Menstrual Disorders Flashcards Preview

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Flashcards in Menstrual Disorders Deck (31):
1

What happens in the follicular phase (pituitary and ovary)?

FSH stimulates ovarian follicle development & granulosa cells to produce oestrogens
Raising oestrogen & inhibin by dominant follicles inhibit FSH production
Declining FSH levels cause atresia of but dominant follicle

2

What happens in ovulation (pituitary and ovary)?

Prior LH surge
Dominant follicle ruptures and releases oocyte

3

What happens in the luteal phase (pituitary and ovary)?

Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation

4

What endometrial events occur in the proliferative phase?

Oestrogen-induced growth of endometrial glands and stroma

5

What endometrial events occur in the luteal phase?

Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation

6

What endometrial events occur in the menstruation?

Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation

7

What is the normal menstrual cycle and loss?

Lasting 4-6 days over 21-35 day cycle (28 avg)
Peaks day 1-2
<80ml per menstruation
No clots, IMB or PCB

8

What is menorrhagia?

Prolonged and increased menstrual flow

9

What is metrorrhagia?

Regular intermenstrual bleeding

10

What is polymenorrhoea?

Menses occurring at <21d interval

11

What is menometrorrhagia?

Prolonged menses and intermenstrual bleeding

12

What is amenorrhoea?

Absence of menstruation >6months

13

What is oligomenorrhoea?

Menses at intervals of >35 days

14

What is non-organic menorrhagia?

Absence of pathology
Aka dysfunctional uterine bleeding

15

What are some local causes of organic menorrhagia?

Fibroids
Adenomyosis
Endocervical or Endometrial polyp
Cervical eversion
Endometrial hyperplasia
Intrauterine contraceptive device (IUCD)
Pelvic inflammatory disease (PID)
Endometriosis
Malignancy of the cervix or uterus
Hormone producing tumours
Trauma
Others e.g. arteriovenous malformations

16

What systemic disorders cause organic menorrhagia?

Hyper/hypothyroidism
DM
Adrenal disease
PRL disorders
Von Willebrand's disease
ITP
Factor II,V,VII and XI deficiency
Liver disorders
Renal disease
Anticoagulants

17

What obstetric disorders cause organic menorrhagia?

Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Postpartum haemorrhage

18

How many women with abnormal uterine bleeding will have dysfunctional uterine bleeding (DUB)?

50%

19

How is the diagnosis of DUB made?

By exclusion

20

What are the two categories of DUB?

Anovulatory
Ovulatory

21

Describe anovulatory DUB

85% of all DUB
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women

22

Describe ovulatory DUB

More common in women aged 35-45 years
Regular heavy periods
Due to inadequate progesterone production by corpus luteum

23

What Ix are required in DUB?

FBC
Smear
TSH
Coag Screen
Renal/LFTs
Transvaginal US
Endometrial sampling

24

What is assessed in DUB by the transvaginal US?

Endometrial thickness
Presence of fibroids and other pelvic masses

25

What occurs in endometrial sampling in the investigation of DUB?

Pipelle biopsies
Hysteroscopic directed
Dilatation & curettage (D & C)

26

What is the non-surgical management of DUB?

Progesterone
Combined pill
Danazol
GnRH analogues
NSAIDs
Anti-fibrinolytics
Capillary wall stabilisers
Progestogen-released IUCD: Mirena IUS

27

What is the surgical management of DUB?

Endometrial resection/ablation
Hysterectomy

28

What endometrial resection/ablation can be used in management of DUB?

Transcervical endometrial resection (TCRE)
Rollerball endometrial ablation (REA)
Bipolar mesh endometrial ablation (Novasure)
Thermal balloon ablation (Thermachoice)
Thermal hydroablation (Hydroblate)

29

What are the hysterectomy options in management of DUB?

Sub-total hysterectomy
Total abdominal hysterectomy
Vaginal hysterectomy
LASH/LAVH/TLH

30

Is fertility retained in surgical management of DUB?

No

31

What HRT is required after an endometrial ablation and hysterectomy?

EA: Combined HRT
Hysterectomy: Oestrogen-only HRT (unless cervix retained)