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Flashcards in Menstrual dysfunction* Deck (14):
1

endometrial events of the menstrual cycle

prolif phase - oestrogen induced growth of endometrial glands and stroma
luteal phase - progesterone induced glandular secretary activity. decidualisation in late secretory phase. endometrial apoptosis and sb=ubsequant menstruation
menstruation - artiolar constriction and shedding of functional endometrial layer. fibrinolytic inhibit scar tissue formation

2

normal menstrual cycle

av 28 day cycle
between 21-35

3

menstual loss

usually lasting 4-6 days
menstrual flow peaks day 1-2
<80ml per menstruation
no clots

4

menorrhagia
metrorrhagia
polymenorrhoea
polymenorrhagia
menometrorrhagia
amenorrhoea
oligomenorrhoea

prolonged and increased menstrual flow
regular intermenstrual bleeding
menses occurring at <21 day interval
increased bleeding and frequent cycle
prolonged mended and inter menstrual bleeding
absence of menstruation >6months
menses at intervals of >35 days

5

causes of organic menohhagia

fibroids
adenomyosis
endocervical or endometrial polyp
cervical expansion
endometrial hyperplasia
intrauterine contraceptive device
PID
endometriosis
malignancy of cervix or uterus
hormone producing tumours
trauma

6

causes of systemic organic menorrhagia

thyroidism, DM, adrenal, prolactin

Von willebrans, ITP
liver disorders
renal
drugs - anti coags

7

causes of organic menorrhagia - preg

miscarriage
ectopic
gestational trophoblastic disease
postpartum haemorrhage

8

causes of non-organic menorrhagia

absence of pathology
50% of cases
also known as dysfunctional uterine bleeding

9

DUB types

anovulatory - 85%, occurs at extremes of reproductive life, irregular cycle, more common in obese woman
ovulatory-35-45 yo, regular heavy periods, due to inadequate progesterone production by CL

10

ix of DUB

FBC
cervical smear
TSH
coag screen
renal/liver function
transvaginal US- endometrial thickens, presence of fibroids and other pelvis masses
endometrial sampling - pipeline biopsies, hysteroscopic directed, dilation and curettage

11

management of DUB non surgical

medical - progestogens, combined pill, danazol, GnRH analogues, NSAIDs, anti fibrinolytics, capillary wall stabilisers

progestogen releasing IUCD - mirena IUS

12

management surgical

endometrial resection/ablation - transcervical endometrial resection, rollerblade endometrial ablation, bipolar mesh endometrial ablation, thermal balloon ablation, thermal hydroablation

hysterectomy - sub total, total abdominal, vaginal, LASH/LAVH, TLH

13

what are the risks with surgical treatment

expensive
anaesthetic risks
complications
very effective however fertility is lost

14

ablation V hysterectomy

A - shorter operating time, shorter recovery, fewer cx, requires cervical smears, combined HRT possible
H - major op, longer operating time, longer recovery, more cx, no cervical smears required for total, oestrogen only HRT unless cervix is retained