Menstruation and its disorders Flashcards
(31 cards)
{ } is a depressive disorder that often follows ovulation and remits within a few days of menses
Premenstrual dysphoric disorder
What is the proposed pathophysiology of endometriosis?
Retrograde menstruation
What is a uterine leiomyoma?
Benign smooth muscle tumours within the myometrium
A uniformly enlarged uterus is characteristic of adenomyosis or leiomyomas?
Adenomyosis
An irregularly enlarged uterus is characteristic of adenomyosis or leiomyomas?
Leiomyoma
What are two risk factors for adenomyosis?
Early menarche
Increased parity
Previous uterine surgery
How do GnRH agonists (leuprolide, goserelin) work to treat leiomyomas?
GnRH → pituitary desensitised to overstimulation → reduced LH and FSH → reduced estrogen synthesis → fibroids deprived of growth → volume reduction
Why are GnRH agonists unsuitable as a long term treatment option for leiomyomas?
Rebound growth
Osteoporosis
What are 3 treatment options for adenomyosis?
COCP - reduced pain and intensity of bleeding
Progestin-only contraception - amenorrhoea
Total hysterectomy
What is adenomyosis?
The presence of endometrial glands and stroma within the myometrium
Ectopic endometrial tissue induces hypertrophy and hyperplasia of the surrounding myometrium, resulting in a diffusely enlarged uterus
How does tranexamic acid work?
Inhibits activation of plasminogen to plasmin.
When is tranexamic for menorrhagia taken during the menstrual cycle?
During menses and 3-5 days following bleeding
What investigations should be done in all women with post-menopausal bleeding?
Ultrasound examination of pelvis
Hysteroscopic examination of uterine cavity
Endometrial biopsy
What should the endometrial thickness be in post-menopausal women?
Less than 5mm
What proportion of infertile women are found to be affected by endometriosis?
Up to 50%
What single investigation effectively diagnoses and assesses the severity of endometriosis?
Laparoscopy
What are the side effects of gonadotrophin releasing hormone analogues?
Hot flushes
Break through bleeding
Vaginal dryness
Headaches
Decreased libido
Bone density loss
What are the causes of primary amenorrhoea?
Delayed puberty
Genital tract anomaly
Turner syndrome or other gonadal dysgenesis
Androgen insensitivity syndrome
Congenital adrenal hyperplasia
What are the causes of premature ovarian failure?
Turner syndrome
Fragile X carrier
Post-chemotherapy
Post-radiotherapy
Oophorectomy
What investigations should be done for someone with suspected PCOS and what would you expect to find?
Testosterone: high
LH: high and LH:FSH ratio > 2:1
DHEA-S: high
Oestrogen: normal or slightly elevated
OGTT
Lipids
TVUS
What are the Rotterdam diagnostic criteria for PCOS?
Two of:
- Oligo/anovulation
- Clinical or biochemical signs of hyperandrogenism
- Polycystic ovaries (12+ peripheral follicles or increased volume)
What are the long term complications of PCOS?
Endometrial hyperplasia and cancer
Type II diabetes
Cardiovascular pathology
Hirsutism and acne
What is the best intervention for a woman with PCOS who wants to conceive?
Weight loss
What are the drugs that can cause hyperprolactinaemia?
Antipsychotics
TCAs
Metoclopramide/domperidone
Verapamil
Methyldopa
