Menstrual Disorders Flashcards

1
Q

First of all define Menorrhagia, Dysmenorrhoea, oligomenorrhoea, IMB & PCB?

A

Menorrhagia = Heavy periods, technically >80ml but its subjective
Dysmenorrhoea = painful periods
Oligomenorrhoea = Irregular periods
IMB = Intermenstrual bleeding
PCB = Post-coital bleeding

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2
Q

What questions might you ask when a patient complains of heavy or painful periods?

A

Are they clots & how large?
Do you use tampons or pads or both?
What type do you use and how often do you change them?
Do you ever flood (aka bleed through clothes)?#
QOL questions like does it affect your work, hobbies or ability to go out in public?

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3
Q

Age is a good way of narrowing down the likely cause of abnormal bleeding, What problems might you expect in an early teenager?

A

Probably anovulatory cycles, which is quite normal as they go through puberty
Or a coagulation disorder (unlikely to develop later)

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4
Q

What problems might you expect in someone from puberty up to their 40s? (fertile age)

A

Chlamydia
Contraception issuesEndometriosis or adenomyosis
Fibroids
Endometrial or cervical polyps
Dysfunctional Bleeding

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5
Q

What problems might you expect in someone >40s?

A

Perimenopausal anovulation
Endometrial cancer
Iatrogenic warfarin
Thyroid disfunction

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6
Q

So if a woman comes to you with a bleeding problem what kind of blood tests would you like to do?

A

FBC
Thyroid function (if history indicates)
Coagulation screen (if younger)
Endometrial biopsy (if >45, persistent IMB or obese)
Pregnancy test (important to ALWAYS consider pregnancy)

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7
Q

Who would you test for chlamydia?

A

Any patient with IMB and/or PCB, especially if they’re younger

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8
Q

What non-blood tests are worth considering in a menstrual disorder?

A

Transvaginal US
Hysteroscopy for endometrial pathology e.g. polyps, fibroids or cancer

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9
Q

When would a hysteroscopy be indicated?

A

Persistant IMB
Or if the US showed up a suspected endometrial pathology

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10
Q

What acronym do we use to remember the causes of abnormal uterine bleeding?

A

PALM-COEIN (FIGO classification):
- Polyps
- Adenomyosis & Endometriosis
- Leiomyoma (fibroid)
- Malignancy
- Coagulation disorder
- Ovarian (e.g. PCOS)
- Endocrine (e.g. Thyroid)
- Iatrogenic (e.g. Warfarin)
- Not Classified

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11
Q

What is Endometriosis?

A

When endometrial tissue is found outside the uterine cavity e.g. in pouch of douglas, pelvic peritoneum or ovary
Its a chronic oestrogen-dependant condition

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12
Q

How might endometriosis present

A

Pre-menstrual pelvic pain and dysmennorhoea
Deep Dyspareunia
Subfertility

On exam you may find tender nodules in rectovaginal septum, adnexal masses or limited uterine mobility.

They may also be asymptomatic

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13
Q

So a 25yr old woman comes in complaining that her periods are painful and hurts before, she also experiences pain during intercourse, how would you test her for endometriosis?

A

Start with an exam to get some more evidence.
Then:
- Laparoscopy is gold standard
- US for endometriomas (chocolate cysts)
- MRI can be helpful in deep endometriosis

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14
Q

You give a diagnosis of endometriosis, what medical treatments will you suggest?

A

Hormonal contraceptives to control the symptoms:
- cOCP
- Oral/injectable progestogens
- GnRH analogues
- LNG-IUS (progestogen)

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15
Q

What surgical treatments could you offer for endometriosis?

A

Can excise the endometrial deposits
Can do diathermy or laser ablation

Can go as far as oophorectomy +/- hysterectomy

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16
Q

Define Adenomyosis?

A

Endometrial tissue appearing in the myometrium

17
Q

How might adenomyosis present?

A

Menorrhagia & Dysmenorrhoea
The uterus may feel bulky and tender
Generally the woman will be parous and you may find it co-exists with endometriosis

18
Q

How can we diagnose adenomyosis?

A

Harder than endometriosis, generally its done by histology after a hysterectomy is done.
An MRI can suggest it but can’t differentiate from fibroids

19
Q

So if we suspect adenomyosis how can we treat them?

A

Start with symptom control using hormonal contraceptives:
- cOCP
- Oral/injectable Progestogens
- LNG-IUS

Try Endometrial Ablation

Most cases these will fail and you’ll end up doing a hysterectomy

20
Q

Define a Fibroids or Leiomyoma?

A

A smooth muscle growth in the uterine wall, its very common and generally asymptomatic

21
Q

Who’s more at risk of fibroids?

A

Afro-carribean women

22
Q

Types of fibroid?

A

Sub-mucosal project into uterine cavity
Intramural
Sub-serous project into peritoneal cavity

23
Q

What presentations could suggest fibroids?

A
  • Pressure symptoms
  • Menorrhagia (increased uterine surface area)
  • IMB
  • Pain, malpresentation or obstructed labour in pregnancy
24
Q

How do we test for a fibroid?

A

You may find the uterus to be irregularly enlarged on exam

US & Hysteroscopy

25
Q

So If a woman has a fibroid and is symptomatic but the uterine cavity isn’t distorted how would you treat her?

A

Medically with hormonal contraceptives

26
Q

What if a woman with a fibroid has a disorted uterine cavity?

A

Treat surgically:
- Transcervical resection for submucosal fibroids
- Myomectomy
- Uterine Artery Embolisation
- Hysterectomy

Can use GnRH analogues neo-adjuvantly to shrink them for surgery