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CPCP > Year 2 - Week 4 - Vaginal Bleeding > Flashcards

Year 2 - Week 4 - Vaginal Bleeding Flashcards

(75 cards)

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1
Q

What is the term of excessive period blood loss?

A

Menorrhagia

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2
Q

What volume constitutes menorrhagia?

A

> 80ml per menses

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3
Q

What is the definition of menorrhagia?

A

Excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.

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4
Q

What can menorrhagia cause?

A

Anaemia

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5
Q

What length is the typical period cycle?

A

21-35 days

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6
Q

What term describes infrequent menstruation?

A

Oligomenorrhoea

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7
Q

What is the definition of oligomenorrhoea?

A

Interval of greater than 35 days between menses.

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8
Q

What can cause oligomenorrhoea?

A

Breastfeeding
Excessive exercise
PCOS
Endocrine disorders
Anorexia

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9
Q

What is the term for the absence of menstruation?

A

Amenorrhoea

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10
Q

What is the difference between primary and secondary amenorrhoea?

A

Primary - P has never had a period
Secondary - periods have ceased

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11
Q

What is the term for too frequent menstrual cycles?

A

Polymenorrhoea

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12
Q

What is the definition of polymenorrhoea?

A

Periods which occur more frequently than every 21 days.

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13
Q

What is the cause of polymenorrhoea?

A

Can be puberty influences
Can also be due to endocrine disorders

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14
Q

What is the typical length of bleeding in a menses?

A

3-7 days

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15
Q

Which term describes painful periods?
Where is the pain felt?

A

Dysmenorrhoea
Low anterior pelvic pain

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16
Q

In which phase of the cycle are PMS symptoms often experienced?

A

Luteal phase

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17
Q

Which term describes any bleeding variation from the normal menstrual cycle?

A

Abnormal uterine bleeding

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18
Q

Which is the most common type of abnormal uterine bleeding?

A

Heavy menstrual bleeding

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19
Q

What is the name of the bleeding which occurs between clearly defined cyclical menses?

A

Intermenstrual bleeding

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20
Q

What are the causes of abnormal bleeding using acronym PALM COIEN

A

Polyms
Adenomyosis
Leiomyoma (Fibroids)
Malignancy or hyperplasia
Coagulopathy
Ovulatory disorders
Iatrogenic (e.g, exogenous hormones)
Endometrial
Not yet classfied

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21
Q

What is Day 1 of the cycle?

A

First day of period

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22
Q

What are the first and second phases of the menstrual cycle?

A

First phase - Follicular phase - FSH stimulates the development of a dominant follicle on the surface of the ovary.

Second phase - Luteal phase - LH rises and triggers the follicle to release the ovum.

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23
Q

How far from menstruation does ovulation occur?

A

14 days before

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24
Q

Which part of the cycle can vary in length - resulting in the variation of cycle lengths between women?

A

The follicular phase.

