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what is menorrhagia?
- heavy menstrual bleeding that is affecting QOL
- not just >80ml loss
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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
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what 4 Ix do you do in menorrhagia?
- FBC - Hb
- TFT
- TVUS - if endo thickness >10mm then biopsy (hysteroscopy)
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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
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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
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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!
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if not trying to conceive what is Rx for menorrhagia?
- progestogen IUS (mirena)
- or COCP
- progestogens
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if above Rx fail what needs to be done?
hysteroscopy and maybe hysterectomy.
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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
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how do you know if medical Rx is best for irregular/IMB?
when cycles are ANOVULATORY
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what is first line Rx for anovulatory HMB?
IUS or COCP
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what are hormone blood test results for hypothalamic hypogonadism and Rx?
- GnRH low
- FSH and LH low
- oestrogen LH
- Rx: COCP or HRT
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what are the 2 main categories for outflow tract problems with menstrual flow?
- congenital problems - primary amenorrhoea
- acquired problems - secondary amenorrhoea
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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
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what causes acquired problems of menstrual flow?
- cervical stenosis
- ashermans syndrome: adhesions after ERPC
-
when is the 1 time PCB can be normal? otherwise what to exclude?
- after 1st intercourse
- otherwise need to exclude cervical carcinoma
-
give 5 main causes of PCB?
- cervical carcinoma
- polyps
- ectropion
- cervicitis
- vaginitis
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what would you do if smear of cervix was normal but still PCB?
cryotherapy for ectropion
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what is dysmenorrhoea?
painful menstruation
-
what causes dysmenorrhoea?
- high PG levels in endometrium
- contraction and uterine ischaemia
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what does primary dysmenorrhoea mean?
- when no organic cause is found
- very common
- at start of period
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what does primary dysmenorrhoea respond to?
- NSAIDs - reduce PG
- COCP - ovulation suppression
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apart from dysmenorrhoea, what other symptoms are common in secondary dysmenorrhoea?
- deep dyspareunia
- menorrhagia
- irregular menstruation
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what 2 Ix do for 2ry dysmenorrhoea?
pelvic US and laparoscopy
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what are top 5 causes of 2ry dysmenorrhoea?
- fibroids
- adenomyosis
- endometriosis
- PID
- ovarian tumour
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