menstrual disorders

Question 1

what are causes of heavy menstrual bleeding

Answer 1

PALM COEIN

polyps, PCOS
adenomyosis 
leiomyoma (fibroids)
malignancy/endometrial hyperplasia 
coagulopathy 
ovulation dysfunction 
endocrine - hypothyroidism 
iatrogenic - anticoagulants, IUDs, CUs 
not known

Question 2

what investigations could you do in HMB

Answer 2

history 
pelvic exam 
clotting profile 
TFTs 
US
vaginal swab for infection

Question 3

what are non-contraceptive management options for HMB

Answer 3

tranexamic acid if no pain

mefenamic acid if associated pain

Question 4

what are contraceptive options for management of HMB

Answer 4

mirena coil is first line
COPC
provera (cyclical oral progesterone)

Question 5

what are ablation management options for HMB

Answer 5

endometrial ablation

balloon thermal ablation

Question 6

what is oligo/amenorrhoea

Answer 6

infequent/absent/light periods

Question 7

what causes oligo/amenorrhoea

Answer 7

stress - physical or psychological 
malnourishment/EDs 
obesity 
hormones 
primary ovarian insufficiency 
hyperprolactinaemia 
prolactinomas 
thyroid disorders 
obstruction of uterus/cervix/vagina

Question 8

what is endometriosis

Answer 8

endometrial tissue outside uterus
called endometriomas
the tissue follows the menstrual cycle - bleeds

Question 9

how can endometriosis present

Answer 9

HMB
spotting 
pelvic pain 
infertility 
fatigue 
systemic symptoms 
dyspareunia 
cyclical bleeding from other sites - haematuria 
painful bowel movements and urination 
diarrhoea, nausea, bloating

Question 10

what investigations could you do in endometriosis

Answer 10

US - shows endometriomas and chocolate cysts

laparoscopic surgery to get biopsy - confirms diagnosis

Question 11

what is stage 1 endometriosis

Answer 11

small superficial lesions

Question 12

what is stage 2 endometriosis

Answer 12

mild but deeper lesions than stage 1

Question 13

what is stage 3 endometriosis

Answer 13

deeper lesions
lesions on ovaries
mild adhesions

Question 14

what is stage 4 endometriosis

Answer 14

deep and large lesions effecting ovaries

extensive adhesions

Question 15

medical management for endometriosis

Answer 15

COCP
POP
implant 
mirena coil 
provera 
GnzRH agonists

Question 16

surgical management of endometriosis

Answer 16

laparoscopic surgery - excise or ablate endometriomas
hysterectomy
salpingo-ophrectomy

Question 17

what is adenomyosis

Answer 17

endometrium becomes embedded in myometrium

Question 18

in what group of patients is adenomyosis common

Answer 18

later productive years
multiparous

symptoms usually resolve after menopause

Question 19

how does adenomyosis present

Answer 19

dysmenorrhoea 
HMB
dyspareunia 
infertility 
enlarged tender uterus

Question 20

what investigations could you do in adenomyosis

Answer 20

transvaginal US
MRI
histological examination of uterus after hysterectomy

Question 21

how can you manage adenomyosis

Answer 21

manage like HMB

endometrial ablation
uterine artery embolism
hysterectomy

Question 22

what are fibroids

Answer 22

benign tumours of SM of uterus
muscle and fibrous tissue
aka myoma or leiomyoma

Question 23

intramural fibroid location

Answer 23

grows in uterus muscle and can distort it

Question 24

subserosal fibroid location

Answer 24

grow below outer layer of uterus and can fill abdominal cavity

Question 25

submucosal fibroid location

Answer 25

grow on endometrium

Question 26

pedunculated

Answer 26

fibroid grows on a stalk

Question 27

how does fibroids present

Answer 27

``` HMB prolonged menstruation abdominal pain bloating/abdominal fullness dyspareunia reduced fertility miscarrige back ache urinary or bowel symptoms ```

Question 28

investigations for fibroids

Answer 28

US id diagnostic abdominal and bimanual examinations hysteroscopy for submucosal MRI if doing surgery

Question 29

how do you manage fibroids <3cm

Answer 29

can give contraceptive: COCP POP mirena surgical options: endometrial ablation, resection, hysterectomy

Question 30

how do you manage fibroids >3cm

Answer 30

myomectomy uterine artery embolisation hysterectomy GnRH agonists to shrink fibroids before surgery

Question 31

how can you manage submucosal fibroids

Answer 31

hysteroscopic fibroid resection

Question 32

what are endometrial polyps

Answer 32

overgrowth of endometrial lining causes polyp formation polyps are pediculated structures benign

Question 33

investigations for endometrial polyps

Answer 33

US | hysteroscopy

Question 34

endometrial polyp management

Answer 34

polypectomy

Question 35

what is dysfunctional uterine bleeding

Answer 35

excessive uterine bleeding in premenopausal woman with no explanation/disease/cause

Question 36

how do you manage dysfunctional uterine bleeding

Answer 36

conservative management | GnRH analogues if patients are nearly menopausal