Irregular Menstruation

Question 1

what does oestrogen cause

Answer 1

proliferation

thickens endometrium

Question 2

primary amenorrhoea

Answer 2

lack of menses at age 15/16 with development of sexual characteristics

lack of sexual characteristics or menses at 13

Question 3

secondary amenorrhoea

3 common causes

Answer 3

absence of periods for >6 months

PCOS, increased prolactin, premature menopause

Question 4

what’s the female triad of primary amenorrhoea

Answer 4

anorexia nervosa
psychological
athleticism

Question 5

complication of amenorrhoea

preventative measures for this

Answer 5

osteoporosis risk as low levels of oestrogen.

ensure adequate vit D, calcium. put on COCP, HRT

Question 6

benefits of weight loss in PCOS

Answer 6

return of ovulation in 80%
reduce hyperinsulinism and hyperandrogenism
reduce risk of CVD and T2DM
restore periods and improve fertility

Question 7

30% of menorrhagia is what

Answer 7

fibroids

Question 8

red flags of menorrhagia/what are we worried about it being

Answer 8

endometrial hyperplasia 
cervical cancer
ovarian cancer 
PID
pregnancy

Question 9

treatment of menorrhagia

Answer 9

1. IUS the mirena coil (progesterone)
2. COCP
3. NSAIDs (mefenamic acid) and antifibrinolytics (tranexamic acid)
   IF PREGNANCY PLANNING OR MIGHT BE SOMETHING ELSE
4. GnRH analogues (mini menopause)
5. surgery (fibroids)

Question 10

Risk factors of fibroids

treatment

Answer 10

black/asian women 
hereditary 
reproductive years
early marche 
nulliparous 

same as menorrhagia (mirena, COCP, NSAIDs and antifibrinolytics, GnRH, surgery)

Question 11

red flags of fibroids

Answer 11

acute pelvic pain
irregular bleeding
increase size menopausal

Question 12

treatment for primary dysmenorrhoea

Answer 12

NSAIDS: decrease prostaglandins
COCP: decrease ovulation
MIRENA: decrease bleeding and pain

Question 13

additional features of secondary dysmenorrhoea

Answer 13

deep dyspareunia 
longer lasting (can be 14 days before bleed -> bleed)

Question 14

what is secondary dysmenorrhoea associated with?

Answer 14

endometriosis

chronic PID
fibroids
adenomyosis
polyps
copper coil

Question 15

three potential aetiologies of endometriosis

Answer 15

retrograde menstruation

coelomic metaplasia (peritoneal mesothelium transforms into glandular epithelium)

Lymphatic/circulatory spread

Question 16

findings on bimanual examination in endometriosis

Answer 16

thickened nodular ligaments
fixed uterus
enlarged ovary
tenderness

Question 17

features of endometriosis presentation symptoms

Answer 17

severe dysmenorrhoea 
chronic pelvic pain 
deep dyspareunia 
ovulation pain 
chronic fatigue 
dyschezia
infertility 
irregular bleeding 
cyclical rectal bleeding
PMS

Question 18

what defines irregular menstrual bleeding

Answer 18

periods outiwth range of 23-25 days

variability of >7 days between shortesrt and longest cycles

Question 19

change in oestrogen in menopause

Answer 19

general lower levels

previously: produce oestradiol from ovaries
now: produce oestrone from adrenal glands

Question 20

long term effects of menopause

Answer 20

increased osteoporosis
(oestrogen normally stimulates osteoblasts) esp. low weight caucasian

increased cardiovascular and cerebrovascular disease

decreased breast cancer

Question 21

lifestyle recommendations for hot flushes

Answer 21

weight loss and exercise

avoid spicy food, caffeine, warm places, stress, alcohol

Question 22

what must you make sure of when prescribing HRT

Answer 22

do they have a uterus?

if yes - MUST be combined with progesterone to prevent hyperplasia/cancer

Question 23

risks of HRT

Answer 23

stroke 
breast ca
VTE 
breast tenderness
vaginal bleeding

Question 24

contraindications of HRT
if risk of breast cancer:
high risk of DVT: 
high risk of CVD:
diabetes:

Answer 24

risk of breast cancer: not hormonal
high risk of DVT: give transdermal
high risk of CVD: control RF, non-hormonal 1st
diabetes: control risk factors, non hormonal 1st

Question 25

major red flag of post-menopausal bleeding

Answer 25

if over 55 with post-menopausal bleeding - it is endometrial cancer until proven otherwise

adenocarcinoma driven by oestrogen.
RF: obesity, long exposure to oestrogen, nulliparity, tamoxifen, family history of cancers, PCOS

Question 26

red flag symptoms 
ovarian cancer
cervical cancer 
PID
cyst torsion
vulval cancer

Answer 26

ovarian cancer: bloating, abdo pain, irregular bleed, weight loss
cervical cancer: post-coital bleed, intermenstrual bleed, mass on cervix
PID: pelvic pain, vaginal discharge, fever
cyst torsion: acute severe lower abdo pain, hypovolaemic shock
vulval cancer: abnormal persistent growing skin lesion