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Flashcards in Menorrhagia Deck (69)
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1

What is the techinical definition of menorrhagia?

> 80ml/month of loss

2

What % of women are affected by menorrhagia?

10%

3

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

4

What type of conditions are most commonly causing menorrhagia?

Benign ones

5

What can menorrhagia often lead to?

Iron deficiency anaemia

6

What can iron-deficiency have an impact on?

Woman's work, family and social life

7

What are the groups of causes of menorrhagia?

- Structural
- Non-structural
- Iatrogenic

8

What are the possible structural causes of menorrhagia?

- Leiomyomata
- Endometrial carcinoma
- Adenomyosis
- Polyps
- Endometrial hyperplasia

9

What is the more common term for leiomyomata?

Fibroids

10

What is the most common structural cause of menorrhagia?

Fibroids

11

When is endometrial cancer more rare?

Under 40 years

12

What is endometrial cancer more likely to cause before menorrhagia?

Irregular bleeding

13

What is adenomyosis usually associated with?

Uniformly enlarged, tender uterus, menorrhagia and dysmenorrhoea

14

What do polyps usually cause as well as menorrhagia?

IMB

15

What can endometrial hyperplasia be associated with?

Irregular anovulatory cycles and overlap with disturbed ovulation

16

What can endometrial hyperplasia be a precursor of?

Endometrial cancer

17

What are the non-structural causes of menorrhagia?

- Disturbed ovulation or anovulation
- Disturbed mechanisms of endometrial haemostasis

18

How else can disturbed ovulation or anovulation affect the menstrual cycle?

- Irregular
- Infrequent
- Prolonged
- Potentially life-threatening bleeding

19

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

20

When do most cases of ovulatory disorders occur?

- Menopause transition
- Adolescence
- Due to endocrinopahties

21

What endocrinopahties can cause ovulatory disorders?

- PCOS
- Hypothyroidism

22

What can cause disturbed mechanisms of endometrial haemostasis?

- Excessive local production of fibrinolytic factors e.g. TPA
- Deficiencies in local vasoconstrictors
- Increased local vasodilators

23

What is a common iatrogenic cause of menorrhagia?

Copper IUD

24

Why should women with menorrhagia have a general examination?

For signs of anaemia or thyroid disease

25

What additional examinations may women with menorrhagia require?

- Pelvic
- Speculum
- Smear

26

What is the first line test for menorrhagia?

Bloods

27

What bloods are useful when assessing menorrhagia?

- FBC
- Serum ferretin
- Serum transferrin receptor

28

When can treatment be started after blood tests alone for menorrhagia?

If examination and history were not of a sinister nature

29

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

30

What is the purpose of further investigations for menorrhagia?

To exclude pelvic pathology, particularly malignancy