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Obstetrics & Gynae RIA > menorrhagia > Flashcards

menorrhagia Flashcards

(46 cards)

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1
Q

primary amenorrhoea is

A

failure to start menses by 16 years old

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2
Q

3 causes of primary amenorrhoea

A
  • Turners syndrome
  • Testicular feminisation
  • CAH
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3
Q

define secondary amenorrhoea

A

cessation of established regular menstruation for 6 months of longer

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4
Q

3 causes of secondary amenorrhoea

A
  • pregnancy
  • PCOS
  • Sheehans syndrome
  • Hypothalamic amehorrhea
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5
Q

what is ENDOMETRIOSIS

A

presence of endometrial tissue outside the uterine cavity.

Will respond to hormones & undergo cyclical bleeding, healing leading to fibrosis & development of adhesiona causes pain & infertility

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6
Q

gold standard diagnosis of endometriosis

A

Laparoscopy

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7
Q

symptoms of endometriosis

A
  • Dyspareunia
  • severe dysmenorrhoea
  • chronic pelvic pain
  • pain on defecation
  • dysuria
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8
Q

risk factors for endometriosis

A
  • early menarche
  • obesity
  • red meat
  • late menopause
  • genetics
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9
Q

causes of Pelvic inflammatory disease

A

ascending infection from endocervix

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10
Q

What is adenomyosis

A

deposits of endometrial tissue in the myometrium of the uterus

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11
Q

what are endometrioma

A

cystic structures developing on the ovaries in endometriosis - referred to as chocolate cysts due to appearance of the contained, old and altered blood

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12
Q

Hormonal therapy for Endometriosis

A

GnRH - e.g. Goserelin: shut down ovaries temporarily - inducing menopause

Cyclical pain management with - hormonal contraceptives to stop ovulation

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13
Q

symptoms of PELVIC INFLAMMATORY DISEASE

A
  • lower abdo pain
  • fever
  • heavy menstrual bleeding
  • dyspareunia
  • ## mucopurulent vaginal discharge
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14
Q

examination findings in PID

A
  • Cervical excitation
  • inflamed cervix
  • purulent discharge
  • pelvic tenderness
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15
Q

what is Fitz Hugh curtis syndrome?

A

inflammation and infection of the liver capsule (Glisson’s capsule), leading to adhesions between the liver and peritoneum

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16
Q

derm finding due to insulin resistance

A

acathosis nigricans

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17
Q

3 signs of androgen excess

A
  • acne
  • hirstuism
  • oligomenorrhoea
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18
Q

hormonal imbalance seen in PCOS

A

elevated LH

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19
Q

what does abnormal LH/FSH ratio lead to?

Study These Flashcards
A

excess androgens produced by theca cells in ovary

20
Q

criteria used to diagnose PCOS

Study These Flashcards
A

Rotterdam criteria

21
Q

outline Rotterdam criteria

Study These Flashcards
A

2 of 3 :

1) Polycystic ovaries on USS
2) Anovulation/oligoovulation - absent/irregular periods
3) Clinical/biochemical signs of hyperandrogenism

22
Q

gold standard for visualising the ovaries in PCOS

Study These Flashcards
A

Pelvic ultrasound

23
Q

diagnostic criteria for when visualising the ovaries in PCOS

Study These Flashcards
A

12 or more developing follicles in one ovary

or

ovarian volume of more than 10 cm3

24
Q

what is ‘string of pearls’ appearance?

Study These Flashcards
A

the follicles arranged around the periphery of ovary seen on TVUS of PCOS

25
glucose level 2 hours post 75g glucose drink? - impaired glucose tolerance - diabetes
Impaired glucose tolerance: 7.8 - 11.1 Diabetes: > 11.1
26
mechanism of orlistat?
lipase inhibitor that stops the absorption of fat in intestines
27
3 options offered by specialist to improve fertility if weight loss fails
- Clomifene - Laparoscopic ovarian drilling - IVF
28
topical trx of facial hirstuism
topical eflornithine takes 6-8 weeks to see a significant improvement
29
other options for managing hirstuism - offered by specialist
- electrolysis - laser hair removal - spironolactone - finasteride - flutamide - cyproterone acetate
30
mechanism of spironolactone
mineralocorticoid antagonist with anti androgen effects
31
mechanism of finasteride
5α-reductase inhibitor that decreases testosterone production
32
management of acne
Topical adapalene (a retinoid) Topical antibiotics (e.g. clindamycin 1% with benzoyl peroxide 5%) Topical azelaic acid 20% Oral tetracycline antibiotics (e.g. lymecycline)
33
definition of heavy menstrual bleeding
excessive menstrual blood loss which interfers with a woman's physical, social, emotional QoL
34
Causes of ABNORMAL MENSTRUAL BLEEDING | pneumonic
PALMCOEINS ``` P - polyps A - Adenomyosis L - Leiomyoma/fibroids M - Malignancy C - Coagulopathy O - Ovulatory disrder (PCOS) E - Endometrial process I - Iatrogenic N - not yet classified S - STD ```
35
red flag symptoms associated with abnormal menstrual bleeding
- Age > 45 - persistent intermenstrual bleeding - Post coital bleeding - Enlarged uterus - Pelvic mass - Lesion on cervix - Post - menopausal bleeding
36
1st, 2nd & 3rd line for heavy menstrual periods in individual requiring contraception
1st line = levonorgestrel releasing IUS 2nd line = COCP 3rd line = long acting progestogens (Depo provera)
37
options for managing heavy menstrual bleeding & not requiring contraception
Tranexamic acid or NSAIDs - mefenamic acid
38
directions for taking tranexamic acid
take tablet 3 times a day for up to 4 days take as soon as your periods start
39
how does mefenamic acid work?
reduced bodys production of a prostaglandin & can relieve period pain
40
invasive treatment offered to women no longer wishing to conceive, with menorrhagia
Endometrial ablation | - heat to thin the endometrium
41
invasive treatment used to treat menorrhagia caused by fibroids
Uterine artery emolization
42
what are fibroids?
benign tumours of the smooth muscle of the uterus
43
examination findinds in fibroids
Abdominal and bimanual examination may reveal a palpable pelvic mass or an enlarged firm non tender uterus
44
medication that can be used to shrink size of fibroids, prior to surgery
GnRH agonists e.g. Goserelin
45
the only treatment known to improve fertility in patients with fibroids?
Myomectomy
46
1st line Invx for uterine fibroids
Pelvic ultrasound

Obstetrics & Gynae RIA (9 decks)

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