menstrual disorders

Question 1

what is heavy menstrual bleeding ?

Answer 1

> 80ml in 7 day cycle
need to change products every 1/2 hours
passage of clots >2.5 cm
flooding

Question 2

what are uterine and ovarian pathologies which cause heavy menstrual bleeding ?

Answer 2

uterine fibroids - dysmenorrhoea and pelvic pain
endometrial polyps - intramenstrual bleeding
endometriosis
PID - discharge, fever, postcoital bleeding
endometrial hyperplasia/carcinoma
PCOS

Question 3

what are systemic disease which cause heavy menstrual bleeding ?

Answer 3

coagulation disorders
hypothyroidism
liver/renal disease

Question 4

what are iatrogenic causes of heavy menstrual bleeding ?

Answer 4

anticoagulant treatment

herbal supplements - ginseng, soya, ginkgo

Question 5

how do you remember causes of heavy menstrual bleeding ?

Answer 5

PALM COEIN

Polyp
Adenomyosis
Leiomyoma/fibroid
Malignancy

Coagulopathy
Ovulation dysfunction
Endometrium/hyperplasia
Iatrogenic
Not yet classified

Question 6

what are fibroids ?

Answer 6

non-cancerous growths made of muscle and fibrous tissue

called myoma or ileomyoma

Question 7

how do fibroids present ?

Answer 7

asymptomatic

HMB
pelvic pain
urinary symptoms
pressure symptoms
backache
infertility
miscarriage

USS

Question 8

how do you treat fibroids ?

Answer 8

small fibroids/HMB - COCP, POP, mirena

large/fertility problem - myomectomy, resection

Question 9

how does endometriosis present ?

Answer 9

HMB
pelvic pain - during and after sex
infertility
fatigue
systemic symptoms

Question 10

what are the stages of endometriosis ?

Answer 10

1. minimal - surface lesions or inflammation on or around organs in the pelvic cavity
2. mild - more widespread and starts to infiltrate organs
3. moderate - peritoneum or other structures, scarring and adhesions
4. severe - affecting many organs, distorted anatomy

Question 11

how do you diagnose endometriosis ?

Answer 11

pelvic exam
USS
diagnostic laparoscopy

Question 12

how do you manage endometriosis ?

Answer 12

medical;
COCP
POP
mirena
GnRH analogues

surgical;
ablation
hysterectomy
excision
pelvic clearance

Question 13

what is adenomyosis ?

Answer 13

endometrium becomes embedded in myometrium
HMB, dysmenorrhoea

partial response to hormones
definitive treatment is hysterectomy

Question 14

what are medical treatments for HMB ?

Answer 14

tranexamic acid
mefenamic acid

COCP
IUS
POP day 5-25 cycle doesn’t reduce bleeding

Question 15

what are surgical treatments for HMB ?

Answer 15

endometrial ablation;
diathermy
thermal balloon, radio frequency

Question 16

what are the different types of hysterectomy ?

Answer 16

1. subtotal - just uterus removed
2. total - uterus and cervix
3. total with bilateral salpingo-oophrectomy
4. Wertheim’s hysterectomy

Question 17

what are the pros and cons of removing the ovaries with uterus ?

Answer 17

pros - reduces risk of ovarian cancer

cons - immediate menopause

Question 18

what causes oligo/amenorrhoea ?

Answer 18

life changes - weight, exercise
hormones - POP, mirena
primary ovarian insufficiency
hyperprolactinaemia 
prolactinomas
thyroid disorders
obstruction of uterus