1- Menstrual disorders (conditions) Flashcards

Question

mangement of dysmenorrhea

Answer 1

- Lifestyle- stop smoking, exercise - NSAIDs - Hormonal treatment  COCP  Dep-povera  Coil - Surgery  Laparoscopic uterine nerve ablation  hysterectomy in rare cases

Answer 2

where there is ectopic endometrial tissue outside the uterus. - lump of endometrial tissue outside the uterus = endometrioma e.g. chocolate cysts in the ovaries

Answer 3

a number of theories - **retrograde** menstruation - due to misplacement of **embryonic** cells - spread of endometiral cells through **lymphatics** like cancers - **metaplasia** of cells

Answer 4

One notable theory for the cause of ectopic endometrial tissue is that during menstruation, the endometrial lining flows backwards, through the fallopian tubes and out into the pelvis and peritoneum. This is called retrograde menstruation. The endometrial tissue then seeds itself around the pelvis and peritoneal cavity.

Answer 5

pelvic pain - cells of endometrial tissue outside the uterus respond to hormones in the same way as endometiral tissue in the uterus - during menstruation the endometrial tissue in the uterus sheds its lining and bleeds, the same happens elsewhere in the boyd - this causes irritation and inflammation of tissues around the sites of endometriosis key features - cyclical - dull, heavy or burning pain - during emnstruation

Answer 6

due to deposits of endometriosis in the bladder or bowel

Answer 7

adhesions due to localised bleeding and inflammation - leads to chronic, non-cyclical pain that can be sharp, stapping or pulling and associasted with nausea

Answer 8

Endometriosis can lead to reduced fertility. Often it is not clear why women with endometriosis struggle to get pregnant. It may be due to adhesions around the ovaries and fallopian tubes, blocking the release of eggs or kinking the fallopian tubes and obstructing the route to the uterus. Endometriomas in the ovaries may also damage eggs or prevent effective ovulation.

Answer 9

- examination - pelvic uS - laparoscopic surgery

Answer 10

* Endometrial tissue visible in the vagina on speculum examination, particularly in the posterior fornix * A fixed cervix on bimanual examination * Tenderness in the vagina, cervix and adnexa

Answer 11

may reveal large endometriomas and chocolate cysts. Ultrasound scans are often unremarkable in patients with endometriosis. Patients with suspected endometriosis need referral to a gynaecologist for laparoscopy.

Answer 12

gold standard for diagnosis - biopsy and stage - surgeon can also remove deposits of endometriosis and improve symptoms

Answer 13

American Society of Reproductive Medicine (ASRM) has a staging system Stage 1: Small superficial lesions Stage 2: Mild, but deeper lesions than stage 1 Stage 3: Deeper lesions, with lesions on the ovaries and mild adhesions Stage 4: Deep and large lesions affecting the ovaries with extensive adhesions

Answer 14

**Initial management involves:** * Establishing a diagnosis * Providing a clear explanation * Listening to the patient, establishing their ideas, concerns and expectations and building a partnership * Analgesia as required for pain (NSAIDs and paracetamol first line) **Hormonal management options** can be tried before establishing a definitive diagnosis with laparoscopy: * Combined oral contractive pill, which can be used back to back without a pill-free period if helpful * Progesterone only pill * Medroxyprogesterone acetate injection (e.g. Depo-Provera) * Nexplanon implant * Mirena coil * GnRH agonists **Surgical management options:** * Laparoscopic surgery to excise or ablate the endometrial tissue and remove adhesions (adhesiolysis) * Hysterectomy * Laparoscopic treatment may improve fertility. *Hormonal therapies may improve symptoms but not fertility.

Answer 15

o Nulliparity (a woman has never given birth to a child, or has never carried a pregnancy) o Early menarche o Short cycles o Heavy bleeding o Low BMI

Answer 16

- Ovaries o Endometrioma= chocolate cyst - Bladder - Rectum - Peritoneal lining and pelvic side walls

Answer 17

benign tumours of the smooth muscle of the uterus. They are also called **uterine leiomyomas** - oestrogen sensitive - very common in women in later reproductive years

Answer 18

- older - black women

Answer 19

* **Intramural** means within the myometrium (the muscle of the uterus). As they grow, they change the shape and distort the uterus. * **Subserosal** means just below the outer layer of the uterus. These fibroids grow outwards and can become very large, filling the abdominal cavity. * **Submucosal** means just below the lining of the uterus (the endometrium). * **Pedunculated** means on a stalk.

