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Repro > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

Fibroids Endometriosis Endometrial Polyps Adenomyosis Oligo/Amenorrhea PCOS Dysfunctional Uterine Bleeding

1
Q

2 phases of menstrual cycle

A

Follicular

Luteal

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2
Q

Define ‘heavy menstrual bleeding’

A 
Bleeding >80mls over a period of 7 days
\+/ need to change menstrual products every 1-2 hours
\+/ passage of clots greater than 2.5cm
\+/ bleeding through clothes
\+/ very heavy periods
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3
Q

What symptom can occur alongside heavy menstrual bleeding?

A

Dysmenorrhea

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4
Q

What implications can Heavy menstrual bleeding have?

A

Anaemia

Hysterectomy at young age

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5
Q

4 origins of causes of heavy menstrual bleeding

A

Uterus
Ovaries
Systemic disorders
Iatrogenic

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6
Q

Uterine and Ovarian causes of Heavy Menstrual Bleeding

A 
Fibroids
Endometrial Polyps
Endometriosis
Adenomyosis
Pelvic Inflammatory Disease & Infection
Endometrial hyperplasia and carcinoma
PCOS
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7
Q

Which infection can also present with pelvic pain, intermenstrual and postcoital bleeding, fever and vaginal discharge?

A

Chlamydia

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8
Q

3 symptoms of endometrial hyperplasia or carcinoma

A

IM or PC bleeding, pelvic pain,

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9
Q

Systemic diseases and disorders that cause heavy menstrual bleeding

A

Coagulation - VW
Hypothyroidism
Liver or Renal disease

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10
Q

Iatrogenic causes of heavy menstrual bleeding

A

Anticoagulant treatment
Herbal supplements
Intrauterine Device

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11
Q

PALM COEIN is the mnemonic for causes of what menstrual symptom/disorder?

A

Heavy Menstrual Bleeding

Polyps
Adenomyosis
Leiomyoma/Fibroma
Malignancy

Coagulopathy
Ovulation Dysfunction
Endometrium/Hyperplasia
Iatrogenic
Not Yet Classified
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12
Q

Name 2 types of fibroid

A

Myoma

Leiomyoma

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13
Q

What are fibroids?

A

Non cancerous growth of muscular and fibrous tissue

Benign smooth muscle tumours arising from myometrium of uterus

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14
Q

Symptoms of fibroids

A 
Asymptomatic
Heavy Menstrual Bleeding
Dysmenorrhea
Back ache
Pelvic pain
Urinary Symptoms
Pressure Symptoms
Infertility
Miscarriage
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15
Q

How are fibroids diagnosed?

A

Ultrasound

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16
Q

Name 4 symptom based courses of management of fibroids

A

HMB and small fibroids
Large fibroids & fertility preservation required
Submucosal fibroids
Declined/Failed medical treatment & fertility preservation not required

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17
Q

Surgical management of fibroids when fertility preservation not required

A

Hysterectomy

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18
Q

Management of small fibroids with HMB

A

COCP
POP
Mirena

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19
Q

Management of large fibroids, fertility needs preserved

A

Fibroid embolization

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20
Q

Management of submucosal fibroids

A

Hysteroscopic fibroid resection

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21
Q

Describe the condition endometriosis

A

Endometrial tissue is present outwith the uterus

Ectopic tissue behaves as endometrial tissue and will bleed during menstruation

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22
Q

Which group of women are affected by endometriosis>

A

Those of Reproductive Age

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23
Q

Presenting symptoms of Endometriosis

A 
Pelvic pain
Painful, worsening menstrual cramps
Lower Back pain
Pain during or after intercourse
Abnormal bleeding or spotting between periods
Diarrhoea 
Nausea
Bloating
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24
Q

Common misdiagnoses and conditions linked to endometriosis

A 
Depression
Stress, anxiety
Fatigue
Thyroid issues
PCOS
Period Pain
'Normal' 
IBS
Overactive imagination/ low pain threshold
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25
Q

Sites of ectopic tissue in Endometriosis

A 
Outer wall of uterus
Fallopian tube
Ovary
Rectum
Colon
Bladder 
Pouch of Douglas
Small intestine
26
Q

Stages of Endometriosis - Minimal, Mild, Moderate, Severe

A

Stage 1 - Minimal - patches/surface lesions on/around organs of pelvic cavity
Stage 2 - Mild - More widespread, infiltrate organs
Stage 3- Moderate - Peritoneum, scarring and adhesions
Stage 4- Severe - Infiltrative, many organs and ovaries affected. Distorts anatomy. Adhesions present

27
Q

Diagnosis of Endometriosis

A

Pelvic examination
Ultrasound
Diagnostic laparoscopy

28
Q

Management of Endometriosis

A

Analagesia
Medical - COCP, POP, Mirena, Depot provera, GnRH analogues
Surgical - Ablation, Hysterectomy, Endometrioma excision, Pelvic clearance

