Gynae - menstrual cycle

Question 1

What is menorrhagia?

Answer 1

heavy menstrual bleeding that occurs at expected intervals of the menstrual cycle
- subjective

Question 2

What are the top causes of heavy menstrual bleeding?

Answer 2

uterine fibroids, uterine polyps, adenomyosis, endometriosis, malignancy, clotting disorders, drug therapy, thyroid disease
40-60% have no pathology on investigation = Dysfunction Uterine Bleeding

Question 3

What tests would you do to investigate heavy menstrual bleeding?

Answer 3

FBC, coagulation, TFT, hysteroscopy and biopsy

Question 4

How would you treat heavy menstrual bleeding?

Answer 4

Reassurance 
Antifibrinolytics e.g. tranexamic acid
NSAIDs e.g. mefenamic acid 
Progestagens for 3 months 
Danazol - inhibits sex production 
COCP or Mirena 
Endometrial ablation 
Myomectomy/resection of fibroids 
Hysterectomy

Question 5

What age is normal menarche?

Answer 5

12-13 (11-14.5)

Question 6

What age is percocious puberty and what causes it?

Answer 6

Puberty before 8 and 9

secretion of high-amplitude pulses of gonadotrpin-releasing hormone (GnRH) by the hypothalamus

Question 7

What age would count as delayed puberty?

Answer 7

aged 11-15, runs in families

Question 8

What is the definition of primary amenhorrhea?

Answer 8

failure of menses to occur <16 and normal secondary sexual characteristics
or
14 with no secondary characteristics

Question 9

What are the 5 main categories of problems that cause amenorrhea? Give 2 examples for each

Answer 9

1 - hypothalamus: low GnRH due to athleticism or underweight
2 - pituitary: prolactinoma, pit adenoma, previous radiation
3 - ovary: dysgenesis, no ovary, early menopause, Turners, PCOS
4 - uterus: no uterus, no outflow (severe FGM)
5 - other: thryroid, pregnancy

Question 10

What is haematocolps?

Answer 10

the accumulation of blood inside vagina

- most often caused by imperforate hymen

Question 11

What would you see with an imperforate hymen?

Answer 11

budlging red disc 3cm proximal to introitus

Question 12

What hormones are secreted by the ovary?

Answer 12

oestrodial, inhibin

Question 13

What is the corpus leteum? What hormone does it secrete?

Answer 13

ruptured follicle, releases progesterone and suppresses FSH

Question 14

Where is somatostatin secreted?

Answer 14

hypothalamus

Question 15

Where is gonadotrophin-releasing hormone secreted?

Answer 15

hypothalamus

Question 16

What triggers LH surge?

Answer 16

oestrogen secretion by growing follicles

Question 17

What hormone is secreted by growing follicles?

Answer 17

oestrogen

Question 18

At what week does the embryonic development of male and female reproductive systems diverge?

Answer 18

week 7 - determined by SRY gene

Question 19

Would FSH be high (hypergonadotropic) or hypogonadotropic in the following?
PCOS, Cushing’s, primary ovarian insufficiency, weight loss, premature ovarian failure

Answer 19

PCOS - low/normal 
Cushing's - low/normal 
primary ovarian sufficiency - high 
weight loss - low 
premature ovarian failure - high

Question 20

What is Asherman syndrome?

Answer 20

adhesions after uterine surgery

Question 21

What is treatment for Asherman’s syndrome?

Answer 21

adhesiolysis surgery

Question 22

What is the treatment for hyperprolactinaemia?

Answer 22

dopamine agonists

Question 23

What are the risks with HRT and VTE?

Answer 23

VTE risk highest in first year
personal hisotry of VTE is a contradindication
HRT stopped if VTE found, and this risk of VTE does not continue after stopping HRT