Menstrual Disorders Flashcards

1
Q

What happens in the follicular phase (pituitary and ovary)?

A

FSH stimulates ovarian follicle development & granulosa cells to produce oestrogens
Raising oestrogen & inhibin by dominant follicles inhibit FSH production
Declining FSH levels cause atresia of but dominant follicle

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2
Q

What happens in ovulation (pituitary and ovary)?

A

Prior LH surge

Dominant follicle ruptures and releases oocyte

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3
Q

What happens in the luteal phase (pituitary and ovary)?

A

Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation

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4
Q

What endometrial events occur in the proliferative phase?

A

Oestrogen-induced growth of endometrial glands and stroma

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5
Q

What endometrial events occur in the luteal phase?

A

Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation

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6
Q

What endometrial events occur in the menstruation?

A

Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation

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7
Q

What is the normal menstrual cycle and loss?

A

Lasting 4-6 days over 21-35 day cycle (28 avg)
Peaks day 1-2
<80ml per menstruation
No clots, IMB or PCB

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8
Q

What is menorrhagia?

A

Prolonged and increased menstrual flow

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9
Q

What is metrorrhagia?

A

Regular intermenstrual bleeding

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10
Q

What is polymenorrhoea?

A

Menses occurring at <21d interval

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11
Q

What is menometrorrhagia?

A

Prolonged menses and intermenstrual bleeding

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12
Q

What is amenorrhoea?

A

Absence of menstruation >6months

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13
Q

What is oligomenorrhoea?

A

Menses at intervals of >35 days

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14
Q

What is non-organic menorrhagia?

A

Absence of pathology

Aka dysfunctional uterine bleeding

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15
Q

What are some local causes of organic menorrhagia?

A
Fibroids
Adenomyosis
Endocervical or Endometrial polyp
Cervical eversion
Endometrial hyperplasia
Intrauterine contraceptive device (IUCD)
Pelvic inflammatory disease (PID)
Endometriosis
Malignancy of the cervix or uterus
Hormone producing tumours
Trauma
Others e.g. arteriovenous malformations
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16
Q

What systemic disorders cause organic menorrhagia?

A
Hyper/hypothyroidism
DM
Adrenal disease
PRL disorders
Von Willebrand's disease
ITP
Factor II,V,VII and XI deficiency
Liver disorders
Renal disease
Anticoagulants
17
Q

What obstetric disorders cause organic menorrhagia?

A

Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Postpartum haemorrhage

18
Q

How many women with abnormal uterine bleeding will have dysfunctional uterine bleeding (DUB)?

A

50%

19
Q

How is the diagnosis of DUB made?

A

By exclusion

20
Q

What are the two categories of DUB?

A

Anovulatory

Ovulatory

21
Q

Describe anovulatory DUB

A

85% of all DUB
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women

22
Q

Describe ovulatory DUB

A

More common in women aged 35-45 years
Regular heavy periods
Due to inadequate progesterone production by corpus luteum

23
Q

What Ix are required in DUB?

A
FBC
Smear
TSH
Coag Screen
Renal/LFTs
Transvaginal US
Endometrial sampling
24
Q

What is assessed in DUB by the transvaginal US?

A

Endometrial thickness

Presence of fibroids and other pelvic masses

25
Q

What occurs in endometrial sampling in the investigation of DUB?

A

Pipelle biopsies
Hysteroscopic directed
Dilatation & curettage (D & C)

26
Q

What is the non-surgical management of DUB?

A
Progesterone
Combined pill
Danazol
GnRH analogues
NSAIDs
Anti-fibrinolytics
Capillary wall stabilisers
Progestogen-released IUCD: Mirena IUS
27
Q

What is the surgical management of DUB?

A

Endometrial resection/ablation

Hysterectomy

28
Q

What endometrial resection/ablation can be used in management of DUB?

A
Transcervical endometrial resection (TCRE)
Rollerball endometrial ablation (REA)
Bipolar mesh endometrial ablation (Novasure)
Thermal balloon ablation (Thermachoice)
Thermal hydroablation (Hydroblate)
29
Q

What are the hysterectomy options in management of DUB?

A

Sub-total hysterectomy
Total abdominal hysterectomy
Vaginal hysterectomy
LASH/LAVH/TLH

30
Q

Is fertility retained in surgical management of DUB?

A

No

31
Q

What HRT is required after an endometrial ablation and hysterectomy?

A

EA: Combined HRT
Hysterectomy: Oestrogen-only HRT (unless cervix retained)