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Obstetrics + Gynaecology > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

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1
Q

What is the definition of menorrhagia?

A

Prolonged and increased (>80ml per period) menstrual flow (heavy bleeding)

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2
Q

What is metrorrhagia?

A

Regular intermenstrual bleeding

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3
Q

What is polymenorrhoea?

A

Menses occurring at < 21 days intervals

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4
Q

What is amenorrhoea?

A

Absence of menstruation for > 6 months

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5
Q

What is oligomenorrhoea?

A

Menses at intervals of > 35 days OR 5 or less menstrual cycles per year

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6
Q

What are the local causes of menorrhagia?

A 
Fibroids
Adenomyosis
Endocervical or endometrial polyp
Endometrial hyperplasia
IUD
PID
Endometriosis
Malignancy
Hormone producing ovarian tumours
Arteriovenous malformation
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7
Q

What are the systemic causes of menorrhagia?

A 
Endocrine:
- thyroid, DM, adrenal disease, prolactin
Haematological:
- vWD, ITP, clotting factor deficiency
Liver cirrhosis
Renal disease
Anticoagulants
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8
Q

What is dysfunctional uterine bleeding (DUB)?

A

Menorrhagia in the absence of pathology –> diagnosis of exclusion

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9
Q

What are the 2 types of DUB and their features?

A

Anovulatory (80%):
- irregular cycle at extremes of reproductive age
Ovulatory:
- regular heavy periods
- due to inadequate progesterone production by corpus luteum

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10
Q

What are the options for medical management of DUB?

A
  1. IUS (mirena coil) - first line
  2. COCP
  3. Tranexamic acid (antifibrinolytic)
  4. NSAIDs e.g. mefenamic acid
  5. Oral progestogens e.g. norethisterone + medroxyprogesterone acetate
  6. GnRH analogues/agonists
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11
Q

When are tranexamic acid and NSAIDs taken for menorrhagia?

A

Taken during menstruation only

Good for women who want to conceive

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12
Q

Give an example of GnRH analogues/agonists?

A

Goserelin

Buserelin

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13
Q

What are the side effects of GnRH analogues/agonists?

A

Long term use causes osteoporosis unless combined with HRT

–> only use short term (< 6 months)

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14
Q

When might surgical management be offered to women with menorrhagia?

A

Failure of medical management

not recommended if wanting to preserve fertility

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15
Q

What are the options for surgical management of menorrhagia?

A

Endometrial resection/ablation

Hysterectomy

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16
Q

What are the risks associated with endometrial ablation?

A

If becomes pregnant, risk of prematurity or morbidly adherent placenta –> must take COCP/HRT

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17
Q

What are the causes of intermenstrual bleeding?

A 
Cervical ectropion
PID and STIs
Endometrial or cervical polyps
Cervical cancer
Endometrial cancer
Undiagnosed pregnancy/pregnancy complications 
Hydatiform molar disease
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18
Q

What are the features of premenstrual syndrome?

A 
Bloating, cyclical weight gain
Mastalgia
Abdominal cramps
Fatigue
Headache
Depression
Changes in appetite + cravings
Irritability
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19
Q

How can premenstrual syndrome be treated if impacting quality of life?

Study These Flashcards
A

SSRIs/SNRIs + CBT
Lifestyle changes for mild symptoms
COCP, transdermal oestrogen, short term GnRH analogues
Hysterectomy + bilateral salpingo-oophorectomy (last resort)

20
Q

What are the causes of post-coital bleeding?

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A 
Cervical ectropion
Cervical cancer
Trauma
Atrophic vaginitis
Cervicitis secondary to STI
Polyps
Idiopathic
21
Q

What is cervical ectropion usually caused by?

Study These Flashcards
A

Hormonal changes:

  • high oestrogenic states in pregnancy
  • use of COCP
22
Q

What are the causes of post-menopausal bleeding?

Study These Flashcards
A 
Atrophic vaginitis (most common)
Endometrial polyps
Endometrial hyperplasia
Endometrial cancer
Cervical cancer
Ovarian cancer (oestrogen-secreting theca cell tumours)
Vaginal cancer - rare
23
Q

How is post-menopausal bleeding investigated?

