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Sex & Sexuality + Women's Health > Women's Health: Blood, Sweat, Tears > Flashcards

Women's Health: Blood, Sweat, Tears Flashcards

1
Q

womens health - blood (menstrual issues) - involves

A
  • menarche
  • amenorrhoea
  • oligomenorrhoea
  • hypomenorrhoea
  • abnormal uterine bleeding
  • polymenorrhoea
  • polymenorrhagia
  • metorrhagia
  • intermenstrual bleeding
  • menorrhagia
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2
Q

womens health - sweat - involves

A
  • premenstrual syndrome
  • perimenopause
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3
Q

womens health - tears (pain) - involves

A
  • dysmenorrhoea
  • endometriosis
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4
Q

define menarche

A
  • onset of menstruation
  • first vaginal bleed (period)
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5
Q

when does menarche occur

A

10-16yo
mean 13 yrs

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6
Q

menarche is influenced by which 2 factors

what is connected to early menarche

A
  • race
  • nutritional factors
  • body fat and fat/lean ratio (higher to early menarche)
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7
Q

what is menarche associated with

A

development of secondary sexual characteristics

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8
Q

define amenorrhoea

A

no vaginal bleeding or periods

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9
Q

types of amenorrhoea

A
  • primary amenorrhoea
  • secondary amenorrhoea
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10
Q

define primary amenorrhoea

A
  • failure of menstruation to occur (no past history of it)
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11
Q

causes of primary amenorrhoea

A
  • chromosomal abnormalities and congenital conditions (most common)
  • malformations of genital tract, congenital absence of uterus / vagina
  • other diseases eg/ thyroid disease, systemic disease
  • constitutional (natural) delay in menarche
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12
Q

define secondary amenorrhoea

A

absence of 3 or more periods in a row by someone who had them in the past

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13
Q

causes of secondary amernorrhoea

A
  • physiological: pregnancy, lactation
  • premature menopause / ovarian failure
  • psychological and environmental: hypothalamic dysfunction occurring in severe anorexia (BMI<18)
  • pituitary dysfunction: pituitary tumours (prolactin secreting tumours), hypopituitarism
  • other endocrine causes: hyperthyroidism, adrenal (Cushings, post pubertal adrenal hyperplasia, adrenogenital syndrome)
  • ovarian causes: ovarian agenesis / dysgenesis, PCOS, ablation or radiation, persistent follicular cysts, granulosa theca cell tumours
  • uterine causes: surgical removal, radiation, tuberculosis, trauma (Asherman’s syndrome)
  • systemic disease
  • iatrogenic: COC (post pill amenorrhoea), DMPA, phenothiazines, certain hypertensive medication
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14
Q

how to prolactinomas lead to secondary amenorrhoea

A
  • produce excessive prolactin (usually for milk secretion stimulation) -> inhibit secretion GnRH by hypothalamus (indirectly suppress;long-loop feedback) -> less gonadotrophins released from pituitary gland -> reduced LH and FSH released by ovaries -> anovulation
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15
Q

what is hypopituitarism

A

deficient in one or more pituitary hormones

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16
Q

menstrual irregularities are common for up to 2 years following what

A

menarche

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17
Q

[menstrual irregularities] anovulatory irregular bleeding patterns - list 3

A
  • oligomenorrhoea (normal menstruation loss but infrequent periods)
  • menorrhagia (prolonged or heavy bleeding)
  • polymenorrhoea (normal menstruation loss but at short intervals)
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18
Q

what -% women have 28 day cycle

A

10-12%

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19
Q

most cycles result in - days of bleeding

A

1-8

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20
Q

there is usually - days in a cycle

A

21-35

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21
Q

define oligomenorrhoea

A
  • normal menstrual loss but intervals >42 days
  • typically in adolescent years
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22
Q

with oligomenorrhoea cycle duration exceeds normal by _ weeks

A

2 weeks

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23
Q

oligomenorrhoea clinical significance

A

none in most cases

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24
Q

possible causes of oligomenorrhoea

A
  • perimenopause
  • obesity
  • anorexia
  • PCOS
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25
Q

does ovulation occur in oligomenorrhoea

A

occurs with most cycles

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26
Q

treatment of oligomenorrhoea

A
  • rarely needs treatment
  • if needed, cyclic sex hormones used
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27
Q

define hypomenorrhoea

A
  • regular but scanty (light) periods
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28
Q

clinical significance of hypomenorrhoea

A
  • no clinical signif
  • unless found w oligomenorrhoea
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29
Q

what is a menstrual irregularity that can occur as a clinical manifestation of Abnormal Uterine Bleeding

