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Obstetrics and Gynaecology > Irregular Menstruation > Flashcards

Irregular Menstruation Flashcards

1
Q

A 46 year old female presents with 4 months amenorrhoea, negative pregnancy test and a history of night sweats and hot flushes do you..

A. Diagnose the perimenopause and offer advice?​

B. Suggest a check of FSH to clarify diagnosis and arrange review appointment?​

C. Prescribe clonidine or SNRI as a safe option for VMS?

A

A. Diagnose the perimenopause and offer advice?​

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2
Q

A 52 year old lady with a history of 14 months amenorrhoea presents with a single episode of spotting (tiny pv bleed) 4 weeks ago, with no recurrence. You perform a normal vagina and speculum examination. Do you : -

A. Reassure her and ask her to report any further episodes

B. Arrange urgent ultrasound examination and follow up appointment

C. Do an urgent, suspected cancer referral

A

C. Do an urgent, suspected cancer referral

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3
Q

A 31 year old lady presents with a 3 month history of pelvic pain, dyspareunia and occasional post-coital bleeding. The likeliest cause is : -

A. Pelvic inflammatory disease

B. Cervical cancer

C. Ectropion

D. Endometrial cancer

A

B. Cervical cancer

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4
Q

A 48 year old lady has a history of infrequent periods and vaginal dryness and occasional stress incontinence. Which of the following are the best treatment options.

A. a daily oestrogen tablet

B. an oestrogen patch

C. an anticholinergic tablet

D. a topical oestrogen pessary

A

D. a topical oestrogen pessary

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5
Q

A 13 year old girl is complaining of heavy, painful periods. Which of the following treatments is least suitable for her

A. the combined oral contraceptive pill

B. tranexamic acid

C. mefenamic acid

A

B. Tranexamic acid may help to reduce blood loss but is unlikely to help pain.

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6
Q

A 53 year old lady with a history of oestrogen dependent breast cancer is getting severe vasomotor symptoms. Which of the following treatments are suitable (there are more than one)​

a. topical oestrogen pessary​
b. a sequential HRT patch​
c. gabapentin​
d. clonidine​
e. Bendroflumethiazide

A

c. gabapentin​

d. clonidine​

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7
Q

Post menopausal bleeding is a common feature of which gynaecological cancer?​

a. endometrial cancer​
b. ovarian cancer​
c. cervical cancer

A

a. endometrial cancer​

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8
Q

Menorrhagia diagnosis is based on a greater than 80mls menstrual loss per month - vrai ou faux?

A

False – it is a clinical diagnosis based on patients history

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9
Q

Progestogen only therapy can be used to reduce excessive menstrual loss - vrai ou faux?

A

true

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10
Q

Tranexamic acid is a non-steroidal anti-inflammatory - vrai ou faux?

A

False it is an anti-fibrinolytic

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11
Q

Naproxen can be an effective treatment for dysmenorrhoea- vrai ou faux?

A

true

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12
Q

Dysfunctional uterine bleeding can be associated with anovulatory cycles - vrai ou faux?

A

Vrai

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13
Q

A 42 year old lady presents with heavy, regular, menstrual bleeding, urinary frequency, and stress incontinence, which is the likeliest diagnosis?

a. endometrial cancer​
b. dysfunctional uterine bleeding​
c. leiomyomata (fibroids)​
d. bladder cancer​
e. ovarian cancer

A

c. leiomyomata (fibroids)​

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14
Q

Which of the following is most likely to cause post-coital bleeding?

a. cervical ectropion (erosion)​
b. dysfunctional uterine bleeding​
c. endometrial polyp​
d. ovarian cancer

A

a. cervical ectropion (erosion)​

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15
Q

Which of the following treatments would be most suitable for a 56 year old female with a history of hysterectomy,hyperlipidaemia and severe vasomotor symptoms?

a. sequential HRT tablets​
b. topical oestrogen pessaries​
c. clonidine​
d. oestrogen only patches

A

d. oestrogen only patches

she is suitable for unopposed oestrogen. Patches may reduce her risk of cardiovascular complications compared to tablets

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16
Q

Which one of the following statements is true?

a. a raised FSH level is needed to diagnose HRT​
b. PCOS can cause DUB​
c. HRT should always be discontinued after 5 years to reduce the risk of breast cancer​
d. The mirena – IUS would be a first line treatment in a 14 year old female with DUB.

A

b. PCOS can cause DUB​

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17
Q

List 5 features of normal menstruation.

A

Menarche 10-16

Menopause > 45 years

Menstruation < 8 days in length

Cycle length 23-35 days

Blood loss < 80ml

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18
Q

How long does menstruation usually last?

A

< 8 days in length

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19
Q

How long does a menstrual cycle usually last?

A

23-35 days

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20
Q

How much blood is usually lost in a menstrual period?

A

< 80ml

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21
Q

List 5 features of an abnormal Menstruation

A

Precocious puberty (before 10)

Premature menopause (before 45)

Absent or long (amenorrhea/oligomenorrhea)

Irregular

Heavy (menorrhagia)

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22
Q

What is menorrhagia?

A

Heavy menstrual bleeding

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23
Q

What is dysmenorrhoea?

A

Painful menstrual bleeding

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24
Q

What is oligomenorrhoea?

A

Infrequent periods > 35 days - 6 months between bleeds

25
Q

What is primary amenorrhoea?

A

Periods never start

26
Q

What is secondary amenorrhoea?

A

Periods stop for ≥ 6 months (not menopause)

27
Q

What is metrorrhagia?

A

Irregular bleeding whereby periods out with range of 23-35 days with variability of > 7 days between shortest and longest cycles

28
Q

What is intermenstrual bleeding?

A

Bleeding between periods

29
Q

What is post-coital bleeding?

