Gynae - menstrual cycle Flashcards
(23 cards)
What is menorrhagia?
heavy menstrual bleeding that occurs at expected intervals of the menstrual cycle
- subjective
What are the top causes of heavy menstrual bleeding?
uterine fibroids, uterine polyps, adenomyosis, endometriosis, malignancy, clotting disorders, drug therapy, thyroid disease
40-60% have no pathology on investigation = Dysfunction Uterine Bleeding
What tests would you do to investigate heavy menstrual bleeding?
FBC, coagulation, TFT, hysteroscopy and biopsy
How would you treat heavy menstrual bleeding?
Reassurance Antifibrinolytics e.g. tranexamic acid NSAIDs e.g. mefenamic acid Progestagens for 3 months Danazol - inhibits sex production COCP or Mirena Endometrial ablation Myomectomy/resection of fibroids Hysterectomy
What age is normal menarche?
12-13 (11-14.5)
What age is percocious puberty and what causes it?
Puberty before 8 and 9
secretion of high-amplitude pulses of gonadotrpin-releasing hormone (GnRH) by the hypothalamus
What age would count as delayed puberty?
aged 11-15, runs in families
What is the definition of primary amenhorrhea?
failure of menses to occur <16 and normal secondary sexual characteristics
or
14 with no secondary characteristics
What are the 5 main categories of problems that cause amenorrhea? Give 2 examples for each
1 - hypothalamus: low GnRH due to athleticism or underweight
2 - pituitary: prolactinoma, pit adenoma, previous radiation
3 - ovary: dysgenesis, no ovary, early menopause, Turners, PCOS
4 - uterus: no uterus, no outflow (severe FGM)
5 - other: thryroid, pregnancy
What is haematocolps?
the accumulation of blood inside vagina
- most often caused by imperforate hymen
What would you see with an imperforate hymen?
budlging red disc 3cm proximal to introitus
What hormones are secreted by the ovary?
oestrodial, inhibin
What is the corpus leteum? What hormone does it secrete?
ruptured follicle, releases progesterone and suppresses FSH
Where is somatostatin secreted?
hypothalamus
Where is gonadotrophin-releasing hormone secreted?
hypothalamus
What triggers LH surge?
oestrogen secretion by growing follicles
What hormone is secreted by growing follicles?
oestrogen
At what week does the embryonic development of male and female reproductive systems diverge?
week 7 - determined by SRY gene
Would FSH be high (hypergonadotropic) or hypogonadotropic in the following?
PCOS, Cushing’s, primary ovarian insufficiency, weight loss, premature ovarian failure
PCOS - low/normal Cushing's - low/normal primary ovarian sufficiency - high weight loss - low premature ovarian failure - high
What is Asherman syndrome?
adhesions after uterine surgery
What is treatment for Asherman’s syndrome?
adhesiolysis surgery
What is the treatment for hyperprolactinaemia?
dopamine agonists
What are the risks with HRT and VTE?
VTE risk highest in first year
personal hisotry of VTE is a contradindication
HRT stopped if VTE found, and this risk of VTE does not continue after stopping HRT
