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Patient > Problems associated with mensturation > Flashcards

Problems associated with mensturation Flashcards

1
Q

what is precocious puberty?

A

onset of puberty earlier in girls <8 for girls

<9 for boys

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2
Q

when is puberty classed as delayed?

A

by 13-15 for girls

14 for boys

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3
Q

what is amenorrhoea?

A

absence of periods

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4
Q

what is dysmenorrhoea

A

problems with periods

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5
Q

what is menorrhagia?

A

bleeding

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6
Q

when Is pre-menstural syndrome?

A

1-2 weeks before periods

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7
Q

what happens in premature ovarian sufficiency

A

menopause <40

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8
Q

what can cause premature ovarian sufficiency

A

heavy diets or exercise
cancer
chemo
medication

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9
Q

average age of menopause?

A

50

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10
Q

when do changes of conceiving decrease?

A

yearly after the age of 35

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11
Q

reasons for post menopausal bleeding?

A

unlikely

usually other reasons that are more sinister

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12
Q

___% of women will have dysmenorrhoea at some point in their life

A

50-80

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13
Q

how many people who experience dysmenorrhoea are debilitated

A

10%

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14
Q

what is primary dysmenorrhoea

A 
symptoms of dysmenorrhoea but there's no cause 
cramping and pelvic pain 
may radiate to thighs 
gi symtoms 
headaches, fatigue
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15
Q

common peak incidence of primary dysmenorrhoea

A

teens to twenties

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16
Q

what is secondary dysmenorrhoea?

A

due to pathology or disease

consequence of pelvic pathology

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17
Q

what is a key symptom of secondary dysmenorrhoea?

A

pain may start before period

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18
Q

peak incidence of secondary dysmenorrhoea?

A

thirties- forties

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19
Q

how is dysmenorrhoea commonly caused?

A

higher concentrations of PGs in mensural fluid

incweasedmyometrial contractility

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20
Q

what PGs are most commonly associated with dysmenorrhoea?

A

PGF

PGE

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21
Q

what are other possible mediators in dysmenorrhoea?

A

endothelins

vasopressin

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22
Q

how can endothelins cause dysmenorrhoea

A

vasoactive peptides

role in local regulation of PG synthesis

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23
Q

how can vasopressin cause dysmenorrhoea

A

posterior pituitary
stimulates uterine activity
decreases uterine blood flow- this causes myometrial ischaemia which contributes to pain

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24
Q

what are mediators of prostaglandin production?

A

endothelins
vasoactive peptides produced in the endothelium
and vasopressin from the posterior pituitary hormone (also a vasoactive peptide)

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25
Q

What is membrane bound phospholipid converted to? and by what enzyme?

A

converted to arachidonic acid

byt phospholipidase

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26
Q

what can phospholipidase be inhibited by?

A

corticosteroids

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27
Q

what 3 things can arachidonic acid be converted to?

A

2 different types of prostaglandins

leukotrines

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28
Q

how is arachidonic acid converted to prostaglandins?

A

by COX-1 (CONSTITUTIVE form of the enzyme) and COX-2 (INDUCIBLE form of the enzyme)

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29
Q

what type of PGs are produced by COX-1 enzyme acting on arachidonic acid?

A

mediators of physiological processes such as cytoprotection

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30
Q

what would inhibit COX-1 enzymes

A

NSAIDS

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31
Q

what type of PGs are produced by COX-2 enzymes acting on arachidonic acid?

A

mediators of some physiological processes e.g. labour and pathological processes such as inflammation

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32
Q

what would inhibit COX-2 enzymes?

A

new compounds

meloxicam

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33
Q

how is arachidonic acid converted to leukotrienes?

A

lipoxygenases

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34
Q

what is the conversion of membrane bound phospholipid to arachidonic acid triggered by?

A

the removal of progestin which produces arachidonic acid

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35
Q

why does period pain arise?

A

progesterone withdraws due to the end of the cycle

increased phospholipidase which forms arachidonic acid which then forms either PG (mainly PGF and PGE) and leukotrienes

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36
Q

how does leukotrienes contribute to dysmenorrhoea

A

vasoconstriction and contractibility in the myometrium

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37
Q

progesterone withdraws triggers?

A

production of Arachidonic acids and leukotrienes

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38
Q

pharmacological management of dysmenorrhoea?

