Menstrual D.O

Question 1

What is abnormal bleeding?

Answer 1

• IMB

- PCB

Question 2

What are indicators of heavy bleeding ?

Answer 2

• too much clotting
• iron def. anemia
• leaking onto clothes

Question 3

What is polymenorrhea?

Answer 3

menses occuring <21 day interval

Question 4

Polymenorrhagia?

Answer 4

• increased bleeding and frequent cycle

Question 5

Amenorrhoea?

Answer 5

• absent menses >6 months

Question 6

Oligomenorrhea?

Answer 6

• menses at >35 days

- usually d/t PCOS

Question 7

wHAT ARE THE 2 GR.S of Menorrhagia?

Answer 7

ORGANIC (pathology)

NON-ORGANIC (DUB, 50% of cases, HORMONAL)

Question 8

LOcal causes of Organic Menorrhagia?

Answer 8

fibroids/ adenomyosis (painful) /endocervical polyps/ cervical eversion (glandular cervix outpouches into the ectocervix)/ endometrial hyperplasia/ IUCD (copper ones)./ PID (chlamydia)/ endometriosis/ cervical or uterine cancer/ hormone tumors (granulosa cell tumors- d/t estrogen) / trauma

Question 9

What endocrine problems cause menorrhagia?

Answer 9

• hypo/hyperthyroidism
• DM
• Adrenal Disease

Question 10

What bleeding disorders cause menorrhagia?

Answer 10

• VWB disease
• ITP
• Fctor III, V, VII and XI def
• anticoagulants

Question 11

What chronic illnesses cause menorrhagia?

Answer 11

• chronic liver disease

Question 12

Why may bleeding occur with pregnancy?

Answer 12

• miscarriage
• ectopic pregnancy
• Gestational trophoblastic disease
• postpartum hemorrhage

——TEST WITH PREG. TEST

Question 13

What is DUB subdivided into?

Answer 13

ANOVULATORY (85%)

• –occurs at extreme ages (menarche and perimenopause)
• —missed ovulation 2months worth of uterine shedding
• —seen in OBESE women

OVULATORY:

• -35-45 y.o
• –regular heavy period
• d.t inadequate progesterone prodn by C.L

Question 14

How to invx DUB?

Answer 14

• FBC
• Cervical smear
• TSH (hypothyroid)
• Coagulation screen
• renal /liver function test
  -TVUS (check thickness/ presence of fiboids )
• Endometrial sampling
  (pipelle biopsy/D&C)

Question 15

How to manage DUB?

Answer 15

Drug rx:

• progestogens (synthetic anologue)
• OCP
• Danazol (testosterone analogue)
• GnRH analogues
• NSAIDs
• Anti-fibrinolytics
• Capillary wall stabilizers

—–progesterone releasing IUCD (MIRENA IUS)

Question 16

Diff. between oral and IUCD progesterone

Answer 16

• coil delievrs drug locally in a sustained manner

Question 17

How to manage regular cycles

with heavy period?

Answer 17

• (non-hormonal rx)
• Tranexamic Acid (3x/day for 4 days)
• NSAIDs (MEFENAMIC acid)

Question 18

Treatment of irregular cycle?

Answer 18

• OCP

Question 19

What does the GnRH Analogue do?

Answer 19

shuts down ovary

Question 20

What is considered to be SURGICAL management of DUB?

Answer 20

1. endometrial ablation- burning of the endometrial lining

2. Hysterectomy

Question 21

Whatare the diff. way s to hysterectomy?

Answer 21

• vaginal hysterectomy (no visible wound sutures; but poor sight into uterus)
• Sub total (leave the cervix —reduced risk of prolapse
• Total abdominal
• LASH/LAVH/TLH

Question 22

WHyis medical rx more desriable?

Answer 22

• cheaper

- no waiting list

Question 23

What does the NICE guidelines suggest with ablation and hysterectomy ?

Answer 23

• ablation to be done first

Question 24

What is the difference between Hysterectomy and Endometrial ablation?

Answer 24

E.ABLATION:

• day case procedure
• shorter time
• quicker recovery
• FEWER complications
• REQUIRES CERVICAL SMEARS
• combined HRT required

Hysterectomy: major op./ longer operating time/longer recovery/ more complications

Question 25

What does LASH/LAVH and TLH stand for?

Answer 25

- LAPAROSCOPIC procedures - LASH= Laparoscopic supracervical hyst. - LAVH= laparoscopic vaginal Hysterec. - TLH- total laparoscopic hysterec

Question 26

What is involved with endometrial ablation?

Answer 26

- TCRE - REA -----THERMAL balloon ablation - thermal hydroablation bipolar MESH endo. ablation

Question 27

What NSAIDs are licensed for dysmennorhoea ?

Answer 27

- Ibuprofen | - Naproxen

Question 28

How are NSAIDs useful to treat menorrhagia?

Answer 28

- PG E2 prodn is raised - PG E sites also Incr. - ---therefore useful to be given NSAIDs (Cyclo-oxygenase inhibitor ---reduces PG prodn) ------reduces blood loss by 20-50% !