A

polymenorrhoea

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30
Q

what is polymenorrhoea

A
  • normal amount of cyclic bleeding
  • but bleeding at too frequent intervals; cycles are less than 24 days
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31
Q

cause of polymenorrhoea

A

unresponsive ovary

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32
Q

what is polymenorrhagia

A
  • excessive bleeding
  • reduced cycle length
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33
Q

causes of polymenorrhagia

A
  • chronic PID
  • anxiety states
  • psychosomatic disorders
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34
Q

all menstrual irregularities

A
  • oligomenorrhoea: normal menstruation; cycle too long
  • polymenorrhoea: normal menstruation; cycle too short
  • hypomenorrhoea: normal menstruation and cycle; blood flow too light
  • polymenorrhagia: excessive blood flow, cycle too short
  • metorrhagia: irregular amount of blood; acyclical - do not follow regular pattern
  • menorrhagia: normal cycle; heavy blood flow
  • dysmenorrhoea: painful periods
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35
Q

define metorrhagia

A
  • bleeding irregular in amount
  • acyclical
  • prolonged in duration
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36
Q

cause of metorrhagia

A

usually pathological condition of uterus

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37
Q

define intermenstrual bleeding / spotting

A

bleeding outside of normal cycle

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38
Q

mid cycle bleed is normal in -%

A

1-2%

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39
Q

does intermenstrual bleeding usually occur in a regular pattern in relation to menstrual cycle

A

not usually
comes out of the blue

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40
Q

possible causes of intermenstrual bleeding / spotting that need to be ruled out

A
  • STIs
  • trauma
  • pregnancy
  • COC
  • cervical pathology
  • malignancy
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41
Q

define menorrhagia

A
  • normal duration of cycle
  • duration of bleeding - normal OR prolonged
  • heavy periods with excessive amount of blood loss (over 8-mls) & passing clots
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42
Q

measured in female hygiene products, what can be expected with menorrhagia

A
  • more than a pack of pads / day
  • flooding overnight
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43
Q

when does clotting occur

A

when bleeding too fast

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44
Q

menorrhagia is due to

A
  • due to certain disturbances (eg/ disturbance of hormonal control of menstruation, disturbances in prostaglandin activity, hyperplastic endometrium)
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45
Q

causes of menorrhagia (ie/ of certain disturbances)

A
  • psychosomatic factors affecting hypothalamus (dysfunctional uterine bleeding - BMI >30-35)
  • ovarian: cysts, oestrogen producing tumours, inadequate progesterone production with inadequate endometrial support, decreased ovarian sensitivity
  • uterine: fibroids, adenomyosis, chronic pelvic infections, uterine body and cervical malignancies, plastic copper IUD
  • disturbances of pregnancy: abortion, ectopic gestation
  • blood dyscrasias
  • endocrine disorders: pituitary disease, hypothyroidism
  • general disease: liver disease
  • iatrogenic: administration of excessive dose oestrogen
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46
Q

aims of treatment of menorrhagia for organic and no organic cause

A
  • treat primary condition if organic cause
  • if no organic cause found = dysfunctional uterine bleeding - treatment depends on age
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47
Q

menorrhagia without organic cause is known as

A

dysfunctional uterine bleeding

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48
Q

treatment options of menorrhagia

A
  • bed rest and sedation if heavy bleeding
    options:
  • hormonal: gestagens orally or by injection, ethinyl estradiol, COC, danazol
  • prostaglandin inhibitors (ibuprofen, naproxen)
  • matrix metalloproteinase inhibitors
  • antifibrinolytic agents
  • LNG IUD (mirena)
  • surgery: curettage - diagnostic purposes and therapeutic for menorrhagia, hysterectomy (last resort)
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49
Q

which is the most common used for menorrhagia treatment

A
  • levonorgestrel (LNG)IUD (mirena)
50
Q

what does levonorgesteral IUD (mirena) do

A
  • local delivery of progestogen (synthetic progesterone), sited inside uterine cavity
51
Q

function of levonorgestrel IUD (mirena)