A

NSAIDS
OTC
contraceptive pil by regulating hormones
anti-spasmodics e.g. hyoscine butyl bromide

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39
Q

how does the contraceptive oil help dysmenorrhoea

A

regulates hormones
inhibits ovulation
prevents increased PG synthesis in luteal phase
decreased uterine contractility

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40
Q

why are antispasmodics limited for use in dysmenorrhoea

A

poor oral bioavailability

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41
Q

is hyoscine butyl bromide licensed for period pains?

A

not OTC

designed to manage iBS

42
Q

Features of secondary dysmenorrhoea?

A

30-40
pain between or before period
feeling of heaviness in pelvis

43
Q

are PGs involved in secondary dysmenorrhoea?

A

yes

44
Q

examples of underlying pelvic pathology in secondary dysmenorrhoea?

A 
PID
endometriosis 
menorrhagia 
fibroids- common 
uterine polyps
45
Q

how would you treat PID, why is this important to be treated quickly?

A

anti-biotics

can effect fertility

46
Q

how do you treat secondary dysmenorrhoea?

A

need to find out underlying cause
surgery
symptomatic relief for pain
pharmacological interventions such as contraceptives

47
Q

how would surgery treat dysmenorrhoea?

A

ablation- removal of thin uppermost layer of endometrium using heat
laser therapy

48
Q

questions you should ask if a lady comes in and asks for a remedy for period pain?

A

◦Location, duration, before or after?
◦Additional symptoms? Irregular bleeding, N&V, faintness-anaemia, clammy?
◦Other medication or medical conditions?

49
Q

OTC options you could offer a lady coming in with period pains?

A 
co-codamol 
ibuprofen 
naproxen 
heat wraps 
hyoscine
50
Q

TF: exercise helps dysmenorrhoea

A

TRUE

helps counteract the vasocontractility in the endometrium

51
Q

what is endometriosis

A

endometrial tissue found outside the uterus

52
Q

examples of where endometrial tissue could be found?

A

GIT
urinary tract
lungs

53
Q

what is a theory for endometriosis?

A

retrograde mensturation- should leave through the vagina but is actually lost/ moved to other areas of the body

54
Q

what would increase the prevalence of endometriosis?

A

outflow obstruction

55
Q

____% of females get endometriosis

A

10

56
Q

after surgery for endometriosis what % get recurrence 2 years post op

A

75

57
Q

what is another theory (not retrograde menstruation) for endometriosis?

A

embryological: cells de-differentiate back into their primitive form to endometrial cells

58
Q

common symptoms of endometriosis?

A 
pain 
fatigue 
subfertility 
dyspareunia- painful sex
dyschezia- difficulty pooing 
dysuria 
mestural irregularities
59
Q

what is dyspareunia

A

painful intercourse

60
Q

what is dyschezia

A

difficulty defecating

61
Q

rarer symptoms of endometriosis?

A

cyclical haematuria- when period is due
cyclical haemoptysis- cough up blood- due to tissues in lungs
cyclical tenesmum- need to open bowels

62
Q

why can endometriosis cause cyclical haematuria?

A

endometrial tissue in the bladder bleeds as a response to hormonal variation

63
Q

how can you get endometriosis diagnosed?

A

pelvic exam
pelvic ultrasound- abdominal or vaginal
laparoscopy to explore

64
Q

what isn’t recommended to test for endometriosis?

A

bloods or MRI as dont tell you much and MRI doesn’t give good imaging

65
Q

how can a pelvic exam diagnose endometriosis?

A

feel for masses or if there’s reduced organ mobility- due to tissues travelling and acting like glue that stick organs together

66
Q

why does endometriosis cause reduced organ mobility?

A

due to tissues travelling and acting like glue that stick organs together

67
Q

how is endometriosis staged?

A

1-4
1-2 is mild
3-4 is moderate to severe

68
Q

what are common implantation sites for legions in stages 1-2 endometriosis?

A

uterine

ovarian

69
Q

what is stage 3-4 endometriosis commonly associated with?

A

adhesions sticking the organs together

rectovaginal endometriosis- adenomyosis- where tissue starts to grow out of the womb into another area e.g. the bowel

70
Q

what is rectovaginal endometriosis?

