Card Set Information
what is menorrhagia?
heavy menstrual bleeding that is affecting QOL
not just >80ml loss
what are causes of menorrhagia? think anatomical
: cancer or polyp
: fibroids, endometrial polyp/cancer, adenomyosis
what 4 Ix do you do in menorrhagia?
FBC - Hb
TVUS - if endo thickness >10mm then biopsy (hysteroscopy)
what are indications for hysteroscopy in menorrhagia?
if endometiral thickness > 10mm and premenopausal or >4mm and postmeno
> 40yo and recent onset HMB
also has IMB
not responded to Rx
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
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!
if not trying to conceive what is Rx for menorrhagia?
progestogen IUS (mirena)
if above Rx fail what needs to be done?
hysteroscopy and maybe hysterectomy.
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
how do you know if medical Rx is best for irregular/IMB?
when cycles are ANOVULATORY
what is first line Rx for anovulatory HMB?
IUS or COCP
what are hormone blood test results for hypothalamic hypogonadism and Rx?
FSH and LH low
: COCP or HRT
what are the 2 main categories for outflow tract problems with menstrual flow?
congenital problems - primary amenorrhoea
acquired problems - secondary amenorrhoea
what congenital problems cause outflow problems and amenorrhoea?
transverse vaginal septum
both OBSTRUCT flow so get accumulation in vagina - haematocolpos or uterus
can palpate abdominally
what causes acquired problems of menstrual flow?
: 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?
what would you do if smear of cervix was normal but still PCB?
cryotherapy for ectropion
what is dysmenorrhoea?
what causes dysmenorrhoea?
high PG levels in endometrium
contraction and uterine ischaemia
what does primary dysmenorrhoea mean?
when no organic cause is found
at start of period
what does primary dysmenorrhoea respond to?
NSAIDs - reduce PG
COCP - ovulation suppression
apart from dysmenorrhoea, what other symptoms are common in secondary dysmenorrhoea?
what 2 Ix do for 2ry dysmenorrhoea?
pelvic US and laparoscopy
what are top 5 causes of 2ry dysmenorrhoea?