menstrual disorders Flashcards
(54 cards)
1
Q
GnRH is secreted by the hypothalamus and stimulates the release of what two hormones from the ant pituitary
A
- FSH
- LH
2
Q
FSH initiates what growth?
A
- follicular growth
3
Q
LH stimulates what?
A
- further development of follicles
4
Q
FSH and LH stimulate ovarian follicles to secrete what?
A
- oestrogen
5
Q
progesterone is secreted mainly by what?
A
- corpus luteum
6
Q
progesterone and oestrogen work together to do what?
A
- maintain endometrium ready for implantation
7
Q
what hormone allows primary follicles to develop into secondary follicles?
A
- FSH
8
Q
a fall in what hormones stimulates the release of prostaglandins causing uterine spiral arterioles to constrict?
A
oestrogen and progesterone
9
Q
what part of the endometrium sloughs off after the cells supplying the spiral arterioles die off?
A
- stratum functionalis
-> leaving thin stratum basalis (2-5mm)
10
Q
what is the normal amount of blood loss from the vagina?
A
5-80ml
11
Q
what phase of the menstrual cycle varies in time?
A
- preovulatory phase
12
Q
which type of follicles secrete oestrogen?
A
- secondary follicles
- one secondary follicle outgrows the rest to become dominant and develops into the graafian follicle
13
Q
what happens in the uterus in response to oestrogens being released into the circulation?
A
- oestrogen released by the secondary follicles and graafian follicle stimulates the growth of the endometrium
14
Q
what part of the endometrium undergoes mitosis during the preovulatory phase?
A
- stratum basalis and produces a new stratum functionalis
- endometrial thickness doubles to 4-10mm
15
Q
what day does ovulatory phase occur?
A
- day 14 (14 days before menstruation)
16
Q
what occurs in the ovaries during the ovulatory phase?
A
- oestrogen stimulates more GnRH release
- leading to an increase in LH and FSH
- LH causes the rupture of the graafian follicle and expulsion of a secondary oocyte (approx 9 hrs after the LH surge)
- the oocyte is taken into the fallopian tube
17
Q
what occurs in the uterus during the ovulatory phase?
A
- progesterone and oestrogen continue to stimulate proliferation of the endometrium
18
Q
what occurs in the ovaries during the preovulatory phase?
A
- secondary follicles secrete oestrogen
- one secondary follicle outgrows the rest to become the dominant and develops into the graafian follicle
19
Q
what occurs in the uterus during the preovulatory phase?
A
- oestrogens released into the circulation by the growing secondary follicles and graafian follicle stimulate growth of the endometrium
- cells of stratum basalis undergo mitosis and produce new stratum functionalis
- endometrial thickness doubles - 4-10mm
20
Q
how long does postovulatory phase occur for?
A
- routinely lasts for 14 days w little variation
21
Q
what occurs in the ovary during the postovulatory phase?
A
- the collapsed follicle becomes the corpus luteum under the influence of LH
- the corpus luteum secretes progesterone, oestrogen, relaxin, and inhibin
- if fertilisation does not occur, this secretory activity declines after 2 weeks and a new cycle begins
22
Q
what occurs in the uterus in the postovulatory phase?
A
- progesterone and oestrogen promote growth and coiling of the endometrial glands, vasculisation and further thickening of the endometrium - 12-18mm
- endometrial glands begin to secrete glycogen
23
Q
how long does a normal cycle last for and how long should bleeding occur for?
A
- 24-38 days
- bleeding should last 8 days or less each cycle
24
Q
how many women are affected by pre-menstrual disorders?
A
- 5% of women
- seen as a disorder when premenstrual symptoms impact on daily living
25
name 3 physical symptoms in PMD?
- breast tenderness
- bloating
- headache
26
name 3 psychological symptoms in PMD?
- mood swings
- anger
- depression
27
name 3 behavioural symptoms in PMD?
- sleep disturbance
- change in appetite
- restlessness/poor concentration
28
what helps make a diagnosis of PMD?
