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Menstrual Disorders Flashcards

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1
Q

What is the normal ages for menarche and menopause?

A

13-51

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2
Q

How long do periods tend to last? How long is the normal cycle of a period?

A

4-5 days

21-35 days

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3
Q

What triggers menstruation?

A

Fall in progesterone 2 weeks after ovulation if the egg is not fertilised

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4
Q

What is the mean blood loss for a period?

A

30-40ml + mucosa of endometrial and secretion from other halnds

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5
Q

What things may cause period abnormalities that are not pathologic?

A

Stress/medications etc. that disrupt hormones

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6
Q

Define menorrhagia

A

Heavy periods

Blood loss >80ml/cycle (or as the woman perceives)

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7
Q

In which conditions would you get menorrhagia?

A

Adenomyosis

Fibroids

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8
Q

Define dysmenorrhoea

A

Painful periods (recurrent lower ab pain during/shortly before period begins)

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9
Q

What may cause dysmenorrhoea?

A

Primary - normal pain occurring on first 1/2 days of period

Secondary - IUD, PID, endometriosis, fibroids, adenomyosis

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10
Q

What is intermenstrual bleeding?

A

Bleeding between periods

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11
Q

In which conditions would you get IMB?

A

Ovarian insufficiency, cervical/endometrial cancer, OCP use

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12
Q

What is post-coital bleeding?

A

Bleeding after sex

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13
Q

What is oligomenorrhoea?

A

Infrequent periods (45-90 day cycle)

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14
Q

What causes oligomenorrhoea?

A

Pregnancy, ectopic pregnancy, PCOS, insufficient calorific intake

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15
Q

What is amenorrhoea?

A

Absence of menses

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16
Q

What can cause amenorrhoea?

A

Pregnancy, ovarian disorders, e.g. PCO, endometriosis, endocrine disorders

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17
Q

What is mittelschmerz?

A

Midcycle pain that occurs with ovulation
Enlargement/rupture of follicle –> peritoneal irritation –> recurrent, unilateral lower abdominal pain

NORMAL

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18
Q

What investigations should you do for heavy periods?

A 
FBC
Thyroid function 
Coagulation testing if Hx suggestive 
Endometrial biopsy 
Pregnancy test
TVUS
Hysteroscopy
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19
Q

When would you do an endometrial biopsy?

A

> 45y, persistent IMB/irreg perimenopausal bleeding, other RFs for endometrial hyperplasia/endometrial thickness 4+cm

to rule out endometrial cancer/hyperplasia

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20
Q

What additional test should you do for IMB/PCB?

A

Chlamydia testing

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21
Q

What would you do a TVUS for?

A

PCO, assess endometrial thickness, adnexa, fibroids

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22
Q

What would you do a hysteroscopy for?

A

Persistent IMB, suspected endometrial pathology on USS

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23
Q

What is likely to be the menstrual disorder in early teens?

A

Coagulation problems

Anovulatory cycles

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24
Q

What are the likely menstrual disorders from teens to 40s?

