Problems commonly associated with menstruation

Question 1

what is puberty?

Answer 1

onset of maturity, tends to happen earlier in girls 8-14 years of age compared to boys 9-15 years.

Question 2

what is precocious puberty?

Answer 2

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

Question 3

what is amenorrhoea/dysmenorrohoea?

Answer 3

something that isnt right with the period

Question 4

what is delayed puberty?

Answer 4

if a girl hasn’t developed breast tissue by 13 or menstruation by the age of 15

Question 5

what is menorrhagia?

Answer 5

heavier bleeding than normal

Question 6

what is PCOS?

Answer 6

polycystic ovarian syndrome

Question 7

what is premenstrual syndrome?

Answer 7

physical and emotional symptoms which you can get in the 1 or 2 weeks before you get your period

Question 8

what is premature ovarain insufficiency?

Answer 8

woman goes into menopause early before the age of 40, can be linked to medication or cancer

Question 9

what is menopause?

Answer 9

the avergae age is 51.

the time in whcih women stop having periods and you can no longer concieve.

Question 10

what is postmenopausal bleeding?

Answer 10

usually a reason that causes this and would always be investigated

Question 11

what is dysmenorrhoea?

Answer 11

pain during menstruation, 50-80% of women will have this throughout their reproductive lives.

Question 12

what are the primary symptoms of dysmenorrhoea?

Answer 12

	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

Question 13

what are the secondary symptoms of dysmenorrhoea?

Answer 13

 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

Question 14

what are the causes of dysmenorrhoea?

Answer 14

• 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]

Question 15

what is the pharmacological treatment for dysmenorrhoea?

Answer 15

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)

Question 16

what is the secondary line treatment for dysmenorrhoea?

Answer 16

investigate the underlying disease which is causing it

• may need suregy to remove some of the endometrium
• symptomatic relief
• pharmacological intervention

Question 17

what is secondary dysmenorrhoea?

Answer 17

• 30-40y/o
• pain may begin days before a period
• general feeling of heaviness within the pelvic area

Question 18

what is endometriosis?

Answer 18

benign, women of reproductive age

• endometrial tissue is found outside of the uterus
• occurs within 10% of women population

Question 19

what causes endometriosis?

Answer 19

the full process is unclear but said to be linked to

1. embyrological cells de-differentiate back to primary form
2. retrogade menstruation

Question 20

what are the symptoms of endometriosis?

Answer 20

most common is pain, fatigue and subfertility

• pain during sex
• pain during bowel movements
• pain during urination
• bleeding

Question 21

how do you diagnose endometriosis/

Answer 21

• pelvic exam
• pelvic ultrasound
• diagnostic laparoscopy

Question 22

what are the stages of endometriosis?

Answer 22

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

Question 23

what is the management of endometriosis?

Answer 23

• 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

Question 24

what are the quality standards which NICE cover for endometriosis treatment?

Answer 24

• 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

Question 25

what is the pharmacological management of endometrisosi?

Answer 25

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

Question 26

what are examples of shrinker drugs?

Answer 26

• contraceptives
• progesterons
• GnRH anaglogues

Question 27

what is menorrhagia?

Answer 27

menstrual blood loss over 80mL
large clots bigger then 50p
tiredness
may lead to anaemia

Question 28

what causes menorrhagia?

Answer 28

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

Question 29

what symptoms suggest there is an underlying pelvic patholgy?

Answer 29

 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

Question 30

how can you diagnose menorrhagia?

Answer 30

	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

Question 31

how can you treat menorrhagia?

Answer 31

 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