Menstrual dysfunction* Flashcards Preview

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Flashcards in Menstrual dysfunction* Deck (14)
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1
Q

endometrial events of the menstrual cycle

A

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
Q

normal menstrual cycle

A

av 28 day cycle

between 21-35

3
Q

menstual loss

A

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

4
Q
menorrhagia 
metrorrhagia
polymenorrhoea
polymenorrhagia
menometrorrhagia
amenorrhoea
oligomenorrhoea
A
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
Q

causes of organic menohhagia

A
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
Q

causes of systemic organic menorrhagia

A

thyroidism, DM, adrenal, prolactin

Von willebrans, ITP
liver disorders
renal
drugs - anti coags

7
Q

causes of organic menorrhagia - preg

A

miscarriage
ectopic
gestational trophoblastic disease
postpartum haemorrhage

8
Q

causes of non-organic menorrhagia

A

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

9
Q

DUB types

A

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
Q

ix of DUB

A

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
Q

management of DUB non surgical

A

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

progestogen releasing IUCD - mirena IUS

12
Q

management surgical

A

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
Q

what are the risks with surgical treatment

A

expensive
anaesthetic risks
complications
very effective however fertility is lost

14
Q

ablation V hysterectomy

A

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