Menstrual Disorders Flashcards

1
Q

A fall in the level of which hormone causes menstruation?

A

Progesterone

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2
Q

What is meant by menorrhagia?

A

Heavy periods (>80ml/cycle)

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3
Q

What is meant by dysmenorrhoea?

A

Painful periods

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4
Q

What is meant by inter-menstrual bleeding?

A

Bleeding between periods

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5
Q

What is meant by postcoital bleeding?

A

Bleeding after intercourse

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6
Q

What is meant by oligomenorrhoea?

A

Infrequent periods (bleeding every 45-90 days)

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7
Q

What are important points to ask a patient about when they are presenting with menstrual problems?

A

1 - The patients perception of the problem

2 - Are there clots present?

3 - Is she flooding her tampon/pad and having to use several of these per day?

4 - Is there pain associated with her period?

5 - How are her symptoms impacting on her lifestyle and quality of life

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8
Q

What types of examination should be carried out when checking woman with menstrual problems?

A

1 - General

2 - Abdominal

3 - Speculum

4 - Bimanual

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9
Q

What investigations should be performed on woman presenting with heavy periods?

A
  • Full blood count
  • Thyroid function and coagulation (if history suggestive)
  • Endometrial biopsy (if >45/persistent IMB/obesity)
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10
Q

What menstrual problems are early teens likely to face?

A
  • Anovulatory cycles
  • Coagulation problems
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11
Q

What menstrual problems are those aged from teens-40 y.o. most likely to face?

A
  • Chlamydia
  • Contraception related
  • Endometriosis/adenomyosis
  • Fibroids
  • Endometrial or cervical polyps
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12
Q

What are the causes of menstrual bleeding in woman who are between 40 y.o. and the menopause?

A

1 - Perimenopausal anovulation

2 - Endometrial cancer

3 - Warfarin

4 - Thyroid dysfunction

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13
Q

What two points are extremely important to remember when establishing the cause of menstrual problems in woman?

A

1 - Always consider pregnancy

2 - Always look at the cervix

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14
Q

What is a useful pnemonic to remember the causes of abnormal uterine bleeding?

A

PALM-COEIN

P - Polyp

A - Adenomyosis

L - Leiomyoma (fibroids)

M - Malignancy/hyperplasia

C - Coagulation disorders (von willebrands disease)

O - Ovarian (polycystic ovaries)

E - Endocrine (Thyroid)

I - Iatrogenic (e.g. warfarin)

N - Not yet classified

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15
Q

What is dysfunctional uterine bleeding?

A

Abnormal bleeding but NO structural/endocrine/neoplastic/infectious cause identified

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16
Q

What is endometriosis?

A

Endometrial type tissue found outside the uterine cavity

17
Q

Which hormone plays an important role in development of endometriosis?

A

Oestrogen

18
Q

Where does endometriosis usually occur?

A

1 - Ovary

2 - Pouch of Douglas

3 - Pelvic peritoneum (more common on left side due to direction of peritoneal fluid flow)

19
Q

What are the signs & symptoms of endometriosis?

A

Symptoms:

1 - Premenstrual pelvic pain

2 - Dysmenorrhoea (painful periods)

3 - Deep dyspareunia (deep pain during sex)

4 - Subfertility

Signs:

1 - Tender rectovaginal nodules

2 - Limited uterine mobility

3 - Adnexal mass

20
Q

How is endometriosis diagnosed?

A

Gold standard = Laparoscopy

Deep endometriosis = MRI

Endometrioma (chocolate cyst) = USS

21
Q

How is endometriosis treated?

A

Medical:

  • Hormonal treatment (Progestogen, combined oral contraceptive pill, GnRH analogues)
  • Analgesics

Surgical:

  • Excision of deposits from peritoneum/ovary
  • Diathermy/laser ablation of deposits
  • Removal of ovaries with or without hysterectomy
22
Q

What is adenomyosis?

A

The presence of endometrial tissue in the myometrium

23
Q

What are the signs & symptoms of adenomyosis?

A

1 - Heavy, painful periods

2 - Bulky tender uterus

3 - Usually observed in parous woman

24
Q

How is adenomyosis diagnosed?

A

MRI

Histology of uterine muscle

25
Q

How is adenomyosis treated?

A

Hormonal contraception (will treat heavy & painful periods)

26
Q

What are fibroids?

A
  • Smooth muscle growths
  • Very common and usually asymptomatic
  • Higher incidence in afro-caribbean woman
27
Q

How are fibroids diagnosed?

A

1 - Clinical exam (irregularly enlarged uterus)

2 - USS

3 - Hysteroscopy

28
Q

What are the different types of fibroids?

A

Sub mucous - protrudes into uterine cavity

Intramural - within uterine wall

Sub serous - project out of uterus into peritoneal cavity

29
Q

What are the symptoms of fibroids?

A

Large fibroids - may cause pressure symptoms

Menorrhagia

Intermenstrual bleeding

May be asymptomatic

30
Q

How are fibroids treated?

A
  • Only if symptomatic
  • Standard menorrhagia treatment
  • Resection
  • Myomectomy
  • Hysterectomy
31
Q

What are the treatment options for dysfunctional uterine bleeding?

A

Medical:

Non-hormonal - Tranexamic acid or Mefanamic acid

Hormonal - Progestogen tablets, injections, combined pill

Surgical (if family complete):

  • Endometrial ablation
  • Hysterectomy
32
Q

What is a hysterectomy and what are the different types that can be performed?

A

Hysterectomy = Surgical removal of uterus

1 - Subtotal hysterectomy (only uterus)

2 - Total hysterectomy (uterus + cervix)

3 - Total hysterectomy with bilateral salpingo-oophorectomy (removes both tubes and ovaries)

33
Q

What are some of the risks of having a hysterectomy?

A

1 - Infection

2 - DVT

3 - Bladder/bowel/vessel injury

4 - Altered bladder function

34
Q

What tests should be carried out on woman presenting with IMB and PMB?

A
  • Test for chlamydia
  • Pregnancy test
  • Transvaginal USS
  • Hysteroscopy (following identification of endometrial pathology on USS)