Women's Health: Blood, Sweat, Tears

Question 1

womens health - blood (menstrual issues) - involves

Answer 1

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

Question 2

womens health - sweat - involves

Answer 2

• premenstrual syndrome
• perimenopause

Question 3

womens health - tears (pain) - involves

Answer 3

• dysmenorrhoea
• endometriosis

Question 4

define menarche

Answer 4

• onset of menstruation
• first vaginal bleed (period)

Question 5

when does menarche occur

Answer 5

10-16yo
mean 13 yrs

Question 6

menarche is influenced by which 2 factors

what is connected to early menarche

Answer 6

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

Question 7

what is menarche associated with

Answer 7

development of secondary sexual characteristics

Question 8

define amenorrhoea

Answer 8

no vaginal bleeding or periods

Question 9

types of amenorrhoea

Answer 9

• primary amenorrhoea
• secondary amenorrhoea

Question 10

define primary amenorrhoea

Answer 10

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

Question 11

causes of primary amenorrhoea

Answer 11

• 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

Question 12

define secondary amenorrhoea

Answer 12

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

Question 13

causes of secondary amernorrhoea

Answer 13

• 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

Question 14

how to prolactinomas lead to secondary amenorrhoea

Answer 14

• 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

Question 15

what is hypopituitarism

Answer 15

deficient in one or more pituitary hormones

Question 16

menstrual irregularities are common for up to 2 years following what

Answer 16

menarche

Question 17

[menstrual irregularities] anovulatory irregular bleeding patterns - list 3

Answer 17

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

Question 18

what -% women have 28 day cycle

Answer 18

10-12%

Question 19

most cycles result in - days of bleeding

Answer 19

1-8

Question 20

there is usually - days in a cycle

Answer 20

21-35

Question 21

define oligomenorrhoea

Answer 21

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

Question 22

with oligomenorrhoea cycle duration exceeds normal by _ weeks

Answer 22

2 weeks

Question 23

oligomenorrhoea clinical significance

Answer 23

none in most cases

Question 24

possible causes of oligomenorrhoea

Answer 24

• perimenopause
• obesity
• anorexia
• PCOS

Question 25

does ovulation occur in oligomenorrhoea

Answer 25

occurs with most cycles

Question 26

treatment of oligomenorrhoea

Answer 26

- rarely needs treatment - if needed, cyclic sex hormones used

Question 27

define hypomenorrhoea

Answer 27

- regular but scanty (light) periods

Question 28

clinical significance of hypomenorrhoea

Answer 28

- no clinical signif - unless found w oligomenorrhoea

Question 29

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

Answer 29

polymenorrhoea

Question 30

what is polymenorrhoea

Answer 30

- normal amount of cyclic bleeding - but bleeding at too frequent intervals; cycles are less than 24 days

Question 31

cause of polymenorrhoea

Answer 31

unresponsive ovary

Question 32

what is polymenorrhagia

Answer 32

- excessive bleeding - reduced cycle length

Question 33

causes of polymenorrhagia

Answer 33

- chronic PID - anxiety states - psychosomatic disorders

Question 34

all menstrual irregularities

Answer 34

- 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

Question 35

define metorrhagia

Answer 35

- bleeding irregular in amount - acyclical - prolonged in duration

Question 36

cause of metorrhagia

Answer 36

usually pathological condition of uterus

Question 37

define intermenstrual bleeding / spotting

Answer 37

bleeding outside of normal cycle

Question 38

mid cycle bleed is normal in _-_%

Answer 38

1-2%

Question 39

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

Answer 39

not usually comes out of the blue

Question 40

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

Answer 40

- STIs - trauma - pregnancy - COC - cervical pathology - malignancy

Question 41

define menorrhagia

Answer 41

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

Question 42

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

Answer 42

- more than a pack of pads / day - flooding overnight

Question 43

when does clotting occur

Answer 43

when bleeding too fast

Question 44

menorrhagia is due to

Answer 44

- due to certain disturbances (eg/ disturbance of hormonal control of menstruation, disturbances in prostaglandin activity, hyperplastic endometrium)

Question 45

causes of menorrhagia (ie/ of certain disturbances)

Answer 45

- 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

Question 46

aims of treatment of menorrhagia for organic and no organic cause

Answer 46

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

Question 47

menorrhagia without organic cause is known as

Answer 47

dysfunctional uterine bleeding

Question 48

treatment options of menorrhagia

Answer 48

- 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)

Question 49

which is the most common used for menorrhagia treatment

Answer 49

- levonorgestrel (LNG)IUD (mirena)

Question 50

what does levonorgesteral IUD (mirena) do

Answer 50

- local delivery of progestogen (synthetic progesterone), sited inside uterine cavity

Question 51

function of levonorgestrel IUD (mirena)

Answer 51

- thickens cervical mucous (harder for sperm) - thinning endometrium (harder for implantation) - plasma oestradiol maintained at normal levels

Question 52

result of levonorgestrel IUD (mirena)

Answer 52

decreased menstrual flow and pain

Question 53

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

Answer 53

35 years

Question 54

premenstrual syndrome definition

Answer 54

- variety of symptoms - varies woman to woman - in different menstrual cycles

Question 55

is premenstrual syndrome related to parity

Answer 55

no

Question 56

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

Answer 56

5%

Question 57

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

Answer 57

- a week or so before period - persist 1st day of bleeding

Question 58

relief from premenstrual syndrome may occur with what

Answer 58

onset of menstruation

Question 59

PMS commonly reported symptoms

Answer 59

- 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

Question 60

premenstrual syndrome diagnosis

Answer 60

- write a diary about their symptoms

Question 61

premenstrual syndrome treatment

Answer 61

= 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

Question 62

define dysmenorrhoea

Answer 62

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

Question 63

2 types of dysmenorrheoa

Answer 63

- spasmodic / true dysmenorrhoea - congestive / secondary dysmenorrhea

Question 64

cause of dysmenorrhea

Answer 64

excess prostaglandins & hypersensitivity to prostaglandins

Question 65

what are prostaglandins

Answer 65

- 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

Question 66

spasmodic / true dysmenorrhoea occurs in _-_% of females

Answer 66

15-25%

Question 67

spasmodic / true dysmenorrhoea occurs _-_ years after menarche

Answer 67

2-3 years

Question 68

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

Answer 68

- 15-25yo - decreases with age

Question 69

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

Answer 69

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

Question 70

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

Answer 70

- hormonal changes - prostaglandins - uterine contractions

Question 71

spastic / true dysmenorrhoea resolve with....