- keeping a symptom diary - paper, online, apps
- needs to occur for a minimum of 2 cycles
29
what kind of management is used for PMD?
- ovulation suppression through a variety of different medications
30
what is the 1st line tx for PMD?
- Yasmin and Eloine COC (combined oral contraception pill)
-> can be used continuously
-> those containing drospirenone COC have proven impact
31
name some other treatments for PMD?
- GnRH agonists
- danazol
- oestrogen
- bilateral oophorectomy and hysterectomy w add back oestrogen only
32
side effect of GnRH agonists
- menopausal symptoms i.e. hot flushes and osteoporosis
- trial of tx 3-6 months
33
what is GnRH indicated for?
- PMD and approaching menopause
- severe endometriosis in younger women to see if they would benefit from an oophorectomy or hysterectomy (i.e. if symptoms improve opt for surgery)
34
side effects of Danazol?
- teratogenic effect so must be used alongside contraceptive
35
side effect of oestrogen
- unopposed oestrogen increases chances of endometrial hyperplasia or cancer
- counteracted by giving progesterone but can bring on PMD symptoms again...
36
other pharmacological and lifestyle mx for ovulation suppression?
SSRIs
- used continuously or during luteal phase only
Diuretics
- reduce bloating
Herbal supplements
CBT
Exercise
vit B6 and calcium
37
what is heavy menstrual bleeding?
- blood loss is perceived by the patient as interfering w physical, social, emotional or material aspect of a woman's life.
38
assessment for heavy menstrual bleeding?
- exclude pregnancy
- history and examination
- bloods (anaemic), cervical smear, swab for infection, USS and if clinically indicated coag screen
- if no abnormality or fibroids <3cm causing no distortion of uterine cavity start medical mx
39
1st line mx for heavy menstrual bleeding
mirena coil
- slowly releases localised progesterone and prevents proliferation of endometrium
40
2nd line heavy menstrual bleeding?
- tranexamic acid
anti-fibrolytic
or
- COC
suppresses ovulation and endometrial proliferation, regulates cycle
41
3rd line for heavy menstrual bleeding?
norethisterone
- prevents proliferation of the endometrium
DMPA
- long acting progesterone, suppresses ovulation and prevents proliferation of the endometrium
42
4th line for heavy menstrual bleeding?
- surgical management/referral to secondary care
43
main cause of menstrual bleeding?
- fibroids (20-30%)
benign SM tumours of uterus, v common, harmless unless they have a pressure affect
44
other causes of menstrual bleeding?
- polyps 5-10%
may be diagnosed on spec exam, USS or hysteroscopy
may be endometrial or endocervical
- adenomyosis 5%
presence of non-neoplastic endometrial glands and stroma in myometrium instead of endometrium
45
what is adenomyosis?
presence of non-neoplastic endometrial glands and stroma in myometrium
assoc w hyperplasia and hypertrophy of surorunding myometrium
46
risk factors for adenomyosis?
- associated with a history of c/section, uterine curettage, surgical termination of pregnancy, inc age, oestrogen exposure and tamoxifen use (blocks action of oestrogen - given as a prevention in breast cancer)
47
most common coagulative pathology causing heavy menstrual bleeding?
- von willebrand disease
48
von willebrand typical presentation?
- younger patient presenting not long after menarche - w heavy menstrual bleeding
49
how else is coagulopathy caused?
- medication
- PPH, inc bleeding during surgery or inc bleeding during dental work
- referral to haem required
50
red flag concern for heavy menstrual bleeding?
- malignancy
51
surgical mx for polyp?
- hysteroscopy then polypectomy
52
surgical mx for minimising monthly blood flow or stopping it?
- endometrial ablation
- less effective in younger patients and it is not contraceptive
53
surgical mx for fibroids?
- uterine artery embolization
cut off blood supply and thus shrink fibroid
can be a painful procedure
or
- myomectomy - fibroids removed surgically from uterus and preserving the uterus (for fertility reasons)
54
indications for hysterectomy?
- older patient
- had a family, do not wish to have any more children