29
Q

Describe adenomyosis

A

Endometrium becomes embedded in myometrium

30
Q

Symptoms of adenomyosis

A

HMB

Dysmenorrhea

31
Q

Treatment of adenomyosis

A

May respond to hormones

Hysterectomy

32
Q

Diagnosis of endometrial polyps

A

Ultrasound

Hysteroscopy

33
Q

Treatment of polyps

A

Polypectomy

34
Q

Overall Management of HMB

A 
History
Pelvic Examination
Clotting and thyroid tests
Pelvic Ultrasound
Laparoscopy if suspected endometriosis
Appropriate treatment
Endometrial biopsy if age 44 and above, refractive to medical treatment
35
Q

6 Medical Treatments for Heavy Menstrual Bleeding

A 
Tranexamic acid
Mefenamic acid
Hormonal contraception
Combined Contraceptive Pill
LNG IUS and Provera
Oral progestrogens - Provera
36
Q

How does tranexamic acid treat HMB?

A

Reduces blood loss - Antifibrinolytic

37
Q

How does mefenamic acid treat HMB?

A

Reduces blood loss and pain

Prostaglandin inhibitor

38
Q

Which 2 medical treatments of HMB are suitable if trying to conceive?

A

Tranexamic acid and Mefenamic acid

Can take both at time of period - don’t regulate cycles

39
Q

Effect of Oral progestrogen on HMB during day 5-15 of menstrual cycle

A

Reduces bleeding and regulates cycle

40
Q

Effect of Oral progestrogen on HMB during day15-25 of menstrual cycle

A

Regulates cycle

41
Q

Types of Endometrial Ablation

A

First generation - diathermy, under hysteroscopic vision

2nd generation - thermal balloon, radiofrequency

42
Q

3 Pre-requisites for treatment by Endometrial Ablation

A

Uterine cavity length < 11cm
Submucosal fibroids < 3cm
Previous normal endometrial biopsy

43
Q

3 Methods of Hysterectomy

A

Abdominal
Vaginal
Laparascopic

44
Q

Types of Laparascopic Hysterectomy

A

Total Laparascopic Hysterectomy
Laparascopically assisted Vaginal Hysterectomy (LAVH)
Laparascopically Assisted Subtotal Hysterectomy

45
Q

What is a total hysterectomy?

A

Cervix and uterus removed

46
Q

What is a subtotal hysterectomy?

A

Uterus removed, cervix spared

47
Q

How long for recovery after hysterectomy?

A

2-3 months

48
Q

Risks invovled with hysterectomy

A 
Infection
DVT
Bladder/Bowel/Vessel injury
Altered bladder function
Adhesions
49
Q

Guaranteed outcome of hysterectomy

A

Amenorrhea

50
Q

What is a salpingoophorectomy?

A

Removal of tubes and ovaries

51
Q

What conditons may require salpingoophorectomy?

A

Endometriosis

Ovarian pathologies

52
Q

Disadvantage of salpingoophorectomy

A

Immediate menopause

Require HRT

53
Q

Advantage of salpingoophorectomy

A

Reduced risk of subsequent ovarian cancer

54
Q

Risk of removing uterus /salpingoophorectomy where ovaries preserved?

A

Menopause within 2 years - blood supply compromised

55
Q

Define Oligo/Amenorrhea

A

Infrequent/Absent/Abnormally light menstruation

56
Q

Causes of amenorrhea

A 
Life changes - stress, eating disorders/malnourishment, obesity, intense exercise
Hormonal - POP, Mirena, Depot injections
Primary ovarian insufficiency
Hyperprolactinaemia
Prolactinoma
Thyroid disease (Grave's)
Obstruction of uterus, cervix or vagina
57
Q

Symptoms of Polycystic Ovarian Syndrome

A 
Weight gain
Acne
Depression
Hair Loss
Excessive facial and body hair
Irregular periods
High blood pressure
Skin discolourance
58
Q

Diagnostic criteria of PCOS

A

2 from
Ultrasound appearance of ovary
Biochemical hyperandrogegism
Clinical hyperandrogegism

59
Q

What conditions is PCOS associated with?

A

Obesity

Infertility

60
Q

Management of PCOS

A

Lifestyle - achieve normal BMI
Symptoms treated
At least 3 withdraw bleeds per year to prevent hyperplasia
- COCP, POP, Mirena

61
Q

Define Dysfunctional Uterine Bleeding

A

Excessive bleeding in a premenopausal woman that is not due to pregnancy or recognisable uterine or systemic diseases

Ovarian hormonal dysfunction

62
Q

Management

A 
Exclude other causes - PALM COEIN
Conservative/Medical based on severity
GnRH Analaogues
Up to 6 months of treatment
Should be given add back HRT until confirmed menopausal unless contraindicated

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