Menstrual Dysfunction Flashcards
What are fibroids? (Leiomyoma)
Non-cancerous growths that develop in or around the uterus
Symptoms of fibroids (1/3 women)
Heavy periods Pelvic pressure/heaviness Dysmenorrhea Abdominal pain Lower back pain Frequent need to urinate Constipation Pain/discomfort during sex
Epidemiology of fibroids
Experienced by 1 in 3 women
Most commonly in women 30-50
More frequent in women of African Caribbean descent
More frequent in obesity
Decreased risk in women who have children
What percentage of women are affected by heavy menstrual bleeding?
20-30%
Things to consider in an abnormal vaginal bleeding history
Age - >45 = higher risk of underlying pathology
Is it regular? Irregularity poses higher risk
Associated symptoms (fibroids) - heaviness in the pelvis, urinary symptoms, fibroids on previous scan?
History - Von Willebrands?
What is considered normal endometrial thickness?
Depends on time of scan in relation to menstrual cycle. Thickest into secretory phase up to 16mm
Common pathologies seen on USS that contribute to heavy menstrual bleeding
Fibroids
Endometrial polyp
Red flags indicative of 2ww referral
>45 Intermenstrual bleeding Postcoital bleeding Postmenopausal bleeding Abnormal examination - pelvic mass/lesion on cervix Treatment failure after 3 months
Indications for hysteroscopy
Sterility Infertility Menstrual disorders Suspusious USS endometrial findings Check ups after IUD or treatment of endometrial hyperplasia Lost IUD
Uterus abormalities
Arcuate
Subseptate
Septate
What is the management of heavy menstrual bleeding? COCendometrial
History, Examination, FBC
If no structural or histological abnormality suspected:
1. Merina (Levonorgestel-releasing intrauterine system)
2. Tranexamic acid, NSAIDS, COC
3. POP, Injected progestogen
(GnRH analogue)
No fibroids/<3cm - see above
USS
Fibroids >3cm same as above but refer to specialists for fibroid treatment
Think about impact on quality of life, desire to conceive/retain uterus
Endometrial ablation
Hysterectomy
Myomectomy
Uterine artery ablation
PALMCOEIN
P - polyp
A - adenomyosis - (PAL perimenopausal women)
L - lieomyoma
M - malignancy
C - coagulopathy (Von Willebrand’s disease
O - ovulatory dysfunction (most common in adolescents)(PCOS)
E - endometrial process
I - iatrogenic
N - non yet classified
Normal menstrual cycle duration
21-35 days
Menstrual flow 4-6 days
The ovary and hormone changes in the menstrual cycle
Primary follicle develops during follicular phase and becomes dominant
Follicle secretes increasing amounts of estradiol
Production of LH increases and there is a surge on day 11-13
Surge triggers ovulation
Dominant follicle becomes corpus luteum - produces progesterone (neg feedback on pituitary)
Progesterone stimulates endometrial lining to become secretory
At the end of luteal phase, progesterone, estradiol and LH are at their lowest
Signs in AUB examination indicating bleeding disorder
Petechiae
Ecchymosis
Skin pallor
Swollen joints
