Menstral Cycle and disorders

Question 1

What does the follicule produce?

Answer 1

Oestrogen and inhibit

Question 2

What happens after the LH surge?

Answer 2

Ovulation

Question 3

Corpus luteum produces what hormone and its action?

Answer 3

Progesterone

Maintains endometrium

Question 4

What is menorrhagia?

Answer 4

Excessive menstraul bleeding which affects her life.

Volume based >80g

Question 5

What causes menorrhagia?

Answer 5

Haematological - Von willibrands
Endocrine - hypothyroidism
Structural - e.g. Fibroids,

Must consider carcinoma in those failing to response to treatment, over 45 years.

Question 6

Irregular bleeding is caused by what 2 main things?

Answer 6

Anovulation
Conditions - benign or malignant
? Contraception

Question 7

Causes of primary and secondary amenorrhea?

Answer 7

1’ never bleed- chromosomes, imperforate hymen (haemocoloposcopy), anorexia, athleticism
2’ had then stopped - e.g. Pregnancy, PCOS

Pathological or not
Location

Question 8

Causes of post-coital bleeding?

Answer 8

Eptropium - movement of the transformation zone (squamous to columnar)
Sti
Polyps
Cancer -

Question 9

Types of fibroid?

Answer 9

Subserousal
Intramural
Pedunculated….

Question 10

At what age would you starting investigating primary amenorrhea?

Answer 10

16y or 14y if she shows no sign of breast development

Question 11

What treatment can be given for primary dysmenorrhea?

Answer 11

NSAIDs eg Mefenamic acid (they inhibit prostaglandins)
Second line - cocp

Secondary dysmenorrhea - refer to gynea for investigation

Question 12

What investigation must you always do for amenorrhea?

Answer 12

Pregnancy test

Question 13

What are the actions of PGF2a, PGE2, and PGI2 in menstruation?

Answer 13

PGF2a - vasoconstriction
Pge2 and pgi2 (prostacyclin) - vasodilation
Pgi2 - inhibits platelet aggregation

Question 14

What is the first line treatment for menorrhagia?

Answer 14

NSAIDs eg Mefenamic acid

Mirena coil 
Antifibrinolytics eg tranexamic acid
Mefenamic acid if also have pain 
Cocp 
IM progestogens (norethisterone)

Surgery- endometrial ablation
Fibroids - myomectomy or uterine artery embolisation // hysterectomy if not wanting to be fertile

Question 15

What are the different types of HRT? Who should be given what?

Answer 15

Combined HRT - with a uterus (progesterone needed)

• those still having periods - give oestrogen and cyclical progesterone (gives a regular withdrawal bleed)
• postmenopausal - give continuous combined HRT eg kliofem, oestrodial and norethisterone

Oestrogen only - without a uterus

Question 16

What are the alternatives to HRT?

Answer 16

SSRIs- eg. Clonidine for vasomotor symptoms
Calcium and vit d, bisphoshanates or strontium or SERMs - oesoporosis
Oestrogen cream- vaginal dryness

Question 17

What is ashermans syndrome?

Answer 17

Amerrhoa due to uterine adhesions after D&C (leading to cervical stenosis)

Question 18

What is Sheehan syndrome?

Answer 18

Amenorrhea caused by Postpartum infarction of the pituitary gland due to PPH

Question 19

What are the contraindications to HRT?

Answer 19

Endometrial/breast cancer
Undiagnosed vaginal bleeding
/ Breast lump
Previous VTE - due to preg/oestrogen

Question 20

What are the blood tests in PCOS?

Answer 20

Raised testosterone
Elevated LH:fsh ratio
Low SHBG
Raised prolactin

Question 21

What is kallman syndrome?

Answer 21

Failure of hypothalamus to produce gnrh - primary amenorrhea