menopause diagnosed
retrospectively when no periods for 12 mnths
define perimenopause
from onset of Sx to 1 year after menopause, can happen up to 5 years before cessation of periods
what causes perimenopause
GnRH, LH, and FSH levels increasing due to loss of negative feedback from reduced levels of oestrogen and progesterone
Menopause physiology (hormone changes and reasons)
decrease in development of ovarian follicles -> reduced oestrogen production -> no negative feedback -> increased levels of FSH and LH
failing follicle development -> anovulation -> irregular menstrual cycles
No oestrogen -> endometrium doesnt develop -> amenorrhoea
Which hormone causes perimoenopausal symtoms
low oestrogen
Perimenopausal Sx
hot flushes, emotional lability/low mood, premenstrual syndrome, irregular periods, arthralgia/muscle pain, skin thinning and decreased elasticity, heavy/light periods, vaginal dryness/atrophy, reduced libido
risks of menopause and low oestrogen
osteoporosis, CV risk (low oestrogen -> body fat alterations, increased BP, reduced glucose tolerance, endothelial dysfunction and vascular inflammation), pelvic organ prolapse, urinary incontinence
When is FSH blood test recommended to diagnose menopause/perimenopause
women under 40 with suspected premature menopause, women aged 40-45 with menopausal Sx or change in menstrual cycle
HRT contraindications
current/pmh breast cancer, any oestrogen sensitive cancer, undiagnosed vaginal bleeding, untreated endometrial hyperplasia
Risks of HRT
VTE, stroke, IHD, breast/ovarian Ca
Risk reduction in HRT
only give unopposed oestrogen if previous hysterectomy, transdermal is pmh VTE or at risk
How long should
