bleeding

Question 1

what is:

painful menstrual periods before mensuration

Answer 1

dysmenorrhoea

Question 2

dysmenorrhea:

1. excessive menstural blood loss >80ml > 7 days
2. painful menstrual periods before mensuration

Answer 2

2. painful menstrual periods before mensuration

Question 3

what is the primary physiological cause of dysmenorrhoea

Answer 3

release of uterine prostaglandins

Question 4

list 3 secondary causes of dysmenorrhea

Answer 4

fibroids 
endometriosis 
adenomyosis 
PID
copper uterine device

Question 5

list 3 symptoms of dysmenorrheoa

Answer 5

suprapubic pain 
may radiate to inner thigh/back 
vomiting/nausea 
diarrhoea 
headache 
fatigue

Question 6

how can you tell dysmenorrhoea is a result of a secondary cause

Answer 6

pain exceeds 3-4 after menarche

Question 7

how is primary dysmenorrhoea diagnosed

Answer 7

clinical diagnosis

Question 8

how would you investigate dysmenorrhoea in a patient suspected of PID

Answer 8

vaginal swabs to investigate for chlamydia and gonorrhoea

Question 9

how would you investigate dysmenorrhoea in a patient suspected of endometriosis

Answer 9

transvaginal ultrasound

gold standard: laproscopy

Question 10

when might symptoms of secondary dysmenorrhoea begin

Answer 10

several years after after painless periods

Question 11

what other symptoms should be asked about when investigating dysmenorrhoea

Answer 11

dyspareunia
vaginal discharge 
menorrhagia 
postictal bleeding 
rectal pain

Question 12

what is dyspereunia

Answer 12

pain in the genital area during sexual intercourse

Question 13

list 3 causes for urgent gynea referral

Answer 13

abnormal cervix
mass NOT FIBROIDS
persistent menorrhagia
abnormal US

Question 14

what is the definition of menorrhagia

1. pain in the genital area during sexual intercourse
2. menstrual periods with abnormally heavy or prolonged bleeding > 50ml >7 days
3. menstrual periods with abnormally heavy or prolonged bleeding >80ml >7 days

Answer 14

2. menstrual periods with abnormally heavy or prolonged bleeding >80ml >7 days

Question 15

what is the 1st line treatment for dysmeorrhoea

Answer 15

NSAIDs

Question 16

which is true:

menorrhagia stays the same with increasing age with no identified cause

menorrhagia increases with age with no identified cause

menorrhagia decreases with age with no identified cause

Answer 16

menorrhagia increases with age with no identified cause

Question 17

list 3 management options for menorrhagia

Answer 17

minerna IUS

tranexamic acid

NSAID

OCP

progesterone only pill

Question 18

what does NICE state about the management of menorrhagia

1. do not combine tranexamic acid with the IUS/OCP
2. combine tranexamic acid with the IUS/OCP
3. do not combine tranexamic acid with the IUS only
4. do not combine tranexamic acid with the OCP only

Answer 18

1. do not combine tranexamic acid with the IUS/OCP

Question 19

when would you consider referral in patient under management of menorrhagia

Answer 19

no improvement in 3 months

Question 20

what med can be used to stop acute menorrhagia

Answer 20

norethisterone 5mg TID x 10 days

Question 21

what is the MOA of norethisterone

Answer 21

inhibits ovulation and follicular maturation

Question 22

what is 1st line medication for dysmenorrhoea

Answer 22

NSAIDs e.g. ibuprofen, mefenamic acid, naproxen

Question 23

what is the MOA of NSAIDs in treating dysmenorrhoea

Answer 23

reduce the amount of prostaglandins in the body = reduces the pain

Question 24

which medications would not be used to treat dysmennorohoea

1. mefenamic acid
2. tranexamic acid

Answer 24

2. tranexamic acid

Question 25

what can be used to treat dysmenorrhoea when NSAID have failed/ineffective/not well tolerated

Answer 25

combined oral contraceptive pill

Question 26

what specific diet changes should be made to manage premenstural syndrome

Answer 26

2-3 hourly small balanced meals rich in complex carbs