menstrual problems.txt

  1. what is menorrhagia?
    • heavy menstrual bleeding that is affecting QOL
    • not just >80ml loss
  2. what are causes of menorrhagia? think anatomical
    • cervix: cancer or polyp
    • uterus: fibroids, endometrial polyp/cancer, adenomyosis
    • ovarian tumour
    • PID
    • thyroid
    • bleeding disorder
    • copper coil
    • other contraception
  3. what 4 Ix do you do in menorrhagia?
    • FBC - Hb
    • TFT
    • TVUS - if endo thickness >10mm then biopsy (hysteroscopy)
  4. what are indications for hysteroscopy in menorrhagia?
    • if endometiral thickness > 10mm and premenopausal or >4mm and postmeno
    • polyp suspcted
    • > 40yo and recent onset HMB
    • also has IMB
    • not responded to Rx
  5. once anaemia, local causes (and cancer) and systemic causes have been excluded, what Q needs to be asked to tailor Rx?
    if trying to conceive
  6. if are trying to conceive what is Rx for menorrhagia? and when to take?
    • transexamic acid = anti fibrinolytic
    • or NSAIDs - mefenamic acid (also useful for dysmenorrhoea)
    • take during menstruation only!
  7. if not trying to conceive what is Rx for menorrhagia?
    • progestogen IUS (mirena)
    • or COCP
    • progestogens
  8. if above Rx fail what needs to be done?
    hysteroscopy and maybe hysterectomy.
  9. if going to have surgery for fibroids, what Rx give before..think of 2
    • GnRH agonist - will get amenorrheoa
    • if want to use for >6/12 then addback HRT
  10. how do you know if medical Rx is best for irregular/IMB?
    when cycles are ANOVULATORY
  11. what is first line Rx for anovulatory HMB?
    IUS or COCP
  12. what are hormone blood test results for hypothalamic hypogonadism and Rx?
    • GnRH low
    • FSH and LH low
    • oestrogen LH
    • Rx: COCP or HRT
  13. what are the 2 main categories for outflow tract problems with menstrual flow?
    • congenital problems - primary amenorrhoea
    • acquired problems - secondary amenorrhoea
  14. what congenital problems cause outflow problems and amenorrhoea?
    • imperforate hymen
    • transverse vaginal septum
    • both OBSTRUCT flow so get accumulation in vagina - haematocolpos or uterus
    • can palpate abdominally
    • Rx: surgically
  15. what causes acquired problems of menstrual flow?
    • cervical stenosis
    • ashermans syndrome: adhesions after ERPC
  16. when is the 1 time PCB can be normal? otherwise what to exclude?
    • after 1st intercourse
    • otherwise need to exclude cervical carcinoma
  17. give 5 main causes of PCB?
    • cervical carcinoma
    • polyps
    • ectropion
    • cervicitis
    • vaginitis
  18. what would you do if smear of cervix was normal but still PCB?
    cryotherapy for ectropion
  19. what is dysmenorrhoea?
    painful menstruation
  20. what causes dysmenorrhoea?
    • high PG levels in endometrium
    • contraction and uterine ischaemia
  21. what does primary dysmenorrhoea mean?
    • when no organic cause is found
    • very common
    • at start of period
  22. what does primary dysmenorrhoea respond to?
    • NSAIDs - reduce PG
    • COCP - ovulation suppression
  23. apart from dysmenorrhoea, what other symptoms are common in secondary dysmenorrhoea?
    • deep dyspareunia
    • menorrhagia
    • irregular menstruation
  24. what 2 Ix do for 2ry dysmenorrhoea?
    pelvic US and laparoscopy
  25. what are top 5 causes of 2ry dysmenorrhoea?
    • fibroids
    • adenomyosis
    • endometriosis
    • PID
    • ovarian tumour
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menstrual problems.txt