Females

Question 1

What is dysmenorrhoea?

Answer 1

Pain during menstruation

Question 2

Describe primary dysmenorrhoea

Answer 2

Peak incidence teens to twenties
Cramping
May radiate to back and thighs
GI symptoms - nausea, vomiting, diarrhoea
Headaches, fatigue, faintness

Question 3

Describe secondary dysmenorrhoea

Answer 3

Peak incidence 30’s to 40’s
Consequence of other pelvic pathology
Pain may begin before menstruation

Question 4

What causes dismenorrhoea?

Answer 4

Prostaglandin withdrawal in cycle triggers production of AA and leukotrienes
Higher concs of PG’s in menstrual fluid
Increased myometrial contractility
Also:
Endothelins - vasoactive peptides - role in local PG synthesis
Vasopressin - posterior pituirory hormones - stimulates uterine activity - decreases blood flow (ischaemia) -pain

Question 5

How is primary dysmenorrhoea pharmacologically managed?

Answer 5

1st Line = NSAIDs - Feminax
Oral Contraceptive pill
Inhibits ovulation and prevents PG synthesis in luteal phases
Antispasmodics - unlicensed OTC

Question 6

What causes Secondary dysmenorrhoea? (examples)

Answer 6

PG;s 
Underlaying pelvic pathology:
PID
Endometriosis
Menorrhagia
Fibroids
Uterine polyps

Question 7

How is secondary dysmenorrhoea pharmacologically managed?

Answer 7

Investigate cause.
Surgery - ablation/laser
Symptomatic relief of pain
Pharmacological interventions (non-analgesic)

Question 8

What is endometriosis?

Answer 8

Endometrial tissue found outside uterus (migrated)

Question 9

What causes endometriosis?

Answer 9

Unclear but 2 theories:
Embryological
Retrograde menstruation

Question 10

What are the common symptoms of endometriosis?

Answer 10

Pain, fatigue, subfertility
Dyspareunia
Dyschezia
Dysuria
Chronic pelvic pain
Menstrual irregularities

Question 11

What are the rare symptoms of endometriosis?

Answer 11

Cyclical haematuria
Cyclical haemoptysis
Cyclical tenesmus
Ureteric obstruction
Rectal bleeding
Rectal obstruction

Question 12

How is endometriosis diagnosed?

Answer 12

Pelvic exam
Pelvic ultrasound
Diagnostis laparoscopy
Bloods/MRI (not recommended)

Question 13

Describe the stages of endometriosis

Answer 13

Stage 1-2
Minimal to mild
Poorly visualized on US
Common implantation sites - uterine and ovarian

Stage 3-4
Moderate to severe
Commonly associated with adhesions 
Rectovaginal endometriosis
Bowel invasion

Question 14

How is endometriosis managed?

Answer 14

Surgery - laparoscopy or hysterectomy - to restore pelvic anatomy, divide adhesions and ablate endometrial tissues

1st Line: analgesia - NSAIDs +/- Paracetamol
2nd line: shrinkers (Contraceptives, progestogens, GnRH analogues, Antiprogestogens)
SARMS

Question 15

Define Menorrhagia

Answer 15

Menstrual blood loss above 80ml per month

Question 16

How many women complain of menstrual bleeding

Answer 16

30%

Question 17

What causes menorrhagia?

Answer 17

Unclear - may be prostanoids
DUB (60%)
No pelvic pathology, disease or pregnancy
Other gynaecological causes (35%)
Menopause, miscarriage, ectopic pregnancy, Fibroids, PID, IUD, Adenomyosis
Endocrine and haematological causes (5%)
Disease, PCOS
Blood thinning meds/condition

Question 18

Which symptoms suggest an underlaying pelvic pathology?

Answer 18

Irregular bleeding
Sudden change in blood loss
Intermenstrual bleeding
Post coital bleeding
Dyspareunia
Pelvic pain
Premenstrual pain

Question 19

How is menorrhagia diagnosed?

Answer 19

Bloods - FBS, Iron, Ferritin
Physical exam
Cervical smear
Endometrial biopsy
Ultrasound
Sonohysterography
Hysteroscopy

Question 20

How is menorrhagia managed?

Answer 20

Surgery - UAE, Myomectomy (fibroidectomy), hysterctomy

CHC, POC
IUS/Depo

Tranexamic acid
GnRH analogues/antagonists
Mefenamic acid
Oral progestogen (high dose 5mg)
Antiprogestogens (LAST RESORT)