A
  • thickens cervical mucous (harder for sperm)
  • thinning endometrium (harder for implantation)
  • plasma oestradiol maintained at normal levels
52
Q

result of levonorgestrel IUD (mirena)

A

decreased menstrual flow and pain

53
Q

premenstrual syndrome occurs in females of all reproductive age but is more common after

A

35 years

54
Q

premenstrual syndrome definition

A
  • variety of symptoms
  • varies woman to woman
  • in different menstrual cycles
55
Q

is premenstrual syndrome related to parity

A

no

56
Q

premenstrual syndrome is severely troublesome in less than x% of women

A

5%

57
Q

in premenstrual syndrome (PMS) cyclic symptoms are most evident when & may persist into

A
  • a week or so before period
  • persist 1st day of bleeding
58
Q

relief from premenstrual syndrome may occur with what

A

onset of menstruation

59
Q

PMS commonly reported symptoms

A
  • feelings of fullness in lower abdomen
  • mastalgia (breast pain)
  • abnormal weight gain
  • intestinal distension, constipation
  • headaches - migraine type
  • emotional instability: lassitude (lack of energy), depression, emotional outbursts, anxiety, irritability, purposeless energy
  • clumsiness
  • carbohydrate craving
60
Q

premenstrual syndrome diagnosis

A
  • write a diary about their symptoms
61
Q

premenstrual syndrome treatment

A

= symptom management
- sympathetic listening
- supportive brassiere for mastalgia
- diuretics (thazide group), spironolactone (for reducing bloating)
- antidepressants - SSRIs
- mild psychotropics - diazepam (eg/ for anxiety)
- ergotamine tartrate (for migrainous headaches)
- progesterone - on days 12-26 of menstrual cycle (by stabilising hormone imbalances & providing luteal phase support)
- eliminate cycle (OCP, implanon, dep, etc)
- didrogesterone
- calcium (reduce mood-related symptoms, alleviate physical discomforts like mastalgia and bloating, regulate hormonal fluctuations)
- bromocriptine

62
Q

define dysmenorrhoea

A

painful periods
50% are moderate pain, 12% is disabling

63
Q

2 types of dysmenorrheoa

A
  • spasmodic / true dysmenorrhoea
  • congestive / secondary dysmenorrhea
64
Q

cause of dysmenorrhea

A

excess prostaglandins & hypersensitivity to prostaglandins

65
Q

what are prostaglandins

A
  • group of compounds
  • with varying hormone-like effects
  • promote uterine contractions
  • cyclic fatty acids
  • hormone-like substances that affect several bodily functions including inflammation, pain, uterine contractions
66
Q

spasmodic / true dysmenorrhoea occurs in -% of females

A

15-25%

67
Q

spasmodic / true dysmenorrhoea occurs - years after menarche

A

2-3 years

68
Q

spasmodic / true dysmenorrhoea is commonest between _-_yo and ______ with age

A
  • 15-25yo
  • decreases with age
69
Q

spasmodic / true dysmenorrhoea occur only in ovulatory cycles which means that

A

menstrual pain is directly related to biological processes that take place when ovulation occurs

70
Q

presence of ovulation leads to _____ changes
that result in production of ______
which cause painful _____ contractions typical of dysmenorrhoea

A
  • hormonal changes
  • prostaglandins
  • uterine contractions
71
Q

spastic / true dysmenorrhoea resolve with….

