Mentruation Flashcards
Normal and Abnormal
What is classified as ‘normal menstruation’?
Lasting 4-6 days with heaviest days being 1 and 2.
<80ml per day and no clots passed
no intermenstrual or post-coital bleeding
What is menorrhagia and metrorrhagia?
Menorrhagia - increased menstrual bleeding
Metrorrhagia - regular intermenstrual bleeding
What is polymenorrhoea and polymenorrhagia?
Polymenorrhoea - cycle lasting <21 days
polymenorrhagia - increased frequency and menstrual bleeding
What is menometrorrhagia?
increased menstrual loss with regular intermenstrual bleeding
What is amenorrhoea and oligomenorrhoea?
Absensce of menstruation
Menstruation cycle lasting >35 days
What is DUB?
Dysfunctional uterine bleeding (menorrhagia in the absence of pathology - 50% of cases)
When does puberty usually start in females?
ages 9-11 with the start of breast development and pubic hair growth.
What is the average age of menarche in the UK?
12.9 years
What does LH act on in the ovary?
the thecal cells - to increase androgen production (and maturation of oocytes)
What are the four structures involved in the regulation of ovulation and menstruation?
Hypothalamus
Anterior pituitary gland
ovary
uterus
What is the definition of primary amenorrhoea?
No periods experienced before the age of 16 if no secondary characteristic present
if secondary characteristics present then investigate at 18
List some causes of primary amenorrhoea
Hypothalmic (lack of GnRH) or hypogonadotrophic (lack of LH or FSH)
List some organic causes of menorrhagia
tumours, fibroids, endometriosis, adenomyosis, IUCD, PID
List some systemic causes of menorrhagia
hypothyroidism/hyperthyroidism, diabetes, adrenal disease, prolactin disorders and coagulopathies (VWF deficiency, ITP, factor deficiency) or on anti-coagulant
List some causes of bleeding during pregnancy
Ectopic or miscarriage
What investigations would you consider in someone with menorrhagia?
FBC Coag screen TSH Endometrial sampling transvag USS cervical smear
What are the different types of DUB? Explain.
Anovulatory - 85% and will occur in the extremes of age
Ovulatory - 15% and due to insufficient secretion of hormone by the corpus luteum
What is the first line treatment of DUB?
IUD (mirena)
What is the second line treatment of DUB?
OCP
Antifibrinolytic e.g. transexamic acid
Antiprostaglanding e.g. mefanamic acid
What is the third line treatment of DUB?
GnRH analogues
What is the surgical treatment of DUB?
endometrial ablation/resection
hysterectomy
What are some physiological causes of amenorrhoea?
pre-menstrual
pregnancy
lactation
post-menopausal
What are some pituitary causes of amenorrhoea?
pituitary adenoma (non-functioning) prolactinoma (prolactin will inhibit GnRH production from hypothalamus and causes downstream decrease in FSH and LH levels)
What are some ovarian causes of amenorrhoea?
Premature ovarian failure
PCOS - ineffective LH so ovum never released from ovary. must have 2 of: cystic ovaries on pelvic USS, evidence of androgen excess (hirsuitism, acne) and amenorrhoea