Study These Flashcards
A

Transvaginal USS first line to assess endometrial thickness

  • if < 3mm - reassure
  • if > 4mm –> biopsy
  • (if taking HRT, cut off is 5mm or less)

Women on Tamoxifen –> hysteroscopy + biopsy if first line (USS not helpful as endometrium will always be thick)

24
Q

How is atrophic vaginitis managed?

Study These Flashcards
A

Topical oestrogen + vaginal lubricants

Consider HRT

25
How is endometrial hyperplasia managed?
Dilatation and curettage Progesterone treatment: - IUS first line - oral progestogens e.g. norethisterone
26
What is the most common cause of menstrual irregularity?
PCOS
27
Which criteria is used to diagnose PCOS and what are the criteria?
Rotterdam criteria - 2 of the following: - clinical or biochemical evidence of hyperandrogenism - polycystic ovaries on USS - oligo/amenorrhoea
28
What are the signs of hyperandrogenism?
``` Hirsutism Acne High free testosterone Low sex hormone binding globulin High free androgen index ```
29
What are the clinical features of PCOS?
Obesity Hypertension Acanthosis nigricans (thickening + pigmentation of the neck, axillae + intertriginous areas) Acne + hirsutism Alopecia Insulin resistance, DM, lipids --> increased CV risk Irregular periods - infertility Increased risk of endometrial hyperplasia + cancer
30
What is the management for infertility in PCOS?
``` Weight loss of 5-10% if BMI >30 First line: Clomifene Can add metaformin Ovarian drilling if clomifene unsuccessful Gonadotrophin injections IVF last resort ```
31
How is acne managed in PCOS?
Dianette | COCP
32
How amenorrhoea managed in PCOS?
COCP Cyclical medroxyprogesterone or IUS --> to manage risk of endometrial hyperplasia/cancer
33
What is dysmenorrhoea and how is it classified?
Excessive pain during the menstrual period - primary --> onset within 2 years of menarche, no underlying pathology - secondary --> develops years after menarche, result of underlying pathology
34
What are the main causes of secondary dysmenorrhea?
``` Endometriosis Adenomyosis PID IUD (copper coil) Fibroids ```
35
How is dysmenorrhoea managed?
Stop smoking NSAIDs first line e.g. mefenamic acid and ibuprofen (inhibit prostaglandin production) COCP second line Levonogestrel IUS - if also menorrhagia GnRH analogues - best of symptomatic relief, esp when due to fibroids, when awaiting hysterectomy
36
How is amenorrhoea categorised?
Primary (absence of menarche): - age 16+ in the presence of secondary sexual characteristics - age 14+ in absence of secondary sexual characteristics Secondary: - cessation of periods for > 6 months, after menarche
37
How can causes of amenorrhoea be categorised?
``` Hypothalamic Pituitary Ovarian Adrenal gland Genital tract ```
38
What are the hypothalamic causes of amenorrhoea?
Functional disorders e.g. eating disorders, exercise Severe chronic conditions e.g. thyroid, sarcoidosis Kallmann syndrome
39
What is Kallmann syndrome?
X linked recessive condition | --> failure of migration of GnRH cells
40
What are the pituitary causes of amenorrhoea?
Prolactinomas Other pituitary tumours e.g. acromegaly or Cushing's (mass effect) Sheehan's syndrome Destruction of pituitary gland e.g. radiation, AI disease Post contraception amenorrhoea e.g. Depo-Provera
41
What is Sheehan's syndrome?
Post-partum pituitary necrosis secondary to massive obstetric haemorrhage
42
What are the ovarian causes of amenorrhoea?
PCOS Turner's syndrome (45 XO) Premature ovarian failure
43
What is Turner's syndrome?
Genetic condition --> amenorrhoea, lack of secondary sexual characteristics + infertility - short stature - webbed neck - aortic coarctation
44
What is premature ovarian failure defined?
Primary ovarian insufficiency before age of 40 associated with menopausal symptoms - low oestrogen + high FSH
45
What are the adrenal causes of amenorrhoea?
Late onset/mild congenital adrenal hyperplasia | - high levels of 17-hydroxyprogesterone in the blood
46
What are the genital tract causes of amenorrhoea?
Ashermann's syndrome Imperforated hymen/transverse vaginal septum Mayer-Rokitansky-Kuster-Hauser syndrome (congenital absence of uterus)
47
What is Ashermann's syndrome?
Secondary to instrumentation of the uterus following surgical management of a miscarriage --> intrauterine adhesions

Obstetrics + Gynaecology (22 decks)

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