Gynaecology

Question 1

In the menstrual cycle what are the 2 phases in the ovary?

Answer 1

Follicular phase

Luteal phase

Question 2

What are the 3 stages of the endometrium?

Answer 2

Menstrual phase
Proliferative phase
Secretory phase

Question 3

What do LH and FSH stand for and where are they secreted from?

Answer 3

Luteinising hormone
Follicle stimulating hormone
Anterior pituitary gland

Question 4

What hormone causes ovulation?

Answer 4

LH surge

Question 5

What happens during proliferative phase of menstruation?

Answer 5

High oestrogen levels stimulate thickening of endometrium, growth of spiral arteries, cervical mucus change so more hospitable to sperm.

After ovulation the remnant of the follicle becomes the corpus luteum which secretes progesterone, this causes negative feedback to pituitary causing FSH and LH release to stop.
Progesterone causes endometrium to be receptive to fertilised gamete.

Question 6

What is menorrhagia?

Answer 6

Excessive bleeding in an otherwise normal menstrual cycle. It interferes with woman’s physical, emotional, social and material quality of life.

Objectively is blood loss >80mL

Question 7

Investigations for menorrhagia?

Answer 7

Bloods - FBC (Hb), clotting, TFT
Transvaginal USS - look for uterine fibroids, ovarian mass, large polyps
Hysteroscopy and biopsy of polyps

Question 8

Management of menorrhagia

Answer 8

If no pathology or fibroids <3cm

• levonorgestrel releasing IUS = mirena coil
• tranexemic acid or NSAIDs (mefenamic acid)
• combined oral contraceptive pill or cyclical oral progesterone

If fibroids >3cm

• specialist referral
• pharmacological same as above
• uterine artery embolization
• surgery - myomectomy, hysteroscopy, endometrial ablation

Question 9

Causes of intermenstrual bleeding?

Answer 9

Anovulatory cycles
Fibroids
Uterine and cervical polyps
Adenomyosis
Ovarian cysts
Chronic pelvic infection
Malignancy - ovarian, cervical, endometrial