W05: Menstrual Disorders Flashcards
Describe the normal and abnormal menstrual cycle and investigation and treatment of
common conditions
a
Presentation of Heavy Menstrual Bleeding
- 8d+
- change products every 1 to 2 hours
- passage of clots 2.5cm+
- Affecting QoL
+ Implications of anemia
Uterine Causes of HMBleeding
*UTERINE FIBROIDS
- ENDOMETRIAL POLYPS
- ENDOMETRIOSIS
- ADENOMYSOSIS
- PELVIC INFLAMM DISEASE
- PELVIC INFECTION
- ENDOMETRIAL HYPERPLASIA / CARCINOMA
- post voital bleeding, intermenstrual bleeding
- PCOS
Systemic Causes of HMBleeding
- COAGULATION DISORDER
- HYPOTHYROIDISM
- LIVER/RENAL DISEASE
Other Causes of HMBleeding
anti coag meds
- herbal supplements
- intrauterine contraceptive device IUD e.g.
Commonest cause of HMBleeds
Fibroids
HMBleeds: PALM COEIN
Polyp
Adenomyosis
Leiomyoma / Fibroid
Malignancy
Coagulopathy
Ovulation dysf.
Endometrium hyperplasia
Iatrogenic
Not yet classified
FIBROIDS
benign growths of muscle
HMB, pelvic pain, pressure, backache
Dx: USS
> symptom based
> Mirena
Tranexamic Acid
ENDOMETRIOSIS
endometrial tissue present outside the lining of uterus .During menstruation this ectopic tissue behaves the same as endometrium and bleeds
+ HMBleeding
+ OFten with PELVIC PAIN
Dx: Lap.; USS
> analgesia
Mirena
Sx
- ablaton
- hysterectomy
ADENOMYOSIS
A condition where endometrium becomes embedded in myometrium .
+ HMB, sig. dysmenorrhoea
> HYSTERECTOMY
ENDOMETRIAL POLYP
overgrowth of endometrial lining
- mostly benign
dx: USS; hysterescopy
> POLYPECTOMY
Link with Thyroid and HMBleeding
Without sufficient thyroid hormone, your ovaries may not be able to make enough of the flow-decreasing hormone progesterone
Hormonal and Non Hormonal Tx for HMB
HORMONAL
* mirena IUS
* COCP
* POP (progesterone only pill)
* depot prover
NON HORMONAL
* mefenamic acid
* tranexemic acid
* GnRh analogues
- endometrial ablation
- fibroid embolisation
- hysterectromy
Grading of HYSTERECTOMY
TOTAL = cx and uterus removed
SUBTOTAL = uterus removed, cx preserved
SALPINGO-OOPHORECTOMY
removal tubes + ovaries
- endometriosis or presence of ovarian pathology
!menopause = HRT recommended
- reduces risk of ovarian ca
