Irregular Menstruation Flashcards
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. Diagnose the perimenopause and offer advice?
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
C. Do an urgent, suspected cancer referral
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
B. Cervical cancer
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
D. a topical oestrogen pessary
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
B. Tranexamic acid may help to reduce blood loss but is unlikely to help pain.
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
c. gabapentin
d. clonidine
Post menopausal bleeding is a common feature of which gynaecological cancer?
a. endometrial cancer
b. ovarian cancer
c. cervical cancer
a. endometrial cancer
Menorrhagia diagnosis is based on a greater than 80mls menstrual loss per month - vrai ou faux?
False – it is a clinical diagnosis based on patients history
Progestogen only therapy can be used to reduce excessive menstrual loss - vrai ou faux?
true
Tranexamic acid is a non-steroidal anti-inflammatory - vrai ou faux?
False it is an anti-fibrinolytic
Naproxen can be an effective treatment for dysmenorrhoea- vrai ou faux?
true
Dysfunctional uterine bleeding can be associated with anovulatory cycles - vrai ou faux?
Vrai
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
c. leiomyomata (fibroids)
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. cervical ectropion (erosion)
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
d. oestrogen only patches
she is suitable for unopposed oestrogen. Patches may reduce her risk of cardiovascular complications compared to tablets
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.
b. PCOS can cause DUB
List 5 features of normal menstruation.
Menarche 10-16
Menopause > 45 years
Menstruation < 8 days in length
Cycle length 23-35 days
Blood loss < 80ml
How long does menstruation usually last?
< 8 days in length
How long does a menstrual cycle usually last?
23-35 days
How much blood is usually lost in a menstrual period?
< 80ml
List 5 features of an abnormal Menstruation
Precocious puberty (before 10)
Premature menopause (before 45)
Absent or long (amenorrhea/oligomenorrhea)
Irregular
Heavy (menorrhagia)
What is menorrhagia?
Heavy menstrual bleeding
What is dysmenorrhoea?
Painful menstrual bleeding
What is oligomenorrhoea?
Infrequent periods > 35 days - 6 months between bleeds
What is primary amenorrhoea?
Periods never start
What is secondary amenorrhoea?
Periods stop for ≥ 6 months (not menopause)
What is metrorrhagia?
Irregular bleeding whereby periods out with range of 23-35 days with variability of > 7 days between shortest and longest cycles
What is intermenstrual bleeding?
Bleeding between periods
What is post-coital bleeding?
Bleeding after sexual intercourse
What is post-menopausal bleeding?
Bleeding 1 year after menopause
What is premenstrual syndrome?
Psychological and physical symptoms in luteal phase
State the two types of amenorrhoea.
1º = never had menses by 16
2º = absence of menses for ≥ 6 months
What is the female triad with regards to amenorrhoea?
Excessive sports
Eating disorders
Amenorrhoea
Give 3 common causes of amenorrhoea.
- PCOS
- Hyper-PRL
- Premature menopause
- POI
- Pregnancy
Which investigation would you order in a patient presenting with amenorrhoea?
- FSH
- LH
- GnRH
- TSH
- PL
- ß-hCG
- Androgens
Imaging: TV-US/MRI
Outline 3 causes of menorrhagia.
Idiopathic
POCS
Fibroids (leiomyomas)
Polyps
Dysfunctional Uterine Bleeding
Pelvic Inflammatory Disease
Obstetric Pathology
Endometrial cancer
Cervical cancer
Ovarian cancer
What is the gold standard investigation for uterine fibroid diagnosis?
TV-US
State the main treatment for uterine fibroids.
Myomectomy
Uterine artery embolisation
Hysterectomy
State 3 red flag signs in a patient with uterine fibroids.
Acute pain, irregular bleeding, increased in size post-menopausal
Outline the two types of Dysmenorrhoea.
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
Give a differential for menorrhagia, apart from uterine fibroids, which is loosely defined
Dysfunctional Uterine Bleeding (DUB)
Give 3 differentials for a patient with metrorrhagia
Endometriosis
PCOS
Fibroids
Adenomyosis
Chronic infection
Cysts
Give 3 types of non-menstrual vaginal bleeding
Intermenstrual bleeding
Post-coital bleeding
Post-menopausal bleeding
List 3 common causes of post-coital bleeding
- Infection - Cervical ectropion - Trauma/sexual abuse - Vaginal atrophy - Cervical cancer
List 3 common causes of post-menopausal bleeding
- Endometrial cancer
- Endometrial polyps - Endometrial hyperplasia
- Cervical cancer
What is the menopause?
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
Outline the 3 time periods of menopause.
Perimenopause (months/years before menopause)
Menopause (last menstrual period/oocyte supply diminished)
Post-menopause (reduced circling oestrogen)
List 3 symptoms of perimenopausal symptoms.
Hot flushes Night sweats Low mood/depression Reduced concentration Reduced libido Vaginal atrophy Irregular menses Vaginal drones Dry skin Dry hair
List 3 vasomotor Sx of Menopause.
Headaches Hot flushes Night sweats Palpitations Insomnia
List 3 psychological Sx of Menopause.
Poor concentration Irritability Depression Reduced short-term memory Lethargy Reduced libido
List 3 urogenital Sx of Menopause.
Urethral Sx Uterine prolapse Stress/urge incontinence Dyspareunia Atrophic vaginitis Irregular menses
List 3 cutaneous Sx of Menopause.
Vaginal dryness
Dry skin
Dry hair
Brittle nails
State 3 potential complications of Menopause.
CVD
CVI
OP
Breast Ca risk reduced
Outline the different ways of managing the Menopause.
COCP
SSRIs
Low-dose vaginal oestrogen
Testosterone
CBT
Weight-loss and exercise
Diet change
Why is oestrogen given with progesterone in menopause?
COCP as oestrogen unopposed would increase risk of endometrial hyperplasia/cancer
List 3 potential risks of HRT
Vaginal bleeding Breast tenderness VTE Breast Ca Stroke
What are the risk factors for post-menopausal bleeding?
- Obesity
- Early menarche
- Late menopause - Nulliparity
- Unopposed oestrogen
- Tamoxifen
- FHx Ca - PCOS
What are the red flags in Gynaecology?
- Bloating
- Abdominal pain
- Irregular bleeding
- Intermenstrual bleeding
- Mass
