Menstrual Disorders Flashcards
What is normal menstruation?
Less 80ml over 7days Average loss = 30-40ml Average duration = 2-7days Length of cycle = 28days Menarche = 10-16years Menopause = 50-55years
What are the causes of heavy menstrual bleeding?
PALM COEIN
Fibroids Polyps Endometriosis Pelvic inflammatory disease PCOS
Coagulation disorders
Hypothyroidism
Liver or renal disease
Anticoagulant treatment
Herbal supplements
CU IUD
(PALM COEIN)
What are fibroids?
Diagnosis and management
Non cancerous growth Asymptomatic Can cause pain and urinary symptoms Diagnosis = USS Management is symptom based For HMB = POP/COCP Large = embolisation and myomectomy Failed treatment = hysterectomy
What is endometriosis?
Diagnosis and management
Endometrial tissue outside the liming of the uterus
Pelvic pain, cramps, pain during and after sex, back pain, HMB, nausea, painful bowel movements
Multi system involvement
Affects QOL
Can cause systemic symptoms
Severity does not correspond with symptoms
What is used for diagnosis and management for menstrual disorders?
Pelvic examination USS Laproscopy Management = analgesia, medical and surgical Medical = COCP, POP, IUS, GnRH analogues Surgical = ablation, hysterectomy
What is adenomyosis?
A condition where endometrium becomes embedded in myometrium Heavy bleed Significant dysmenorrhoea May respond to hormones Definitive treatment is hysterectomy
What are endometrial polyps?
Diagnosis and management
Overgrowth of lining which extends into endometrium
Benign
Diagnosis = USS or hysteroscopy
Management = polypectomy
Management of heavy menstrual bleeding?
History Examination Clotting profile and thyroid function Pelvic USS Laparoscopy - endometriosis Management = QOL, underlying pathology, desire for fertility
Biopsy all women 44+
What are the treatments for heavy menstrual bleeding?
Hormonal = Mirena IUS
COCP and POP
Non-hormonal = mefenamic and tranexemic acid, GnRH analogues
Endometrial ablation
Fibroid embolisation
Hysterectomy
What is a salpingo-oophorectomy?
Removal of the tubes and ovaries
What is Oligomennorhea and Amennorhoea?
Infrequent, absent or light menstruation
Check if normal to patient
Causes = life changes, stress, obesity, hormones, PCOS, prolactinomas, thyroid disorders, obstructions
Investigate and treat cause
What are polycystic ovarian cysts. How is it diagnosed and treated?
Metabolic syndrome when 2/3 criteria met USS Biochemical hyperandrogenism Associated with infertility and obesity Management = lifestyle changes Symptom based treatment 3 withdrawal bleeds per year -Achieved with COCP, POP or mirena IUS