Answer 20

Fibroids are often asymptomatic. They can present in several ways: * Heavy menstrual bleeding (menorrhagia) is the most frequent presenting symptom * Prolonged menstruation, lasting more than 7 days * Abdominal pain, worse during menstruation * Bloating or feeling full in the abdomen * Urinary or bowel symptoms due to pelvic pressure or fullness * Deep dyspareunia (pain during intercourse) * Reduced fertility

Answer 21

- submucosal fibroids: hysteroscopy - larger fibroids: pelvic US - MRI scanning - can give info about size, shape and blood supply

Answer 22

same as menorrhagia * Mirena coil (1st line) – fibroids must be less than 3cm with no distortion of the uterus * Symptomatic management with NSAIDs and tranexamic acid * Combined oral contraceptive * Cyclical oral progestogens Surgical options for smaller fibroids: * Endometrial ablation * Resection of submucosal fibroids during hysteroscopy * Hysterectomy

Answer 23

* Uterine artery embolisation * Myomectomy * Hysterectomy **GnRH agonists,** such as goserelin (Zoladex) or leuprorelin (Prostap), may be used to reduce the size of fibroids before surgery. They work by inducing a menopause-like state and reducing the amount of oestrogen maintaining the fibroid. - Usually, GnRH agonists are only used short term, for example, to shrink a fibroid before myomectomy.

Answer 24

- Uterine artery embolisation is a surgical option for larger fibroids, performed by interventional radiologists. - The radiologist inserts a catheter into an artery, usually the femoral artery. - This catheter is passed through to the uterine artery under X-ray guidance. - Once in the correct place, particles are injected that cause a blockage in the arterial supply to the fibroid. - This starves the fibroid of oxygen and causes it to shrink.

Answer 25

involves surgically removing the fibroid via laparoscopic (keyhole) surgery or laparotomy (open surgery). Myomectomy is the only treatment known to potentially improve fertility in patients with fibroids.

Answer 26

- can be used to destroy the endometrium. Second generation, non-hysteroscopic techniques are used, such as balloon thermal ablation. - this involves inserting a specially designed balloon into the endometrial cavity and filling it with high-temperature fluid that burns the endometrial lining of the uterus.

Answer 27

Involves removing the uterus and fibroids. Hysterectomy may be by laparoscopy (keyhole surgery), laparotomy or vaginal approach. The ovaries may be removed or left depending on patient preference, risks and benefits.

Answer 28

* Heavy menstrual bleeding, often with iron deficiency anaemia * Reduced fertility * Pregnancy complications, such as miscarriages, premature labour and obstructive delivery * Constipation * Urinary outflow obstruction and urinary tract infections * Red degeneration of the fibroid * Torsion of the fibroid, usually affecting pedunculated fibroids * Malignant change to a leiomyosarcoma is very rare (<1%)

Answer 29

ishaemia, infarction and necrosis of fibroid due to disrupted blood supply - more likely in large fibroids >5cm during 2nd and 3rd trimester of pregnancy - this may be because the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic. - may also occur due to kinking of blood vessels as the uterus changes shape and expands

Answer 30

- severe abdominal pain - low-grade fever - tachycardia - often vomiting. **Management** is supportive, with rest, fluids and analgesia.

Answer 31

fibroids are made of muscle cells and connective tissue, whereas polyps are made up of the tissue that lines the uterus, also known as endometrial tissue.

Answer 32

fibroids are made of muscle cells and connective tissue, whereas polyps are made up of the tissue that lines the uterus, also known as endometrial tissue.

Answer 33

are growths in the inner lining of your uterus (endometrium). - usually benign but may cause problems with menstruation and fertility - can grow as large as a golf ball

Answer 34

- 40s and 50s - overweight - high BP - taking tamoxifen - HRT with high dose of oestrogen

Answer 35

abnormal bleeding including: - irregular menstrual periods - post menopausal bleeding - post coital - intermenstrual Other problems: infertility usually not painful

Answer 36

Polyps can sometimes prolapse, or slip, through your cervix. The cervix is the opening between your vagina and your uterus. In these instances, your provider may be able to see the polyp during a physical exam.

Answer 37

- pelvic examination - transvaginal US - hysteroscopy - endometrial biopsy - curettage

Answer 38

- **Medication**: GnRH agonist e.g. goserlin helps with symptoms, but symptoms return when the medication stops being taken - Surgical: uterine polypectomy

Answer 39

removal of polyps during hysteroscopy - can also send to histology to look for malignancy

Answer 40

precancerous condition involving thickening of the endometrium - risk factors, presention and investigationsa re similar to endometiral cancer

Answer 41

Most cases of endometrial hyperplasia will return to normal over time. Less than 5% go on to become endometrial cancer. T

Answer 42

* Hyperplasia without atypia * Atypical hyperplasia

Answer 43

same as endometrial cancer Situations where there is increased exposure of unopposed oestrogen are: * Increased age * Earlier onset of menstruation * Late menopause * Oestrogen only hormone replacement therapy * No or fewer pregnancies * Obesity * Polycystic ovarian syndrome * Tamoxifen

Answer 44

Postcoital bleeding (PCB) refers to bleeding after sexual intercourse. This is a red flag that should make you consider cervical and other cancers, although other causes are more common. Often no cause is found. The key causes are: * Cervical cancer, ectropion or infection * Trauma * Atrophic vaginitis * Polyps * Endometrial cancer * Vaginal cancer

1- Menstrual disorders (conditions) Flashcards

(68 cards)