A

Bleeding after sexual intercourse

30
Q

What is post-menopausal bleeding?

A

Bleeding 1 year after menopause

31
Q

What is premenstrual syndrome?

A

Psychological and physical symptoms in luteal phase

32
Q

State the two types of amenorrhoea.

A

1º = never had menses by 16

2º = absence of menses for ≥ 6 months

33
Q

What is the female triad with regards to amenorrhoea?

A

Excessive sports

Eating disorders

Amenorrhoea

34
Q

Give 3 common causes of amenorrhoea.

A
  • PCOS
  • Hyper-PRL
  • Premature menopause
  • POI
  • Pregnancy
35
Q

Which investigation would you order in a patient presenting with amenorrhoea?

A
  • FSH
  • LH
  • GnRH
  • TSH
  • PL
  • ß-hCG
  • Androgens

Imaging: TV-US/MRI

36
Q

Outline 3 causes of menorrhagia.

A

Idiopathic

POCS

Fibroids (leiomyomas)

Polyps

Dysfunctional Uterine Bleeding

Pelvic Inflammatory Disease

Obstetric Pathology

Endometrial cancer

Cervical cancer

Ovarian cancer

37
Q

What is the gold standard investigation for uterine fibroid diagnosis?

A

TV-US

38
Q

State the main treatment for uterine fibroids.

A

Myomectomy

Uterine artery embolisation

Hysterectomy

39
Q

State 3 red flag signs in a patient with uterine fibroids.

A

Acute pain, irregular bleeding, increased in size post-menopausal

40
Q

Outline the two types of Dysmenorrhoea.

A

1) 1º Dysmenorrhoea: No pathology, increased prostaglandins in menstrual fluid

- Within 2 years of menarche 

- Severity on day 1 of bleeding

- Cramping in lower abdominal pain, radiates to lower back and legs 

- Associated Sx: GI nausea, vomiting, fatigue, headache

Rx: 

- NSAIDs (reduce PG)

- COCP/Depot (reduce ovulation) 

- Mirena coil (reduce bleeding and pain)

2) 2º Dysmenorrhoea:

- Many years after menarche

- Starts in luteal phase and continues throughout menstruation 

- Cramping in lower abdominal pain, radiates to lower back and legs 

- Associated Sx: GI nausea, vomiting, fatigue, headache, deep dyspareunia

- Associated with pathology: Endometriosis, chronic PID, fibroids, adenomyosis, polyps, copper coil

Rx: Underlying cause as mainly 1º dysmenorrhoea

41
Q

Give a differential for menorrhagia, apart from uterine fibroids, which is loosely defined

A

Dysfunctional Uterine Bleeding (DUB)

42
Q

Give 3 differentials for a patient with metrorrhagia

A

Endometriosis

PCOS

Fibroids

Adenomyosis

Chronic infection

Cysts

43
Q

Give 3 types of non-menstrual vaginal bleeding

A

Intermenstrual bleeding

Post-coital bleeding

Post-menopausal bleeding

44
Q

List 3 common causes of post-coital bleeding

A 
- Infection 

- Cervical ectropion 

- Trauma/sexual abuse 

- Vaginal atrophy 

- Cervical cancer
45
Q

List 3 common causes of post-menopausal bleeding

A
  • Endometrial cancer
    
- Endometrial polyps 

  • Endometrial hyperplasia

  • Cervical cancer
46
Q

What is the menopause?

A

Last menstrual period due to reduced oestrogen and oocyte supply diminished with 12 months of cessation of periods occurring after 45 years, mean age 51

47
Q

Outline the 3 time periods of menopause.

A

Perimenopause (months/years before menopause)

Menopause (last menstrual period/oocyte supply diminished)

Post-menopause (reduced circling oestrogen)

48
Q

List 3 symptoms of perimenopausal symptoms.

A 
Hot flushes 
Night sweats 
Low mood/depression 
Reduced concentration 
Reduced libido 
Vaginal atrophy 
Irregular menses 
Vaginal drones
Dry skin
Dry hair
49
Q

List 3 vasomotor Sx of Menopause.

A 
Headaches
Hot flushes 
Night sweats
Palpitations 
Insomnia
50
Q

List 3 psychological Sx of Menopause.

A 
Poor concentration
Irritability 
Depression
Reduced short-term memory
Lethargy
Reduced libido
51
Q

List 3 urogenital Sx of Menopause.

A 
Urethral Sx
Uterine prolapse 
Stress/urge incontinence 
Dyspareunia 
Atrophic vaginitis 
Irregular menses
52
Q

List 3 cutaneous Sx of Menopause.

A

Vaginal dryness
Dry skin
Dry hair
Brittle nails

53
Q

State 3 potential complications of Menopause.

A

CVD

CVI

OP

Breast Ca risk reduced

54
Q

Outline the different ways of managing the Menopause.

A

COCP

SSRIs

Low-dose vaginal oestrogen

Testosterone

CBT

Weight-loss and exercise

Diet change

55
Q

Why is oestrogen given with progesterone in menopause?

A

COCP as oestrogen unopposed would increase risk of endometrial hyperplasia/cancer

56
Q

List 3 potential risks of HRT

A 
Vaginal bleeding 
Breast tenderness
VTE 
Breast Ca 
Stroke
57
Q

What are the risk factors for post-menopausal bleeding?

A
  • Obesity 

  • Early menarche
    
- Late menopause 

  • Nulliparity 

  • Unopposed oestrogen
    
- Tamoxifen
    
- FHx Ca 

  • PCOS
58
Q

What are the red flags in Gynaecology?

A
  • Bloating
  • Abdominal pain
  • Irregular bleeding
  • Intermenstrual bleeding
  • Mass

Obstetrics and Gynaecology (8 decks)

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