Flashcards in Menorrhagia Deck (69)
What is the techinical definition of menorrhagia?
> 80ml/month of loss
What % of women are affected by menorrhagia?
What is the clinical definition of menorrhagia?
Excessive menstrual loss leading to interference with physical, emotional, social or material quality of a woman's life
What type of conditions are most commonly causing menorrhagia?
What can menorrhagia often lead to?
Iron deficiency anaemia
What can iron-deficiency have an impact on?
Woman's work, family and social life
What are the groups of causes of menorrhagia?
What are the possible structural causes of menorrhagia?
- Endometrial carcinoma
- Endometrial hyperplasia
What is the more common term for leiomyomata?
What is the most common structural cause of menorrhagia?
When is endometrial cancer more rare?
Under 40 years
What is endometrial cancer more likely to cause before menorrhagia?
What is adenomyosis usually associated with?
Uniformly enlarged, tender uterus, menorrhagia and dysmenorrhoea
What do polyps usually cause as well as menorrhagia?
What can endometrial hyperplasia be associated with?
Irregular anovulatory cycles and overlap with disturbed ovulation
What can endometrial hyperplasia be a precursor of?
What are the non-structural causes of menorrhagia?
- Disturbed ovulation or anovulation
- Disturbed mechanisms of endometrial haemostasis
How else can disturbed ovulation or anovulation affect the menstrual cycle?
- Potentially life-threatening bleeding
What often leads to disturbed ovulation causing menorrhagia?
Unopposed oestrogen leading to thickening and hyperplasia of the endometrium which then breaks down in a patchy and erratic fashion
When do most cases of ovulatory disorders occur?
- Menopause transition
- Due to endocrinopahties
What endocrinopahties can cause ovulatory disorders?
What can cause disturbed mechanisms of endometrial haemostasis?
- Excessive local production of fibrinolytic factors e.g. TPA
- Deficiencies in local vasoconstrictors
- Increased local vasodilators
What is a common iatrogenic cause of menorrhagia?
Why should women with menorrhagia have a general examination?
For signs of anaemia or thyroid disease
What additional examinations may women with menorrhagia require?
What is the first line test for menorrhagia?
What bloods are useful when assessing menorrhagia?
- Serum ferretin
- Serum transferrin receptor
When can treatment be started after blood tests alone for menorrhagia?
If examination and history were not of a sinister nature
When should patients with menorrhagia be referred for further investigation?
- Risk factors for endometrial cancer
- Persistent IMB
- Abnormal cervical smear
- Significant pelvic pain
- Not responding to first-line treatment after 6 months