Problems commonly associated with menstruation Flashcards
what is puberty?
onset of maturity, tends to happen earlier in girls 8-14 years of age compared to boys 9-15 years.
what is precocious puberty?
maturity that happens earlier than normal, if it happens before the age of 8 for girls or 9 for boys. toddlers can go through puberty
what is amenorrhoea/dysmenorrohoea?
something that isnt right with the period
what is delayed puberty?
if a girl hasn’t developed breast tissue by 13 or menstruation by the age of 15
what is menorrhagia?
heavier bleeding than normal
what is PCOS?
polycystic ovarian syndrome
what is premenstrual syndrome?
physical and emotional symptoms which you can get in the 1 or 2 weeks before you get your period
what is premature ovarain insufficiency?
woman goes into menopause early before the age of 40, can be linked to medication or cancer
what is menopause?
the avergae age is 51.
the time in whcih women stop having periods and you can no longer concieve.
what is postmenopausal bleeding?
usually a reason that causes this and would always be investigated
what is dysmenorrhoea?
pain during menstruation, 50-80% of women will have this throughout their reproductive lives.
what are the primary symptoms of dysmenorrhoea?
Peak incidence teens to twenties Cramping with pelvic pain May radiate to thighs and back GI symptoms – nausea, vomiting and diarrhoea Headaches, fatigue or faintness
what are the secondary symptoms of dysmenorrhoea?
Peak incidence thirties, forties may be a link to fertility issues
Consequence of other pelvic pathology – underlying reason why the pain is happening
Pain may begin before menstruation, could be up to 3-5 days before
what are the causes of dysmenorrhoea?
• Higher concentrations of prostaglandins in menstrual fluid [mainly PGF and PGE]
• Increased myometrial contractility – this is what causes the cramping pain
• Other potential mediators include
o Endothelin’s – vasoactive peptides
Role in [local] regulation of prostaglandin synthesis
o Vasopressin – post. Pituitary hormone
Stimulates uterine activity
Decreases uterine blood flow [vasoconstriction causes myometrial ischaemia contributing to the pain]
what is the pharmacological treatment for dysmenorrhoea?
just used to treat the symptoms as there is no underlying issue
- NSAIDs
- OTC pain relief for periods
- oral contraception pill as it inhibits ovulation and therefore would prevent an increase in PG synthesis in luteal phase\
- antispasmodics (e.g. hyoscine butylbromide)
what is the secondary line treatment for dysmenorrhoea?
investigate the underlying disease which is causing it
- may need suregy to remove some of the endometrium
- symptomatic relief
- pharmacological intervention
what is secondary dysmenorrhoea?
- 30-40y/o
- pain may begin days before a period
- general feeling of heaviness within the pelvic area
what is endometriosis?
benign, women of reproductive age
- endometrial tissue is found outside of the uterus
- occurs within 10% of women population
what causes endometriosis?
the full process is unclear but said to be linked to
- embyrological cells de-differentiate back to primary form
- retrogade menstruation
what are the symptoms of endometriosis?
most common is pain, fatigue and subfertility
- pain during sex
- pain during bowel movements
- pain during urination
- bleeding
how do you diagnose endometriosis/
- pelvic exam
- pelvic ultrasound
- diagnostic laparoscopy
what are the stages of endometriosis?
1-2 are when minimal and mild, and poorly visiable on an ultrasound
3-4 is when there is moderate to severe and usually linked to adhesions
what is the management of endometriosis?
- surgical removal aims to restore the pelvic anatomy and divide the adhesions so they are less painfil
- medical treatment aimts to provide relief from the symptoms
what are the quality standards which NICE cover for endometriosis treatment?
- should recieve an abdo and if appropriate a pelvic exam
- referred to a gynaecology service if inital treatment has not been effective
- if they have been shown to have confirmed deep endometrisis they should be referred to specialist stragiht away
what is the pharmacological management of endometrisosi?
1st line = anaglesics (NSAIDs or paracetamol)
2nd line = shrinkers which are used to oppose oestrogen so they inhibit the growth of endometrial tissue
new treatments = SARMS
what are examples of shrinker drugs?
- contraceptives
- progesterons
- GnRH anaglogues
what is menorrhagia?
menstrual blood loss over 80mL
large clots bigger then 50p
tiredness
may lead to anaemia
what causes menorrhagia?
o Absence of pelvic pathology, disease or pregnancy
o idiopathic
o Menopause
o Fibroids, PID
o Miscarriage or ectopic pregnancy
o IUD – can make periods heavier
o Adenomyosis (inner lining of the uterus breaks through myometrium)
o Hepatic, renal or thyroid disease, PCOS. If you have some kind of liver or renal impairment it effects RBC production
o Blood thinning medication or condition
what symptoms suggest there is an underlying pelvic patholgy?
Irregular bleeding – in-between periods
Sudden change in blood loss – period lasted 4 days and now lasting 7-10 days
Intermenstrual bleeding
Post coital bleeding
Dyspareunia (painful intercourse)
Pelvic pain
Premenstrual pain
how can you diagnose menorrhagia?
Blood tests o FBC, Iron, Ferritin (thyroid??) Physical exam (tummy, cervix, enlarged or tender ovaries and uterus) Cervical smear o Pap smear/cervical smear Endometrial biopsy Ultrasound (pelvic or transvaginal) o uterus, ovaries and pelvis Sonohysterography Hysteroscopy
how can you treat menorrhagia?
Surgical treatment option
o UAE (uterine artery embolization)
o Myomectomy (fibroidectomy – this is a cut off if they get to a certain size you have to remove them)
o Hysterectomcy