Answer 71

pregnancy, vaginal delivery of viable child

Question 72

true dysmenorrhoea is defined as menstrual pain without what

Answer 72

an underlying medical condition that

Question 73

[spasmodic / true dysmenorrhoea] pain experienced is related to onset of ______ begins within __ hrs before & lasts __-__hrs after commencement

Answer 73

- menstruation - 24hrs - 24-36 hrs

Question 74

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

Answer 74

12 hrs

Question 75

[spasmodic / true dysmenorrhoea] pain is ____ in origin

Answer 75

uterine (consider prostaglandin)

Question 76

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

Answer 76

- clots - hyperplastic

Question 77

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

Answer 77

hypogastrium / lower abdomen

Question 78

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

Answer 78

cultural attitudes

Question 79

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

Answer 79

- vomiting - diarrhoea

Question 80

congestive / secondary dysmenorrhoea is defined as menstrual pain with what

Answer 80

underlying medical condition

Question 81

secondary / congestive dysmenorrhoea is uncommon <__yo

Answer 81

30yo

Question 82

secondary / congestive dysmenorrhoea causes include

Answer 82

- endometriosis - PID - fibroids, polyps - Pelvic Congestion Syndrome

Question 83

when does pain for secondary / congestive dysmenorrhoea occur

Answer 83

before or late in menstruation

Question 84

treatments for dysmenorrhoea

Answer 84

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

Question 85

what are prostaglandin antagonists

Answer 85

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

Question 86

what is endometriosis

Answer 86

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

Question 87

in uterine endometriosis / adenomyosis, the endometrial deposits are between the ____ _____ of myometrium these endometrial deposits can be at various locations in the _______ cavity eg/ ___

Answer 87

muscle fibres pelvic eg/ ovary, cul de sac

Question 88

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

Answer 88

- 10% - cramping pains - constipation

Question 89

endometriosis - in __% no symptoms

Answer 89

25%

Question 90

__% of endometriosis are discovered accidentally on what

Answer 90

40% laparoscopies

Question 91

most popular aetiology theory for endometriosis

Answer 91

retrograde menstruation

Question 92

endometriosis is more common in (list 3) demographics

Answer 92

- higher socio-economic groups - single women - none or few children

Question 93

describe the characteristics of pain occurrence timing in endometriosis

Answer 93

- begins pre-menstruation - occurs throughout menstruation - peaks in last days of menstruation - subsides after period

Question 94

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

Answer 94

no

Question 95

in endometriosis what is the characteristic of the pain regarding location

Answer 95

occurs in similar place each month

Question 96

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

Answer 96

- menorrhagia (excessive flow) - polymenorrhoea (more frequent periods)

Question 97

30% of women with endometriosis have _____

Answer 97

infertility

Question 98

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

Answer 98

- dyspareunia (painful sex) - defecation - pyrexia (fever) - cul de sac (area between rectum and uterus) - uterine & premenstrually

Question 99

treatment of endometriosis depends on (4)

Answer 99

- size - extent of lesions - age - desire for child bearing

Question 100

treatment for asymptomatic endometriosis

Answer 100

do not treat

Question 101

endometriosis treatment options

Answer 101

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)

Question 102

what is a hysterectomy

Answer 102

- removal of uterus - no more periods, no more pregnancies

Question 103

what is an oophorectomy

Answer 103

- removal of ovaries - stops hormone production - if both removed leads to menopause

Question 104

danazol vs high progesterone MoA for endometriosis treatment

Answer 104

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

Question 105

define perimenopause

Answer 105

- period of waning ovarian function - signaling end of reproductive life - occurs over few years

Question 106

perimenopause leads to ________ which is the....

Answer 106

menopause - cessation of menopause

Question 107

onset of perimenopause is variable between x-y years

Answer 107

37-45 years

Question 108

finish of perimenopause is variable x-y+ years

Answer 108

43-55+ years

Question 109

duration of perimenopause

Answer 109

5-10 years

Question 110

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

Answer 110

- oestrogens - gonadotrophins - variable - progressive

Question 111

cardinal feature of perimenopause

Answer 111

increasingly irregular periods (flow, duration, frequency)

Question 112

other symptoms of perimenopause

Answer 112

- 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

Question 113

define cystocele

Answer 113

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

Question 114

management of perimenopause

Answer 114

- 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

Question 115

what is atrophic vaginitis

Answer 115

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

Question 116

what is involved in the explanation for management of menopause

Answer 116

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

Question 117

what can doctors do for patients in perimenopause

Answer 117

- exclude disease - explain phases and progress - discuss strategies of management - give permission to act (self care)

Question 118

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

Answer 118

- 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

Question 119

female sexual dysfunction affects __% of women

Answer 119

43%

Question 120

some types of female sexual dysfunction

Answer 120

- hypoactive sexual desire disorders - sexual aversion disorder - sexual arousal disorders - orgasmic disorder - vaginismus - dyspareunia - post-coital disorders

Question 121

contraception meds

Answer 121

- 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)