menorrhagia, amenorrhoea

Question 1

what is menorrhagia?

Answer 1

prolonged, heavy bleeds loss of >80mls

Question 2

what is dysmenorrhoea?

Answer 2

painful periods

Question 3

polymenorrhoea?

Answer 3

cycle lasting less than 21 days

Question 4

oligomenorrhoea?

Answer 4

cycle lasting longer than 35 days

Question 5

amennorhoea?

Answer 5

absence of period for more than 6 months

Question 6

types of amenorrhoea?

Answer 6

primary and secondary

Question 7

which type of amenorrhoea is when 16 year old has never had period?

Answer 7

primary

Question 8

causes of primary?

Answer 8

imperforate hymen, Turners, testicular feminization, anorexia, exercise etc

Question 9

in menorrhagia, what is it important to ask symptoms about ?

Answer 9

anaemia

Question 10

causes of menorrhagia?

Answer 10

obesity
drugs : copper coil, POP, anti coagulation
pregnancy related miscarriage, ectopic, molar
systemic disease (hypothyroidism, diabetes, adrenal disease, ITP, von willebrand, renal disease, liver disease)

Question 11

local causes of menorrhagia?

Answer 11

trauma 
PID 
fibroids 
cervical disease (ectropion, polyps) 
IUD IUS 
malignany - cervical, endometrial 
endometrial disease - hyperplasia, endometriosis, polyp

Question 12

what is DUB?

Answer 12

abnormal uterine bleeding in the absence of any pathology

Question 13

DUB is a diagnosis of ?

Answer 13

exclusion- made when all other causes of mrnorrhagia have been ruled out

Question 14

2 types of DUB?

Answer 14

ovulatory and anovulatory

Question 15

Anovulatory DUB - why does this happen?

Answer 15

due to irregularity of the cycles. endometrium is not as regularly shed, so when bleeding happens - it tends to be heavy

Question 16

ovulatory DUB. what is this caused by?

Answer 16

poor egg quality. fails to produce adequate amounts of progesterone. So you get bleeding and shed.

Question 17

assessment of menorrhagia?

Answer 17

PV exam

Bloods (FBC/TFT/LFT/coag screen)

Question 18

in menorrhagia, if history is suggestive of a uterine or cervical pathology - what tests would you do?

Answer 18

ultrasound

hysteroscopy and endometrial sampling

Question 19

management of menorrhagia - symptom control?

Answer 19

TXA - anti fibrinolytic. reduce bleeding

mefanamic acid - anti progesterone to reduce pain

Question 20

control periods: contraceptives?

Answer 20

o 1st line: mirena coil.
o 2nd line: COCP not as effective as coil.
o 3rd line: IM progestogens.
o 4th line: GnRH analogues / Danazol dampen HPA axis and induce a medical menopause.

Question 21

surgical management of menorrhagia?

Answer 21

endometrial ablation

hysterectomy

Question 22

causes of secondary amenorrhoea?

Answer 22

pregnancy
menopause
PCOS
Drug induced: withdrawal from contraception, recreational, steroids
lifestyle - sudden weight loss, stress, over exercising, obesity
Genetic - Kallmans, turners, prader willi

Question 23

causes of oligomenorrhoea?

Answer 23

PCOS
menopause
drug induced - withdrawal from contraception, recreational, steroids.
lifestyle - sudden weight loss, stress, over eating, obesty

Question 24

Investigation of amenorrhoea?

Answer 24

urine hcg
bloods - FSH, LH, oestrogen, progesterone, prolactin, TFT, androgen
genetic - karyotyping

Question 25

what would you do if pituitary tumour suspected?

Answer 25

head MRI

Question 26

what are the two types of hypogonadism?

Answer 26

hypergonadotrophic (high LH and FSH)

hypogonadotrophic (low FSH and LH)

Question 27

which type of hypogonadism do you see in ovarian failure?

Answer 27

hypergonadotrophic

Question 28

when would you get hypogonadotrophic ?

Answer 28

problems with the hypothalamic axis (et pituitary tumour)

Question 29

how do you manage amenorrhea?

Answer 29

treat underlying cause

approach lifestyle factors first