A 
Chlamydia (esp IMB)
Contraception related
Endometriosis/adenomyosis
Fibroids (menorrhagia) 
Endometrial/cervical polyps (IMB/PCB)
Dysfunctional bleeding
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25
What are the likely menstrual disorders in 40s-menopause?
Perimenopausal anovulation Endometrial cancer Warfarin Thyroid dysfunction
26
What is the main complaint in endometriosis?
PAIN
27
What is the main compliant in adenomyosis?
MENORRHAGIA
28
What is an anovulatory cycle?
Menstrual cycle with absence of ovulation leading to menstrual irregularities
29
When is it most common to get anovulatory cycles?
In first few months/years after menarche
30
Why do woman get anovulatory cycles?
HPO axis not fully established yet
31
What are the symptoms of hypothyroidism?
Menorrhagia, tiredness, cold tolerance, wt gain, dry skin and hair etc.
32
What are the symptoms of hyperthyroidism?
Olgiomenorrhoea/amenorrhoea, tachycardia, palpitations, HTN, excess sweating, diarrhoea, wt loss, hyperreflexia
33
What is the PALM-COEIN FIGO classification for abnormal uterine bleeding?
``` Polpys Adenomyosis Leiomyoma Malignancy/hyperplasia Coagulation, e.g. vWF dx Ovarian, e.g. PCOs/anovulatory cycles Endocrine, e.g. thyroid Iatrogenic, e.g. warfarin Not yet classified ```
34
What is DUB?
Dysfunctional unterine bleeding Abnormal bleeding with no structural/endocrine/neoplastic/infectious cause found as of yet A lot can be different subjective opinion
35
How many hysterectomies are for DUB?
50%
36
Define endometriosis
Endometrial tissue outside the uterine cavity
37
Why does endometriosis lead to symptoms?
This endometrial tissue is still oestrogen responsive so will grow and shed like normal endometrial tissue --> inflammation, scarring, pain
38
Where does this endometrial tissue in endometriosis tend to be found?
Ovary, pouch of Douglas, Fallopian tubes, pelvic peritoneum | Can be extra pelvic, e.g. lung/brain
39
What are the theories for explaining the pathogenesis of endometriosis?
Retrograde menstruation - backflow of menstrual fluid containing endometrial tissue which implants in the tubes/ovaries etc. Coelomic metaplasia: peritoneal cells & endometrial cells from same embryonic precursor so cells thought to undergo metaplasia Haematogenous spread - menstrual blood enters BV and endometrial cells implant in various organs Direct transplantation: e.g. scar endometriosis - endometrial cells implant on C-section/episitomy scars
40
What are the symptoms of endometriosis?
Premenstrual pelvic pain Dysmenorrhoea (2 days before periods - several days) Deep dyspareunia Subfertility
41
Why do you get subfertility in some cases of endometriosis?
Adhesions/inflammation affect egg quality and implantation
42
What signs do you get in endometriosis?
May be none Tender nodules in rectovaginal septum if advanced Limited uterine mobility Adnexal masses
43
What is used to diagnose endometriosis?
Laparoscopy - gold standard MRI for deep endometriosis USS to diagnose endometrioma
44
How is endometriosis graded?
1-->4 1 = superficial lesions 4 = deep lesions
45
What are chocolate cysts?
AKA endometriomas | Cyst like structures in ovaries containing blood, fluid and menstrual debris
46
What is powder burn in endometriosis?
Mild endometriosis appears like superficial burn
47
How does the appearance of the endometrial deposits change?
Red (flame red endometriosis) in active bleeding stage --> blue/back --> white and fibrous with the stages of the menstrual cycle
48
What is involved in treatment of endometriosis?
``` Progesterone - POP/LNG-IUS/depoProvera COCP - tricycle (as symptoms predominantly during menstruation) GnRH analogues (leuprorelin) - induce perimenopause so implants regress ``` Surgery Excision of deposits Diathermy/laser ablation of deposits Hysterectomy +/- oophorectomy
49
What are the signs/symptoms of adenomyosis?
Heavy, painful periods Bulky, tender uterus Uniformly enlarged uterus
50
How do you diagnose adenomyosis?
MRI may suggest diagnosis | Tend to diagnose post-hysterectomy via histology
51
How do you treat adenomyosis?
LNG-IUS, POP, COCP | Often failed medical Rx/endometrial ablation --> hysterectomy
52
What are fibroids?
Smooth muscle growths | AKA leiomyomas
53
What are risk factors for fibroids?
Afro-caribbean, obesity, nulliparity, early menarche
54
How do you diagnose fibroids?
Ex - irreg, enlarged uterus TVUS/ab USS Hysteroscopy (if think inside uterine cavity)
55
What are the different kinds of fibroids?
Submucous - protruding into uterine cavity Intramural - in uterine wall Subserous - projecting into peritoneal cavity May be called a polyp if it has a stalk
56
What symptoms are associated with fibroids?
Often asymptomatic Large fibroids --> pressure symptoms (constipation, urinary frequency/retention) Menorrhagia (due to increased SA of endometrium) Submucosal fibroids --> IMB
57
How can fibroids complicate pregnancy?
Can grow rapidly in pregnancy and cause pain, malpresentation and obstruction in labour
58
When do you treat fibroids?
Only if symptomatic
59
How do you treat fibroids?
GnRH analogues/ulipristal acetate to temporarily shrink them before surgery Submucous fibroids can be removed transcervically Myomectomy (intramural/subserous) Uterine artery embolization (block artery supplying fibroid so it dies) Hysterectomy
60
What are risk factors for adenomyosis?
Early menarche, increased parity, previous uterine surgery
61
What are risk factors for endometriosis?
Retrograde menstruation
62
How do you treat DUS?
Non-hormonal if trying to conceive: tranexamic acid/mefenamic acid Hormonal: COCP, POP, LNG-IUS, Depo Surgery: endometrial ablation/hysterectomy
63
What is tranexamic acid?
Anti-fibrinolytic | Reduces blood loss by 60%
64
What is mefenamic acid?
Prostaglandin inhibitor | Inhibits pain and reduces blood loss by 30%
65
When is COCP CI?
Migraine, >35, smoker, high BMI
66
Why might you not go for depo?
Stimulates appetite --> wt gain
67
What are the different for endometrial ablation?
First gen: diathermy | Second gen: thermal balloon (85 degree water in balloon), radiofrequency
68
What are the pre-requisites for endometrial ablation?
Uterine cavity length <11cm Submucous fibroids <3/4cm Previous normal endometrial biopsy (ensure no cancer which we may leak into the peritoneum --> spreading)
69
What are the different ways a hysterectomy can be done?
Abdominally Vaginally Laparoscopically
70
What are the different types of hysterectomy?
Subtotal: uterus only Total: uterus and cervix Total + bilat salphino-oophorectomy Wertheim's hysterectomy (T + BSO + upper vagina and parametrial tissue)
71
What are the risks of hysterectomy?
Infection, DVT, bladder/bowel/vessels damage, altered bladder function, adhesions
72
What are the disadvantages and advantages of oophorectomy?
Adv - reduces risk of ovarian cancer | Disadv - immediate menopause (HRT recommended until 50y)

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