Problems associated with mensturation Flashcards
1
Q
what is precocious puberty?
A
onset of puberty earlier in girls <8 for girls
<9 for boys
2
Q
when is puberty classed as delayed?
A
by 13-15 for girls
14 for boys
3
Q
what is amenorrhoea?
A
absence of periods
4
Q
what is dysmenorrhoea
A
problems with periods
5
Q
what is menorrhagia?
A
bleeding
6
Q
when Is pre-menstural syndrome?
A
1-2 weeks before periods
7
Q
what happens in premature ovarian sufficiency
A
menopause <40
8
Q
what can cause premature ovarian sufficiency
A
heavy diets or exercise
cancer
chemo
medication
9
Q
average age of menopause?
A
50
10
Q
when do changes of conceiving decrease?
A
yearly after the age of 35
11
Q
reasons for post menopausal bleeding?
A
unlikely
usually other reasons that are more sinister
12
Q
___% of women will have dysmenorrhoea at some point in their life
A
50-80
13
Q
how many people who experience dysmenorrhoea are debilitated
A
10%
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
15
Q
common peak incidence of primary dysmenorrhoea
A
teens to twenties
16
Q
what is secondary dysmenorrhoea?
A
due to pathology or disease
consequence of pelvic pathology
17
Q
what is a key symptom of secondary dysmenorrhoea?
A
pain may start before period
18
Q
peak incidence of secondary dysmenorrhoea?
A
thirties- forties
19
Q
how is dysmenorrhoea commonly caused?
A
higher concentrations of PGs in mensural fluid
incweasedmyometrial contractility
20
Q
what PGs are most commonly associated with dysmenorrhoea?
A
PGF
PGE
21
Q
what are other possible mediators in dysmenorrhoea?
A
endothelins
vasopressin
22
Q
how can endothelins cause dysmenorrhoea
A
vasoactive peptides
role in local regulation of PG synthesis
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
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)
25
What is membrane bound phospholipid converted to? and by what enzyme?
converted to arachidonic acid
| byt phospholipidase
26
what can phospholipidase be inhibited by?
corticosteroids
27
what 3 things can arachidonic acid be converted to?
2 different types of prostaglandins
| leukotrines
28
how is arachidonic acid converted to prostaglandins?
by COX-1 (CONSTITUTIVE form of the enzyme) and COX-2 (INDUCIBLE form of the enzyme)
29
what type of PGs are produced by COX-1 enzyme acting on arachidonic acid?
mediators of physiological processes such as cytoprotection
30
what would inhibit COX-1 enzymes
NSAIDS
31
what type of PGs are produced by COX-2 enzymes acting on arachidonic acid?
mediators of some physiological processes e.g. labour and pathological processes such as inflammation
32
what would inhibit COX-2 enzymes?
new compounds
| meloxicam
33
how is arachidonic acid converted to leukotrienes?
lipoxygenases
34
what is the conversion of membrane bound phospholipid to arachidonic acid triggered by?
the removal of progestin which produces arachidonic acid
35
why does period pain arise?
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
36
how does leukotrienes contribute to dysmenorrhoea
vasoconstriction and contractibility in the myometrium
37
progesterone withdraws triggers?
production of Arachidonic acids and leukotrienes
38
pharmacological management of dysmenorrhoea?
NSAIDS
OTC
contraceptive pil by regulating hormones
anti-spasmodics e.g. hyoscine butyl bromide
39
how does the contraceptive oil help dysmenorrhoea
regulates hormones
inhibits ovulation
prevents increased PG synthesis in luteal phase
decreased uterine contractility
40
why are antispasmodics limited for use in dysmenorrhoea
poor oral bioavailability
41
is hyoscine butyl bromide licensed for period pains?
not OTC
| designed to manage iBS
42
Features of secondary dysmenorrhoea?
30-40
pain between or before period
feeling of heaviness in pelvis
43
are PGs involved in secondary dysmenorrhoea?
yes
44
examples of underlying pelvic pathology in secondary dysmenorrhoea?
```
PID
endometriosis
menorrhagia
fibroids- common
uterine polyps
```
45
how would you treat PID, why is this important to be treated quickly?
anti-biotics
| can effect fertility
46
how do you treat secondary dysmenorrhoea?
need to find out underlying cause
surgery
symptomatic relief for pain
pharmacological interventions such as contraceptives
47
how would surgery treat dysmenorrhoea?
ablation- removal of thin uppermost layer of endometrium using heat
laser therapy
48
questions you should ask if a lady comes in and asks for a remedy for period pain?
◦Location, duration, before or after?
◦Additional symptoms? Irregular bleeding, N&V, faintness-anaemia, clammy?
◦Other medication or medical conditions?
49
OTC options you could offer a lady coming in with period pains?
```
co-codamol
ibuprofen
naproxen
heat wraps
hyoscine
```
50
TF: exercise helps dysmenorrhoea
TRUE
| helps counteract the vasocontractility in the endometrium
51
what is endometriosis
endometrial tissue found outside the uterus
52
examples of where endometrial tissue could be found?
