Flashcards in Menstral Cycle and disorders Deck (21):
What does the follicule produce?
Oestrogen and inhibit
What happens after the LH surge?
Corpus luteum produces what hormone and its action?
What is menorrhagia?
Excessive menstraul bleeding which affects her life.
Volume based >80g
What causes menorrhagia?
Haematological - Von willibrands
Endocrine - hypothyroidism
Structural - e.g. Fibroids,
Must consider carcinoma in those failing to response to treatment, over 45 years.
Irregular bleeding is caused by what 2 main things?
Conditions - benign or malignant
Causes of primary and secondary amenorrhea?
1' never bleed- chromosomes, imperforate hymen (haemocoloposcopy), anorexia, athleticism
2' had then stopped - e.g. Pregnancy, PCOS
Pathological or not
Causes of post-coital bleeding?
Eptropium - movement of the transformation zone (squamous to columnar)
Types of fibroid?
At what age would you starting investigating primary amenorrhea?
16y or 14y if she shows no sign of breast development
What treatment can be given for primary dysmenorrhea?
NSAIDs eg Mefenamic acid (they inhibit prostaglandins)
Second line - cocp
Secondary dysmenorrhea - refer to gynea for investigation
What investigation must you always do for amenorrhea?
What are the actions of PGF2a, PGE2, and PGI2 in menstruation?
PGF2a - vasoconstriction
Pge2 and pgi2 (prostacyclin) - vasodilation
Pgi2 - inhibits platelet aggregation
What is the first line treatment for menorrhagia?
NSAIDs eg Mefenamic acid
Antifibrinolytics eg tranexamic acid
Mefenamic acid if also have pain
IM progestogens (norethisterone)
Surgery- endometrial ablation
Fibroids - myomectomy or uterine artery embolisation // hysterectomy if not wanting to be fertile
What are the different types of HRT? Who should be given what?
Combined HRT - with a uterus (progesterone needed)
- those still having periods - give oestrogen and cyclical progesterone (gives a regular withdrawal bleed)
- postmenopausal - give continuous combined HRT eg kliofem, oestrodial and norethisterone
Oestrogen only - without a uterus
What are the alternatives to HRT?
SSRIs- eg. Clonidine for vasomotor symptoms
Calcium and vit d, bisphoshanates or strontium or SERMs - oesoporosis
Oestrogen cream- vaginal dryness
What is ashermans syndrome?
Amerrhoa due to uterine adhesions after D&C (leading to cervical stenosis)
What is Sheehan syndrome?
Amenorrhea caused by Postpartum infarction of the pituitary gland due to PPH
What are the contraindications to HRT?
Undiagnosed vaginal bleeding
/ Breast lump
Previous VTE - due to preg/oestrogen
What are the blood tests in PCOS?
Elevated LH:fsh ratio