A

pregnancy, vaginal delivery of viable child

72
Q

true dysmenorrhoea is defined as menstrual pain without what

A

an underlying medical condition that

73
Q

[spasmodic / true dysmenorrhoea] pain experienced is related to onset of ______

begins within __ hrs before & lasts __-__hrs after commencement

A
  • menstruation
  • 24hrs
  • 24-36 hrs
74
Q

[spasmodic / true dysmenorrhoea] rarely severe for more than __hrs

A

12 hrs

75
Q

[spasmodic / true dysmenorrhoea] pain is ____ in origin

A

uterine
(consider prostaglandin)

76
Q

FACT CHECK [spasmodic / true dysmenorrhoea] pain is related to passage of ____ / shedding ____ endometrium

A
  • clots
  • hyperplastic
77
Q

[spasmodic / true dysmenorrhoea] pain experienced with cramping in _______

A

hypogastrium / lower abdomen

78
Q

[spasmodic / true dysmenorrhoea] pain severity is associated with ____ attitudes

A

cultural attitudes

79
Q

[spasmodic / true dysmenorrhoea] pain may be associated with which 2 symptoms

A
  • vomiting
  • diarrhoea
80
Q

congestive / secondary dysmenorrhoea is defined as menstrual pain with what

A

underlying medical condition

81
Q

secondary / congestive dysmenorrhoea is uncommon <__yo

A

30yo

82
Q

secondary / congestive dysmenorrhoea causes include

A
  • endometriosis
  • PID
  • fibroids, polyps
  • Pelvic Congestion Syndrome
83
Q

when does pain for secondary / congestive dysmenorrhoea occur

A

before or late in menstruation

84
Q

treatments for dysmenorrhoea

A
  • heat
  • exercise
  • prostaglandin antagonists
  • painkillers (paracetamol)
  • suppression of ovulation - COCP, progesterone alone
  • dydrogesetone
  • LNG IUD (mirena)
  • dilation of cervix (very unusual)
85
Q

what are prostaglandin antagonists

A

prostaglandin synthetase inhibitors such as aspirin, ibuprofen, mefenamic acid, etc

86
Q

what is endometriosis

A

foci of ectopic (outside where meant to be) endometrial (lining uterus) glandular tissue

87
Q

in uterine endometriosis / adenomyosis, the endometrial deposits are between the ____ _____ of myometrium

these endometrial deposits can be at various locations in the _______ cavity eg/ ___

A

muscle fibres

pelvic eg/ ovary, cul de sac

88
Q

endometriosis - in __% the gut is involved which can cause (2) at menstruation

A
  • 10%
  • cramping pains
  • constipation
89
Q

endometriosis - in __% no symptoms

A

25%

90
Q

__% of endometriosis are discovered accidentally on what

A

40%
laparoscopies

91
Q

most popular aetiology theory for endometriosis

A

retrograde menstruation

92
Q

endometriosis is more common in (list 3) demographics

A
  • higher socio-economic groups
  • single women
  • none or few children
93
Q

describe the characteristics of pain occurrence timing in endometriosis

A
  • begins pre-menstruation
  • occurs throughout menstruation
  • peaks in last days of menstruation
  • subsides after period
94
Q

is the severity of pain in endometriosis related to amount of menstrual bleeding (flow)

A

no

95
Q

in endometriosis what is the characteristic of the pain regarding location

A

occurs in similar place each month

96
Q

60% of people with endometriosis experience menstrual irregularities such as (2)

A
  • menorrhagia (excessive flow)
  • polymenorrhoea (more frequent periods)
97
Q

30% of women with endometriosis have _____

A

infertility

98
Q

endometriosis symptoms also can include:
- ______ on deep penetration
- painful _____ at menstruation
- intermittent ____ during menstruation
- tender nodules ___ __ ___
- _____ enlargement with pelvic examination ________

A
  • dyspareunia (painful sex)
  • defecation
  • pyrexia (fever)
  • cul de sac (area between rectum and uterus)
  • uterine & premenstrually
99
Q

treatment of endometriosis depends on (4)

A
  • size
  • extent of lesions
  • age
  • desire for child bearing
100
Q

treatment for asymptomatic endometriosis

A

do not treat

101
Q

endometriosis treatment options

A

hormonal treatment
- danazol (steroid and pituitary gonadotrophin inhibitor), gestagen (synthetic progesterone) only pills (eg/ POPs, oral levonorgesterol) or gestagens at intervals (eg/ IMI depot, COCP)

surgery (severe cases)
- hysterectomy with or without oophorectomy

radiation therapy (rare)

