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Menstrual problems Flashcards

1
Q

What is the normal age range for menstruation?

A

13-51yrs

Menarche-menopauce

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2
Q

How is menstruation triggered?

A

Fall in progesterone 2wks after ovulation if not pregnant

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3
Q

What is the mean volume of blood lost during menstruation?

A

30-40ml

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4
Q

What is menorrhagia and typically what volume?

A

Heavy periods (>80ml/cycle)

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5
Q

What is dysmenorrhoea?

A

Painful periods

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6
Q

What is inter-menstrual bleeding (IMB)?

A

Bleeding between periods

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7
Q

What is postcoital bleeding (PCB)?

A

Bleeding after intercourse

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8
Q

What is oligomenorrhoea?

A

Infrequent periods

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9
Q

What do you ask in history of menstrual problems?

A

PAtient’s perception
Clots/flooding/pads/tampons
Pain
Effect on lifestyle

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10
Q

What do you exam in history of menstrual problems?

A

General
Abdo
Speculum
Bimanual

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11
Q

What are the investigations for those with menstrual problems?

A

Heavy periods: FBC, thyroid function, coag, endometrial biopsy

IMB and PCB: chlamydia

Pregnancy test
TV US
Hysteroscopy

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12
Q

When would you do hysteroscopy?

A

Persistent IMB

Suspected endometrial pathology on US

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13
Q

If early teens, what are likely menstrual problem?

A

Anovulatory cycles

Coagulation problems

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14
Q

If teens-40, what are likely menstrual problems?

A 
Chlamydia
Contraception related
Endometriosis/adenomyosis
Fibroids
Endometrial/cervical polps
Dysfunctional bleeding
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15
Q

If 40-menopause, what are likely menstrual problems?

A

Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction

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16
Q

What is the mneumonic for the FIGO classification of abnormal uterine bleeding?

A

PALM-COEIN

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17
Q

What is PALM-COEIN (FIGO classification of abnormal uterine bleeding)?

A 
P - polyp
A - adenomyosis
L - leiomyoma
M - malignancy/hyperplasia
C - coagulation
O - ovarian (PCOS/anovulatory)
E - endocrine (thyroid)
I - iatrogenic (warfarin)
N - not yet classified
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18
Q

What is DUB?

A

Dysfunctional uterine bleeding

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19
Q

What is dysfunctional uterine bleeding (DUB)?

A

Abnormal bleeding but no structural/endocrine/neoplastic/infectious cause found

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20
Q

What is endometriosis?

A

Endometrial type tissue outside the uterine cavity

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21
Q

What is endometriosis dependent on?

A

Oestrogen

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22
Q

Where does endometriosis usually affect?

A

Ovary, pouch of Douglas, pelvic peritoneum

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23
Q

What are the signs/symptoms of endometriosis?

A

Premenstrual pelvic pain
Dysmenorrhoea
Deep dyspareunia
Subfertility

May be no signs
Tender nodules in rectovaginal septum
Limited uterine mobility
Adnexal mass

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24
Q

What is the gold standard for diagnosing endometriosis?

A

Laparoscopy

25
What can be seen on laparoscopy for endometriosis?
Clear, red, bluish black or white lesions
26
What is the diagnostic technique for deep endometriosis?
MRI
27
What can be used to diagnose endometrioma?
US
28
What are the investigations for endometriosis?
Laparoscopy | MRI
29
What are chocolate cysts?
Noncancerous, fluid-filled cysts that typically form deep within the ovaries
30
What are the treatment options for endometriosis?
Medical | Surgical
31
What are the medical treatments for endometriosis?
Progesterone: oral/injection/Levonorgesterel IUD CHC pill GnFH analogues (e.g. leuprorelin)
32
What are the surgical treatments for endometriosis?
Excision of deposits from peritoneum/ovary Diathermy/laser ablation of deposits Removal of ovaries with/without hysterectomy
33
What is adenomyosis?
Presence of endometrial tissue in the myometrium
34
What are the symptoms/signs of adenomyosis?
Heavy painful periods Bulky tender uterus Usually parous women May co-exist with endometriosis
35
How is adenomyosis diagnosed?
MRI | Histology (post-hysterectomy)
36
What is the treatment for adenomyosis?
Hormonal contraception for painful/heavy periods: LNHIUS (Mirena), progestogens, combined OCP
37
What are fibroids?
Smooth muscle growths (leiomyoma)
38
What are the symptoms of fibroids?
``` Usually asymptomatic Large = pressure symptoms Menorrhagia IMB In pregnancy: pain, malpresentation, obstruction in labour ```
39
What group have a higher incidence of fibroids?
Afro-Caribbean women
40
What are the investigations for fibroids?
Clinical exam = irregularly enlarged uterus US Hysteroscopy
41
What are the 3 types of fibroids?
``` Submucous = protrude into uterine cavity Intramural = within uterine wall Subserous = project out of uterus into peritoneal cavity ```
42
What is the treatment for fibroids?
``` Only symptomatic GnRH analogues or Ulipristal acetate - shrink fibroids Transcervical resection Myomectomy Uterine artery embolisation Hysterectomy ```
43
What is the treatment for submucous fibroids?
Transcervical resection hysteroscopically
44
What are treatments options for DUB?
Reassurance not sinister Medical Surgical
45
What are the medical treatments for DUB?
Non-hormonal: tranexamic acid or mefanamic acid | Hormonal: POP, injection (Depo Provera), LNG IUS, CHC pill
46
What are the surgical treatments for DUB?
Endometrial ablation | Hysterectomy
47
What does tranexamic acid do in DUB?
Reduces blood loss
48
What does Mefenamic acid do in DUB?
Reduces blood loss and pain
49
When are tranexamic acid and Mefenamic acid taken for DUB?
At time of periods
50
What approaches are there to hysterectomy?
Abdominal Vaginal Laparoscopic
51
What is removed in a total hysterectomy?
Cervix and uterus
52
What is removed in subtotal hysterectomy?
Uterus removed | Cervix left
53
What are the risks for hysterectomy?
Infection, DVT, bladder/bowel/vessel injury, altered bladder function, adhesions
54
What does hysterectomy guarantee?
Amenorrhoea
55
What is removal of the ovaries with uterus called?
Total hysterectomy with bilateral salpingo-oophrorectomy
56
What are disadvantages of oophroectomy?
Immediate menopause, recommended HRT till age 50
57
What are advantages of oophorectomy?
Reduces risk of ovarian cancer
58
Why is there a high risk of menopause 2yrs post-hysterectomy?
Compromised blood supply

Reproductive (20 decks)

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