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25
What happens if the ovum is not fertilised?
The corpus luteum degenerates, oestrogen and progesterone levels all and blood vessels of endometrium constrict, shed as menstrual blood.
26
What does the corpus luteum do?
Produces progesterone which prepares the endometrium for implantation.
27
If a woman presents with heavy menstrual bleeding - what questions should you ask?
Nature of the symptoms What is 'normal' for the patient's menstrual cycle - length, duration, and any variation in the pattern The patient's age How do the symptoms affect the woman's quality of life? Has the patient attended cervical screening as scheduled (where appropriate) and what were the results Sexual history, including contraceptive use and future plans Pregnancy history. Could the patient be pregnant now? Medical history - especially conditions such as endometriosis and coagulation disorders Surgical history Family history of coagulation disorders Drug history - including previous treatment for menorrhagia Related symptoms - e.g. pelvic pain, inter-menstrual bleeding
28
When is a physical exam required if the patient has heavy menstrual bleeding?
If they also have any other symptoms - e.g. inter-menstrual bleeding, pelvic pain, dysmenorrhoea, pressure symptoms
29
If a woman has heavy menstrual bleeding and NO other symptoms - what is the appropriate next step?
Initiation of pharmacological treatment
30
When should you investigate secondary amenorrhoea?
When the periods have stopped for at least 6 months.
31
What is the most common cause of amenorrhoea?
Pregnancy
32
Which women with heavy menstrual bleeding (HMB) should be referred on the 2-week-wait pathway?
Those with symptoms suggestive of cancer
33
Which symptoms are suggestive of cancer in Ps with HMB?
Pelvic or abdominal mass Ascites Suspicious ultrasound Abnormal appearance of cervix on examination Mass of vagina/vulva or ulceration Post-menopausal bleeding
34
When do you refer a woman with HMB?
Complications (e.g. compressive symptoms - dyspareunia, pelvic pain, constipation, urinary symptoms) P has iron deficiency anaemia & has failed to respond to treatment, and other causes excluded Menorrhagia has not improved despite initial treatment Fibroids >3cm
35
How can the HPAA be disrupted to cause amenorrhoea?
Extreme weight gain / loss Excessive exercise Chronic illness
36
What causes hyperprolactinaemia?
Pregnancy Puerperium Stress Breastfeeding Pituitary tumour Drugs (anti-psychotics, SSRIs) Hypothyroidism
37
What signs can indicated hyperpolactinaemia?
Galactorrhea Infertility Hirsutism Loss of libido Hx of hypothyroidism Drug Hx Prolactinomas - can cause pressure symptoms - e.g. headaches and visual-field defects
38
What can cause hypopituitarism?
Surgery Trauma Irradiation Infiltration (Sarcoidosis, tumour) Sheehan's
39
What percentage of couples in the general population conceive naturally within 1 year if they are having regular sex?
84%
40
What proportion of couples in the Uk have difficulty conceiving?
1 in 7
41
In approx what percentage of couples with infertility is no cause found?
25%
42
What are the main causes of infertility?
Ovulatory disorders (25%) Tubal damage (20%) Male infertility (30%) Uterine or peritoneal (10%) Unknown - 25%
43
What questions should you ask in a subfertility history?
Woman's age Previous pregnancies How long have they been trying? Frequency of intercourse? Previous contraception and when was it stopped? Menstrual history cycle Previous gynae history and smear history Previous STIs/pelvic infections? Systemic symptoms/history of systemic disease? Medications (inc OTC) Alcohol and recreational drugs Smoking status
44
At what age does a decrease in fertility occur in men and women?
Men = 40-45 Women = mid-30s
45
When should a couple be referred for subfertility?
If they have failed to conceive after 12m of regular unprotected intercourse
46
When might you decide to refer a couple earlier than 1 year for infertility?
If the women is >36 Those with a known cause of infertility or predisposing factors for infertility Women undergoing medical treatments which may result in infertility - e.g. cancer treatment Women unable to have vaginal intercourse
47
What lifestyle factors can affect fertility?
Smoking Drinking Regular intercourse Health BMI Caffeine - max 200mg/day. No caffeine if undergoing IVF Tight Fitting Underwear
48
How can we support couples going through infertility treatment?
Acknowledge stress Support Offer resources Link to support groups Refer to counselling
49
Who should be referred for IVF?
Women <40 not conceived >2yrs trying or 12 cycles of artificial insemination. They get 3 full cycles of IVF - unless woman hits 40 during this - in which case stop after the current cycle. Women 40-42 - not conceived >2 yrs or 12 cycles AI - offer 1 IVF cycle provided they have never had IVF previously, is no evidence of low ovarian reserve and there has been a discussion of implications of IVF and pregnancy at this stage.
50
What can cause amenorrhoea?
HPAA dysfunction Hyperprolactinaemia Hypopituitarism High levels of gonadal hormones Ovarian problems Anatomical problems (e.g. Ashermann's syndrome - endometrium is scarred following surgery)
51
What are the ovarian causes of amenorrhoea?
PCOS - excess androgen production Ovarian carcinoma Ovarian failure (menopause)
52
What do you check levels of for PCOS?
Androgen levels - high levels can indicate PCOS
53
What is the diagnostic criteria for PCOS?
Rotterdam criteria - need 2 out of 3: - polycystic ovaries on US - oligomenorrhoea or anovulation - clinical or biochemical signs of hyperandrogenism
54
What types of abnormal bleeding are there?
Intermenstrual bleeding Postcoital bleeding
55
What can cause spotting?
STD (chlamdiya) or PID
56
What type of cells are found in - the cervical canal - the outside of the cervix What is name if these two meet on the outer cervix?
- Columnar cells - Squamous cells Ectropion
57
What are the risk factors for an ectropion?
High levels of oestrogen - so pregnancy or contraceptive pill
58
What is the term for severe or persistent pain with menses?
Dysmenorrhoea
59
What is the difference between primary and secondary dysmenorrhoea?
Primary = no underlying pathology - common in young women and smokers Secondary = caused by pathology
60
What can cause secondary dysmenorrhoea?
Fibroids PID Endometriosis Adenomyosis Adhesions Anatomical abnormalities
61
What is endometriosis?
Endometrial tissue that is deposited in sites outside the uterus lining.
62
What are the symptoms of endometriosis?
Chronic pelvic pain Pain on intercourse Infertility Urinary tract symptoms Painful defecation Backache Bleeding at extrapelvic sites
63
What is the gold standard investigation for endometriosis?
Laparoscopy
64
If Ps do not have severe or unusual symptoms of endometriosis, what is acceptable first line treatment?
Mirena coil = first line Contraceptive pill or NSAIDs, Tranexamic acid or Mefanamic acid
65
When is dysunfctional uterine bleeding the most common?
At the extremes of the fertile years = v young or perimenopause
66
What can cause excessive menstrual bleeding?
Fibroids Hypothyroidism Bleeding disorders Cirrhosis of liver
67
What should you check in a P with HMB?
FBC + serum ferritin
68
What is the potential problem of running two packs of contraceptive pills together to stop a period?
Breakthrough bleeding
69
What treatment can be prescribed to postpone menstruation?
Norethisterone - start 3 days before period is due. When ceased - should have a period 2-3 days later. If progesterone. Is not a contraceptive in this manner,
70
What are the progesterone-only options for contraception?
Progesterone only pill Injectable contraceptives Implantable contraceptives Mirena IUS or non-hormonal copper IUD
71
What are the risks of the COC?
Can inc risk of VTE - from 5-10 per 100k to 20 per 100k. Decreases overall risk of cancer BUT can small increase risk of breast cancer & inc risk of cervical cancer (depending how long used for).
72
What are the side effects of the COC?
Nausea Headaches Breast tenderness Mood changes Change in libido Can inc BP Breakthrough bleeding
73
On the COC - how many periods is it recommended you have a year?
4
74
What is the risk of injectable or implantable contraception?
May cause reduced bone mineral density Not immediately reversible May have unschedule bleeding for months
75
What are the types of emergency contraception?
IUD - can be used 5 days post intercourse Levonelle - progesterone only pill - up to 72 hours Ulipristal acetate - progesterone receptor modulator that inhibits ovulation & acts on endometrium to prevent implantation - 5 days

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