102
Q

what is a hysterectomy

A
  • removal of uterus
  • no more periods, no more pregnancies
103
Q

what is an oophorectomy

A
  • removal of ovaries
  • stops hormone production
  • if both removed leads to menopause
104
Q

danazol vs high progesterone MoA for endometriosis treatment

A

danazol
- suppresses ovarian function reducing oestrogen production -> create hypoestrogenic and mildly hyperandrogenic state
- mimic menopausal state to shrink endometrial tissue => reduce symptoms
- hence androgenic side effects

high progesterone
- causes endometrial tissue become thin and less active, reducing menstrual flow and pain

105
Q

define perimenopause

A
  • period of waning ovarian function
  • signaling end of reproductive life
  • occurs over few years
106
Q

perimenopause leads to ________ which is the….

A

menopause
- cessation of menopause

107
Q

onset of perimenopause is variable between x-y years

A

37-45 years

108
Q

finish of perimenopause is variable x-y+ years

A

43-55+ years

109
Q

duration of perimenopause

A

5-10 years

110
Q

perimenopause is caused by a decreased circulation of _____ and increased production of _______
these changes are ____ in severity and slowly _____

A
  • oestrogens
  • gonadotrophins
  • variable
  • progressive
111
Q

cardinal feature of perimenopause

A

increasingly irregular periods (flow, duration, frequency)

112
Q

other symptoms of perimenopause

A
  • breast changes
  • dyspareunia, vaginal burning / dryness
  • urgency, frequency, dysuria
  • cystocele leading to stress incontinence
  • vasomotor (relating to constriction or dilation of blood vessels) disturbances (declining oestrogen production): hot flushes, flashes, sweating, headaches, palpitations, fainting, insomnia
  • joint stiffness
  • muscle aches
  • tiredness
  • psychological changes: depression, insomnia, lassitude, irritability, increased or decreased sexual urges, mood changes
113
Q

define cystocele

A

wall between bladder and vagina weakens
- can lead to stress incontinence

114
Q

management of perimenopause

A
  • explanation to the patient
  • hormone replacement therapy for vasomotor symptoms (hot flushes, flashes, sweats, insomnia), (atrophic vaginitis) causing dyspareunia, pruritis
  • symptomatic treatment of depression, irritability, mood changes
115
Q

what is atrophic vaginitis

A

thinning, drying, inflammation of vaginal walls
may occur when body has less oestrogen

116
Q

what is involved in the explanation for management of menopause

A
  • what is happening for the patient
  • analogy with puberty
    ->physiological change over specific time
    -> has an endpoint
  • exasperating intermittent process
  • postmenopausal zest
117
Q

what can doctors do for patients in perimenopause

A
  • exclude disease
  • explain phases and progress
  • discuss strategies of management
  • give permission to act (self care)
118
Q

female sexuality has association with illness, list some reasons why illnesses may impact female sexuality

A
  • prolonged illness, long term hospitalisation, immobility, intractable pain, mood problems -> decr sexual interest and responses, decreased satisfactory sex
  • drugs for psychological or physical illnesses -> adverse effects on sexual interest and responses
  • drugs or diseases changing bodily appearances -> impairment of woman’s self image and sexual confidence
  • surgery in women -> masectomy, uterine, other gynaecological procedures may impact woman’s sex life
  • tiredness, pain
  • altered body
  • altered abilities
  • ‘untouchable’
  • disease common after middle alge -> great impact on sex life
119
Q

female sexual dysfunction affects __% of women

A

43%

120
Q

some types of female sexual dysfunction

A
  • hypoactive sexual desire disorders
  • sexual aversion disorder
  • sexual arousal disorders
  • orgasmic disorder
  • vaginismus
  • dyspareunia
  • post-coital disorders
121
Q

contraception meds

A
  • intrauterine contraceptive devices (IUD) - copper, mirena
    > copper IUD: not contain hormones; releases copper ions that toxic to sperm; prevent fertilisation
    > mirena IUD: hormonal progestogen - levonorgestrel releasing IUD
  • oral contraception - COC (progestin, oestrogen), POP (progestin)
  • injectable contraception - depo (hormonal; progestin)
  • contaceptive implants - implanon (hormonal; progestin)
122
Q
A

Sex & Sexuality + Women's Health (4 decks)

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