G- Disorders of Menstruation

Question 1

When does LH spike occur?

Answer 1

Oestrogen levels rise after granulosa cells have been stimulated by some LH. Positive feeback loop induces spike.

Question 2

What are the stages of thecal development?

Answer 2

1) Primordial: egg with single layer of granulosa cells - 1m at birth to 4,000.
2) Primary follicle; granulosa cells start to replicate
3) Secondary follicle: acquires thecal cells from the stroma.

Question 3

How is oestrogen produced?

Answer 3

Thecal cells recieve cholesterol, transform it through various progestins, producing testosterone and androstenedione. Andostenedione can then be converted into oestrogen by granulosa cells.

Question 4

When does ovulation take place?

Answer 4

Day 14 +/- extra days to cycle

Question 5

When does embryo enter uterine cavity?

Answer 5

5 days after ovulation

Question 6

How is progesterone produced?

Answer 6

By the corpus luteum. If the blastocyst implants, it will produce HCG allowing maintenance of the corpus luteum (takes over from LH as have similar structure)

Question 7

What bacteria make the vagina acidic?

Answer 7

lactobacilli

Question 8

9 main causes of abnormal uterine bleeding?

Answer 8

Polyps
Adenomyosis
Leiomyomas
Malignancy
--
Coagulopathy
Ovulatory defect
Endometrial 
Idiopathic 
Not yet specified.

Question 9

Hx heavy menstrual bleeding

Answer 9

• amount and timing of bleeding
• flooding
• large blood clots
• method of contraception?

Question 10

Ix heavy menstrual bleeding?

Answer 10

• Check Hb
• Coagulation and thyroid function
• TV ultrasound
• Consider endometrial biopsy if >40, NRTMT, IMT, RFs

Question 11

RFs for endometrial cancer?

Answer 11

obeisity, diabetes, nulliparity, PCOS, FH of hereditary non-polyposis colorectal cancer

Question 12

Medical Tx for HMB

Answer 12

1st) IUS
2nd) (if trying -> tranexamic acid and NSAIDs) Combined pill can be effective.
3rd) High dose progesten, GNrH agonist

Question 13

Surgical Tx for HMB

Answer 13

Hysteroscopic polyp removal, TCRE (previously diathermy, now microwaves/radiotherapy). hysterectomy

Question 14

Management of irregular menstrual bleeding

Answer 14

1. IUS or COCP

2. High dose progestogen causing amenorrhea

Question 15

Difference between primary and secondary amenorrhea

Answer 15

Primary- not had a period by 16yrs. Secondary - when previously normal menstruation ceases for 3 months or more.

Question 16

Define oligomenorrhea

Answer 16

When menstruation occurs every 35 days to 6 months

Question 17

Most common causes of secondary amenorrhea

Answer 17

Pregnancy, premature menopause, PCOS, hyperprolactinaemia.

Question 18

Tx for hyperprolactinaemia

Answer 18

Bromocriptine, surgery

Question 19

Causes of PCB

Answer 19

Cervical carcinoma, cervical ectropion, cervical polyps, cervicitis/vaginitis, vaginal atrophy

Question 20

Difference between primary and secondary dysmenorrhea

Answer 20

Primary - no identifiable cause, occurs alongside bleeding. Secondary - pain due to pelvic pathology, occurs preceeding menstruation.

Question 21

DDx secondary dysmenorrhea (5)

Answer 21

• fibroids
• adenomyosis
• endometriosis
• PID
• ovarian tumours

Question 22

Define precocious puberty

Answer 22

Menstruation occuring before 9yrs, secondary sexual characteristics before 8yrs.

Question 23

Common causes of precocious puberty

Answer 23

central causes - meningitis, tumours, ovarian causes - McCune Albright, ovarian tumours.