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Repro > 18 - Menstrual Disorders (endometriosis, adenomyosis, endometrial polyps, HMB, amenorrhoea, PCOS, DUB) > Flashcards

18 - Menstrual Disorders (endometriosis, adenomyosis, endometrial polyps, HMB, amenorrhoea, PCOS, DUB) Flashcards

1
Q

what is the length of a menstrual cycle?

A

the time from the first day of a woman’s period to the day before her next period

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2
Q

what is the normal loss of blood during a cycle?

A

less than 80 ml over 7 days (16 tsp)

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3
Q

what is the avergae loss of blood during a cycle?

A

30-40 ml (6-8tsp)

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4
Q

how long is the average cycle?

A

28 days (average 24-35 days)

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5
Q

what is the average menarche?

A

average -12 years

10-16 years

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6
Q

when is the average onset of menopause?

A

50-55years

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7
Q

describe days 1-5 of a 28 day cycle in terms of uterus lining?

A

uterus lining breaks down due to no implantation and menstruation occurs

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8
Q

describe days 6-10 of a 28 day cycle in terms of uterus lining?

A

uterus lining begins to thicken again

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9
Q

describe days 11-18 of a 28 day cycle in terms of uterus lining?

A

ovulation occurs - usually @ day 14

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10
Q

describe days 19-28 of a 28 day cycle in terms of uterus lining?

A

uterine line continues to thicken to prepare for implantation

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11
Q

define frequent periods?

A

taking place every <24 days

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12
Q

define infrequent periods?

A

taking place every >38 days

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13
Q

define regular periods?

A

<20 days variation in 12 m

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14
Q

define irregular periods?

A

> 20 days variation in 12 m

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15
Q

define prolonged periods?

A

> 8 days

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16
Q

define shortened periods?

A

< 2 days

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17
Q

define normal duration periods?

A

2-7 days

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18
Q

define a heavy period?

A

> 80 ml

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19
Q

define a normal flow/ volume period?

A

5-80 ml

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20
Q

describe a light period?

A

<5 ml

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21
Q

describe 5 uterine and ovarian pathologies for heavy menstrual bleeding?

A

Uterine fibroids

Endometrial polyps

Endometriosis and adenomyosis

Pelvic inflammatory disease and pelvic infection

PCOS

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22
Q

describe 3 systemic diseases and how they cause heavy menstrual bleeding?

A

coagulation disorders

hypothyroidism

renal disease

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23
Q

describe 3 iatrogenic causes for heavy menstrual bleeding?

A

Anticoagulant treatment

Herbal supplements

Intrauterine contraceptive device(CU IUD)

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24
Q

define fibroids?

A

Non cancerous growths made of muscle and fibrous tissue. also called myoma or lieomyoma

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25
Q

name 4 possible symptoms of fibroids?

A

pressure symptoms

HMB

backache

asymptomatic

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26
Q

diagnosis of fibroids?

A

US scan

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27
Q

management of fibroids?

A

symptom-based

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28
Q

describe treatment of small fibroids?

A

COCP

POP

Mirena

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29
Q

describe treatment of large fibroids?

A

fibroid embolisation

myomectomy

30
Q

describe treatment of submucosal fibroids?

A

Hysteroscopic fibroid resection

31
Q

describe treatment for failed medical treatment and fertility preservation is not required?

A

hysterectomy

32
Q

define endometriosis?

A

endometrial tissue present outside the lining of uterus - during menstruation this ectopic tissue behaves the same as endometrium and bleeds

33
Q

who does endometriosis affect?

A

women of reproductive age

34
Q

how does endometriosis present?

7 symptoms

A

pelvic pain

HMB

menstrual cramps which get worse

pain during/ after sex

painful bowel movements/ peeing

abmormal bleeding/ spotting between periods

diarrhoea/ nausea/ bloating

multi-systemic presentation

35
Q

what can endometriosis cause?

A

infertility

fatigue and systemic symptoms

36
Q

4 differential diagnoses for endometriosis?

