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Menstrual Disorders Flashcards

1
Q

What is endometriosis?

A

Presence of endometrial tissue outside of the uterus, inducing a chronic inflammatory reaction

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2
Q

What is adenomyosis?

A

Endometrial tissue within the myometrium of the uterus

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3
Q

Describe the pathophysiology of endometriosis

A

Exact cause is unclear, but there are many theories

Retograde mestruation

Lymphatic spread

Metaplasia

Embryonic cells remain in areas outside the uterus and develop later

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4
Q

What are the most common sites of endometrial lesions?

A

Ovary

Pouch of Douglas

Pelvic peritoneum

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5
Q

How does endometriosis present?

A

Premenstrual/cyclical abdominal and pelvic pain

Dysmenorrhoea

Deep dyspareunia

N&V

Infertility

Cyclical bleeding from other sites, such as haematuria

Urinary or bowel symptoms

Tenderness on examination

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6
Q

What investigations are used in endometriosis diagnosis?

A

Pelvic USS

  • Endometrioma
  • Chocolate cysts (endometrioma in the ovaries)
  • But often unremarkable

Pelvic laparoscopy and biopsy, diagnostic gold standard

  • Clear, red, bluish black or white lesions

MRI

  • For deep endometriosis and surgical planning
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7
Q

What is the management of endometriosis?

A

Analgesia as required

  • NSAIDs and paracetamol are first line

Progestogen

  • Oral, injection or IUS

COCP

GnRH analogues

Surgical management

  • Laparoscopic excisions
  • Hysterectomy and bilateral salpingo-opherectomy
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8
Q

Give an example of a GnRH analogue

A

Goserelin

Leuprorelin

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9
Q

What endometriosis management improves fertility?

A

Surgery, not hormonal treatment

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10
Q

Give complications of a hysterectomy

A

Infection

DVT

Bladder and bowel damage

Vessel injury

Altered bladder function

Adhesions

Guarantees amenorrhoea

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11
Q

What are fibroids?

A

Oestrogen sensitive benign smooth muscle growths arising from the myometrium of the uterus

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12
Q

What are the types of fibroids?

A

Submucosal, protrude into uterine cavity

Subserosal, project out of the uterus and into peritoneal cavity

Intramural, stay within uterine wall/myometrium

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13
Q

Give risk factors for fibroids

A

Obesity

>Age

FH

Afro-Caribbean ethnicity

Nulliparity

Early menarche

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14
Q

How do endometrial fibroids present?

A

Often asymptomatic

Menorrhagia, is the most frequent presenting symptom

Prolonged menstruation, lasting more than 7 days

Abdominal pain worsening with menstruation

Urinary or bowel symptoms due to pressure

Deep dyspareunia

Palpable pelvic mass on examination

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15
Q

What investigation is used in fibroid diagnosis?

A

Pelvic USS, investigation of choice for large fibroids

Hysteroscopy, for submucosal fibroids

MRI considered before surgery

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16
Q

How are endometrial fibroids managed?

A

If asymptomatic, no treatment

Standard menorrhagia treatment

  • Mirena IUS
  • COCP
  • POP
  • NSAIDS
  • Tranexaminc acid

GnRH analogues

  • Used to temporarily shrink the fibroid post-operatively

Uterine artery embolisation

Resection, if submucosal

Edometrial ablation

Hysterectomy

17
Q

What is the general management of menorrhagia/dysfunctional uterine bleeding?

A

Paracetamol

Tranexamic Acid

Mefenamic acid/NSAIDS

COCP

POP

Mirena IUS

18
Q

What is the only effective treatment for large fibroids causing fertility problems?

A

Myomectomy

19
Q

Give complications of myomectomy

A

Adhesions, most common

Bladder injury

Uterine perforation

20
Q

Give complications of fibroids

A

Iron deficiency anaemia

Infertility

Miscarriage, premature labour and obstructive delivery

Urinary outflow obstruction and UTI

Fibroid torsion

Red degeneration of fibroid

21
Q

What is red degeneration of fibroid?

A

Refers to ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply, most likely to occur in larger fibroids during pregnancy

22
Q

What are endometrial polyps?

A

Overgrowth of endometrial lining which can lead to the formation of pedunculated structures known as polyps

23
Q

What is the diagnostic criteria for PCOS?

A

Rotterdam criteria

24
Q

Describe the Rotterdam criteria

A

Diagnose if 2/3

PCO morphology on US, 12 or more peripheral follicles

Clinical or biochemical hyperandrogenism

  • Hirsute
  • Acne
  • Increased testosterone

Oligoovulation or anovulation, presenting as irregular or abscent periods

25
Q

What investigations are used in PCOS diagnosis?

A

Pelvic US, intial imaging

Transvaginal US, gold standard

Raised testosterone

Sex hormone binding globulin

Raised LH compared to FSH (raised LH:FSH ratio)

Normal or raised oestrogen levels

Raised insulin

OGTT

26
Q

What US sign can be seen in PCOS?

A

String of pearls sign

27
Q

How is PCOS managed, for those not wishing to conceive?

A

Co-cyprindrol, useful for hirtuism reduction and inducing regular menstruation

COCP, reduces irregular bleeding and protects against endometrial cancer

Metformin, helps with menstrual irregularity, hirtuism and acne

28
Q

How is PCOS managed, for those wishing to conceieve?

A

Weight loss

Clomifene, induces ovulation and improves conception rates

Metformin, can be used with/without clomifene to improve chances

Ovarian drilling

Gonadotrophins

29
Q

Give complications of PCOS

A

Obstructive sleep apnoea

Endometrial hyperplasia and cancer

DM/insulin resistance

CVS disease and hypercholesterolaemia

Acne

Obesity

Miscarriage and infertility

Acanthosis nigricans, occurs due to insulin resistance

30
Q

What are women with PCOS who undergo IVF at risk of?

A

Ovarian hyperstimulation syndrome

Reproduction (18 decks)

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