GIT
urinary tract
lungs
53
what is a theory for endometriosis?
retrograde mensturation- should leave through the vagina but is actually lost/ moved to other areas of the body
54
what would increase the prevalence of endometriosis?
outflow obstruction
55
____% of females get endometriosis
10
56
after surgery for endometriosis what % get recurrence 2 years post op
75
57
what is another theory (not retrograde menstruation) for endometriosis?
embryological: cells de-differentiate back into their primitive form to endometrial cells
58
common symptoms of endometriosis?
```
pain
fatigue
subfertility
dyspareunia- painful sex
dyschezia- difficulty pooing
dysuria
mestural irregularities
```
59
what is dyspareunia
painful intercourse
60
what is dyschezia
difficulty defecating
61
rarer symptoms of endometriosis?
cyclical haematuria- when period is due
cyclical haemoptysis- cough up blood- due to tissues in lungs
cyclical tenesmum- need to open bowels
62
why can endometriosis cause cyclical haematuria?
endometrial tissue in the bladder bleeds as a response to hormonal variation
63
how can you get endometriosis diagnosed?
pelvic exam
pelvic ultrasound- abdominal or vaginal
laparoscopy to explore
64
what isn't recommended to test for endometriosis?
bloods or MRI as dont tell you much and MRI doesn't give good imaging
65
how can a pelvic exam diagnose endometriosis?
feel for masses or if there's reduced organ mobility- due to tissues travelling and acting like glue that stick organs together
66
why does endometriosis cause reduced organ mobility?
due to tissues travelling and acting like glue that stick organs together
67
how is endometriosis staged?
1-4
1-2 is mild
3-4 is moderate to severe
68
what are common implantation sites for legions in stages 1-2 endometriosis?
uterine
| ovarian
69
what is stage 3-4 endometriosis commonly associated with?
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
what is rectovaginal endometriosis?
adenomyosis
| where tissue starts to grow out of the womb into another area e.g. the bowel
71
surgical ways to treat endometriosis
laparoscopy or hysterectomy
72
what do laparoscopy or hysterectomy aim to do?
restore pelvic anatomy
divde adhesions
ablate endometrial tissue
73
when isn't a hysterectomy appropriate?
if they want children
74
can medical treatment of endometriosis improve fertility?
yes
75
when should patients with endometriosis be referred to a gynaecology service?
if initial hormonal treatment has not been effective, tolerated or is contraindicated
76
first line treatments for endometriosis?
analgesia
NSAIDS
paracetamol
77
second line treatments for endometriosis?
shrinkers- drugs that oppose oestrogen
contraceptives
progesterones
GnRH analogues
SELECTIVE ANDROGEN RECEPTOR MODULATOR: target steroid pathways
antiprogesterones- Danazol and Gestrinone (LAST RESTOR)
78
what do shrinker drugs rely on?
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
examples of GnRH analogues?
buserelin
goserelin
nafarelin
leuprorelin
80
examples of antiprogestogens?
Danazol
| Gestrinone
81
what is Menorrhagia?
menstural blood loss above 80 ml per month
82
why is Menorrhagia subjective?
may just think they're bleeding heavily
83
__% of women complain about heavy bleeding
30
84
cause of menorrhagia?
unclear
| prostanoids?
85
__% of women have no underlying pelvic pathology or medical conditions which account for Menorrhagia
60
| this is dysfunctional uterine bleeding (DUB)
86
causes of Menorrhagia
```
dysfunctional uterine bleeding- absence of disease
gynaecological causes (35%
endocrine and haematological causes (5%)
```
87
gynaecological causes of Menorrhagia?
```
menopause
fibroids
PID
cancer
miscarriage
ectopic pregnancy
IUD
adenomyosis
```
88
what is adenomyosis?
inner lining of uterus growths and breaks through myometrium and invades other organs
89
endocrine and haematological causes of menorrhagia?
hepatic, renal or thyroid disease- effect blood production
| blood thinning medication or condition such as Von Willebrand disease
90
example of a disease which could cause blood problems and cause Menorrhagia
Von Willebrand disease
91
symptoms suggestive of underlying pelvic pathology in menorrhagia
```
irregular bleeding
sudden change in the blood loss
intermenstural bleeding
post coital bleeding
dyspareunia (painful sex)
pelvic pain
premenstural pain
```
92
how to diagnose menorrhagia
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
what is a sonohysterography?
look at pelvis, insert a thin tube through vagina and deliver saline solution to pelvis for imaging
94
what is a hysteroscopy?
camera inserted into vagina and cervix
95
surgical treatment of menorrhagia?
Uterine artery embolisation- shut vessels down where there's heavy bleeding
myomectomy- removal
hysterectomy
96
what is a contraceptive licensed for treatment of menorrhagia
Mirena IUS
97
treatment for menorrhagia if contraception is required?
CHC, POC
IUS
parenteral progesterone
98
treatment for menorrhagia if contraception isn't required?
```
tranexamic acid
GnRH analogues
Medenamic acid- NSAID
oral progestogen
antiprogestogens
```
99
how does tranexamic acid treat menorrhagia?
antifibrinolytic- reduces blood loss
100
how is oral progestogen used to treat menorrhagia?
higher dose northisterone used.
5mg for menorrhagia
0.35mg used for contraception
101
examples of antiprogestogens?
Gestinone/ Danazol