A

PCOS

fatigue

thyroid issues

IBS

37
Q

how many stages of endometriosis?

A

4

38
Q

describe stage 1 of endometriosis?

A

MINIMAL -

mall patches, surface lesions or inflammation around the organs in pelvic cavity

39
Q

describe stage 2 of endometriosis?

A

MILD -

more widespread and starting to infiltrate pelvic organs

40
Q

describe stage 3 of endometriosis?

A

MODERATE -

peritoneum (pelvic side walls) - also scarring and adhesions

41
Q

describe stage 4 of endometriosis?

A

SEVERE -

infiltrative and affecting many pelvic organs

42
Q

diagnosis of endometriosis?

A

US scan and diagnostic laparoscopy

43
Q

3 management options for endometriosis?

A

medical

surgical

analgesic

44
Q

give 2 examples of medical management of endometriosis?

A

COCP (combined oral contraceptive pill)

POP

45
Q

give 2 examples of surgical management of endometriosis?

A

Ablation

Hysterectomy

46
Q

define adenomyosis?

A

condition where endometrium becomes embedded in myometrium

47
Q

2 symptoms of adenomyosis?

A

HMB

significant dysmenorrhea
painful periods

48
Q

treatment for adenomyosis?

A

may respond to hormones partially

definitive treatment - hysterectomy

49
Q

define endometrial polyps?

A

Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium

50
Q

diagnosis of endometrial polyps?

A

US or Hysteroscopy

51
Q

management of endometrial polyps?

A

polypectomy

52
Q

give 2 examples of medical treatments for HMB?

A

Tranexamic acid

Mefenamic acid

(both reduce blood loss)

53
Q

give an example of hormonal treatment for HMB?

A

COCP

oral progesterones

54
Q

3 ways in which a hysterectomy can be undertaken?

A

abdominally

vaginally

laparoscopically

55
Q

name 3 risks associated with hysterectomy?

A

infection

DVT

altered bladder function

56
Q

what does a hysterectomy guarantee?

A

amenorrhoea

57
Q

what procedure removes the fallopian tubes and the ovaries?

A

Salpingo-oophorectomy

58
Q

name one advantage and one disadvantage of oophorectomy?

A

adv - reduced risk of ovarian cancer

dis - immediate menopause - HRT until age 50

59
Q

define oligo/ amenorrhoea?

A

Infrequent, absent or abnormally light menstruation

60
Q

4 lifestyle causes of oligo/ amenorrhoea?

A

stress

eating disorders

obesity

intense exercise

61
Q

3 hormonal causes of oligo/ amenorrhoea?

A

POP

mirena

depot injection

62
Q

4 medical causes of oligo/ amenorrhoea?

A

Primary ovarian insufficiency

Polycystic ovarian syndrome

Hyperprolactinemia

Grave’s Disease

63
Q

define PCOS?

A

Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria met

64
Q

name the criteria which must be met for PCOS to be diagnosed?

A

Clinical hyperandrogenism

oligomenorrhoea

hirsuitism

acne

infertility

obesity

65
Q

conservative management of PCOS?

A

symptom-based treatment

aim to achieve normal BMI

66
Q

hormonal treatment of PCOS?

A

COCP/ POP/ mirena IUS or norethisterone -

used to achieve At least 3 withdrawl bleeds required per year to prevent hyperplasia

67
Q

define DUB - dysfunctional uterine bleeding?

A

common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases

68
Q

cause of DUB?

A

ovarian hormonal dysfunction

69
Q

what are the common causes to rule out for DUB and other mentrual disorders?

A

P - polyp
A - adenomyosis
L - leiomyoma/ fibroid
M - malignancy

C - coagulopathy 
O - ovulation dysfunction 
E - endometrium/hyperplasia 
I - iatrogenic 
N - not yet classified
70
Q

what is a good treatment for bridging pre-menopausal women with DUB?

A

GnRh analogues - these are anti-oestrogen and they create a pseudo-menopause

71
Q

conservative management of DUB?

A

based on severity of symptoms and patient’s wishes

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