Menstrual Disorders Flashcards
(53 cards)
When does the menstrual cycle begin and end?
From the first day of a woman’s period until the day before her next period
What is considered a normal amount of period blood loss?
less than 80ml over 7 days (16tsp)
What is the average period blood loss?
30-40ml (6-8 tsp)
What is the average period duration?
2-7 days
How long does a menstrual cycle last?
28 days (average 24-35 days)
When does menarche occur?
10-16 years old (average 12)
At what age does menopause occur?
50-55
What are the different types of menstrual disturbance?
disturbance of menstrual frequency - infrequent or frequent
irregular menstrual bleeding - absent or irregular
abnormal duration of flow - prolonged or shortened
abnormal menstrual volume - heavy or light
What are the criteria for a diagnosis of heavy menstrual bleeding?
Bleeding >80ml over 7 days, regular cycle
AND/OR
The need to change menstrual products every one to two hours
AND/OR
Passage of clots greater than 2.5cm
AND/OR
Bleeding through clothes
AND/OR
‘Very heavy’ periods as reported by the woman/affecting quality of life
Can occur alone or in combination with symptoms like dysmenorrhoea
Which uterine and ovarian pathologies can cause heavy menstrual bleeding?
Uterine fibroids (HMB/dysmenorrhoea, pelvic pain) Endometrial polyps (HMB/intermenstrual bleeding) Enometriosis and adenomyosis (HMB/dysmenorrhoea, dyspareunia, pelvic pain, difficulty conceiving) Pelvic inflammatory disease and pelvic infection (for example chlamydia - may also present with vaginal discharge, pelvic pain, intermenstrual and postcoital bleeding, and fever) Endometrial hyperplasia or carcinoma (postcoital bleeding, intermenstrual bleeding, pelvic pain) Polycystic ovary syndrome (causes anovulatory menorrhagia and irregular bleeding)
Which systemic diseases and disorders can cause heavy menstrual bleeding?
Coagulation disorders (for example von Willebrand disease)
Hypothyroidism
Liver or renal disease
What are some iatrogenic causes of heavy menstrual bleeding?
Anticoagulant treatment
Herbal supplements (ginseng, ginkgo, soya) - these may cause menstrual irregularities by altering oestrogen levels or coagulation parameters
Intrauterine contraceptive device (Cu IUD)
What does PALM-COEIN stand for and what is it used for?
Causes of abnormal menstrual bleeding
Polyps Adenomyosis Leiomyoma/fibroid Malignancy Coagulopathy Ovulatory dysfunction Endometrium/hyperplasia Iatrogenic Not yet classified
What are fibroids?
Non cancerous growths made of muscle and fibrous tissue, also called myoma or lieoyoma
What are some of the symptoms of fibroids?
May be asymptomatic
Can cause: HMB Pelvic pain Urinary symptoms Pressure symptoms Backache Infertility Miscarriage
How is a diagnosis of fibroids made?
Ultrasound
How is HMB +/- small fibroids treated?
COCP
POP
Mirena
How are large fibroids treated in a patient who wishes to preserve their fertility?
Fibroid embolisation
Myomectomy
How are submucosal fibroids treated?
Hysteroscopic fibroid resection
How do you treat fibroids in a patient who has declined or failed medical treatment and fertility preservation is not required?
Hysterectomy
What is endometriosis?
Endometrial tissue present outside the lining of the uterus. During menstruation this ectopic tissue behaves the same as endometrium and bleeds.
How many women in the UK are affected by endometriosis?
1.5 million
What are some of the symptoms of endometriosis?
Painful menstrual cramps that get worse over time
Pain during and after sexual intercourse
Lower back pain
Painful bowel movements or urination
Abnormal bleeding or spotting between menstrual periods
Diarrhoea, nausea and blotting
What are some possible sites for endometriosis?
Ovary Pouch of Douglas Bladder Colon Small intestine Fallopian tube Rectum