A

adenomyosis

where tissue starts to grow out of the womb into another area e.g. the bowel

71
Q

surgical ways to treat endometriosis

A

laparoscopy or hysterectomy

72
Q

what do laparoscopy or hysterectomy aim to do?

A

restore pelvic anatomy
divde adhesions
ablate endometrial tissue

73
Q

when isn’t a hysterectomy appropriate?

A

if they want children

74
Q

can medical treatment of endometriosis improve fertility?

A

yes

75
Q

when should patients with endometriosis be referred to a gynaecology service?

A

if initial hormonal treatment has not been effective, tolerated or is contraindicated

76
Q

first line treatments for endometriosis?

A

analgesia
NSAIDS
paracetamol

77
Q

second line treatments for endometriosis?

A

shrinkers- drugs that oppose oestrogen
contraceptives
progesterones
GnRH analogues
SELECTIVE ANDROGEN RECEPTOR MODULATOR: target steroid pathways
antiprogesterones- Danazol and Gestrinone (LAST RESTOR)

78
Q

what do shrinker drugs rely on?

A

the fact that endometrial tissue is oestrogen dependent
when oestrogen is present the tissue will grow
therefore drugs opposing oestrogen will inhibit endometrial growth

79
Q

examples of GnRH analogues?

A

buserelin
goserelin
nafarelin
leuprorelin

80
Q

examples of antiprogestogens?

A

Danazol

Gestrinone

81
Q

what is Menorrhagia?

A

menstural blood loss above 80 ml per month

82
Q

why is Menorrhagia subjective?

A

may just think they’re bleeding heavily

83
Q

__% of women complain about heavy bleeding

A

30

84
Q

cause of menorrhagia?

A

unclear

prostanoids?

85
Q

__% of women have no underlying pelvic pathology or medical conditions which account for Menorrhagia

A

60

this is dysfunctional uterine bleeding (DUB)

86
Q

causes of Menorrhagia

A 
dysfunctional uterine bleeding- absence of disease 
gynaecological causes (35%
endocrine and haematological causes (5%)
87
Q

gynaecological causes of Menorrhagia?

A 
menopause
fibroids
PID
cancer 
miscarriage 
ectopic pregnancy 
IUD
adenomyosis
88
Q

what is adenomyosis?

A

inner lining of uterus growths and breaks through myometrium and invades other organs

89
Q

endocrine and haematological causes of menorrhagia?

A

hepatic, renal or thyroid disease- effect blood production

blood thinning medication or condition such as Von Willebrand disease

90
Q

example of a disease which could cause blood problems and cause Menorrhagia

A

Von Willebrand disease

91
Q

symptoms suggestive of underlying pelvic pathology in menorrhagia

A 
irregular bleeding 
sudden change in the blood loss
intermenstural bleeding 
post coital bleeding 
dyspareunia (painful sex)
pelvic pain 
premenstural pain
92
Q

how to diagnose menorrhagia

A

blood tests- Fe, FBC
cervical smear
endometrial biopsy
ultra sound
Sonohysterography- look at pelvis, insert a thin tube through vagina and deliver saline solution to pelvis for imaging
hysteroscopy- camera inserted into vagina and cervix

93
Q

what is a sonohysterography?

A

look at pelvis, insert a thin tube through vagina and deliver saline solution to pelvis for imaging

94
Q

what is a hysteroscopy?

A

camera inserted into vagina and cervix

95
Q

surgical treatment of menorrhagia?

A

Uterine artery embolisation- shut vessels down where there’s heavy bleeding

myomectomy- removal
hysterectomy

96
Q

what is a contraceptive licensed for treatment of menorrhagia

A

Mirena IUS

97
Q

treatment for menorrhagia if contraception is required?

A

CHC, POC
IUS
parenteral progesterone

98
Q

treatment for menorrhagia if contraception isn’t required?

A 
tranexamic acid 
GnRH analogues 
Medenamic acid- NSAID
oral progestogen
antiprogestogens
99
Q

how does tranexamic acid treat menorrhagia?

A

antifibrinolytic- reduces blood loss

100
Q

how is oral progestogen used to treat menorrhagia?

A

higher dose northisterone used.
5mg for menorrhagia
0.35mg used for contraception

101
Q

examples of antiprogestogens?

A

Gestinone/ Danazol

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