Women's reproductive health Flashcards
What is PMs? When does it happen?
Happens in luteal phase
cyclic occurrence of symptoms = mood or behaviour changes, cognitive disturbances, physical problems
Begins 14 days before and resolve w/in 3 days of start of period
List some PMS symptoms
depressed mood, anxiety, irritability, feeling overwhelmed
dec interest in usual activities, lack of energy, hypersomnia or insomnia, change in appetite
overeating, food cravings, breast tenderness, bloating
What can be used to manage PMS?
Calcium
Pyridoxine (vit B6), limited evidence
COCs (monophasic)
What can be used to manage PMDD?
COCs w/ drospirenone and low dose ethinylestradiol 24/28 days of cycle
SSRIs = fluoxetine, sertraline
What is amenorrhoea? What are the different kinds?
Absence of menstrual period in women of repro age
Primary = period not started by 14, not other sexual characteristics OR no period by 16 even w/ sex characteristics
Secondary = period stops for ~6 months, due to hormone disruptions
What are some causes of amenorrhoea?
Weight change
Emotional stress
excessive exercise
imperforate hymen
lactational amenorrhoea and preg
hormonal disorders (hypothyroidism, PCOS, hyperprolactinaemia)
hypogonadism = long-term oestrogen def on bone density and cardiovascular health
What is dysmenorrhoea and what are the causes?
Painful menstruation (PGE2 and PGF2alpha)
Primary
- no pathology, begins before/after period onset, lasts 8-72 hrs
Secondary
- pelvic pathology = fibroids, endo, pelvic inflammatory disease, polyps
- later in life, changers in pain of dysmenorrhoea
What can be used to manage dysmenorrhoea?
NSAIDs = naproxen, mefenamic acid, ibuprofen (max approved dose for 1st 2-3 days of period)
Paracetamol = less evidence
COCs = ovulation inhibition, endometrial thinning reduces uterine prostaglandins
Levonorgestrel IUD = useful in dysmen if menorrhagia is also a problem
What is menorrhagia?
Abnormally heavy menstrual bleeding
Drugs will = symptom relief, control bleeding, prevent anaemia, reduce long-term risk of chronic anovulation
What are some non-hormonal treatments of menorrhagia?
Tranexamic acid = antifibrinolytics –> inhibit clot breakdown and binding of plasminogen and plasmin to fibrin, reduces blood loss
NSAIDs = dec [prostaglandin] in endometrium –> reduce blood loss
What are hormonal drug treatments for menorrhagia?
LNG-IUS = 1st line, most effective
- avoid systemic ADRs of oral progestins, higher patient satisfaction, reduced bleeding
COCs or Vaginal ring
- produce thinner endometrium, regular bleeding
Used second-line option to control HMB, whether anovulatory or ovulatory
Depot medroxyprogesterone
Oral progestogens
- used in anovulatory or ovulatory H<B, alterative to COC, given throughout cycle
- medroxyprogesterone, norethisterone
What is endometriosis? (Cause? When diagnosed?)
Presence of endometrial tissue outside the uterus, 8-15% of female population
caused by retrograde menstruation via the fallopian tube –> cells adhere to structure in pelvic peritoneum, recto-vaginal septum, bladder, bowel, ovaries
Diagnosis = 7-9 yrs adults, 8-10 yrs adolescents
List the symptoms of endo
Recurrent pelvic pain or chronic pelvic pain
dysmenorrhoea (+/- nerve pain down back of thigh)
Deep dyspareunia
Heavy, irregular, extended bleeding
Cyclic bladder/bowel symptoms = dysuria, dyschesia, cyclic haematuria
ovulation pain
infertility
Complications = adhesions (fibrous scar tissue), endometriomas (cysts)
How is endo managed?
Individualised (based on) = age, symptoms, extent of disease, preg plans
Laparoscopic surgery = pref for infertility
NSAIDs = inhibit inflam process of endometriosis
Hormonal treatments = induce atrophy in ectopic endometrium
What hormonal treatments are used for endometriosis?
Progestogens = oral norethisterone, dydrogesterone, medroxyprogesterone, dienogest, levonorgestresl IUD, depot
GnRH analogues = subcut goserelin, intranasal nafarelin
