Menstration

Question 1

what hormone system controls menstration

Answer 1

hypothalamic-pituatary-ovarian axis

Question 2

describe menstral cycle

Answer 2

Question 3

primary amennorhea - ? / c

Answer 3

failure to start menstrating (investigate if >15 years old) c - simply late/ structural problem / genetic (turners)

Question 4

secondary ammen - ? / c / I

Answer 4

periods stop for >6 months (excluding preg) c - HPO axis upset (emotion, weight etc) / Pit tumor / PCOS I - serum LH + testosterone (PCOS) FSH (premature menopause) TFT’s (thyroid issues)

Question 5

Menorrhagia - c / I / T

Answer 5

c - IUD (copper coil) , anaemia, hypothyroid, fibroids, CA, polyps I - regular tests + hysteroscopy + TVUS + biopsy(if polyp/CA) T - mirena or OCP +/- transexamix acid or mefenamic acid / SURG: endometrial ablation or hysterectomy

Question 6

Fibroids - ? / classify / I / CF / T

Answer 6

? - smooth, benign muscle tumors of the uterus classed as peduncle, subserosal, submucosal, intramural I - US / hysteroscopy CF - Heavy bleeding, esp during periods + OCP use +/- pain +/- subfertility (Fibroids atrophy after menopause) T - Observe: if needed - MED (GnRH analogue to decrease oest) SURG (myomectomy / hysterectomy

Question 7

menopause + HRT - CF / diff diag/ I/ T / pro and con of HRT

Answer 7

CF - menstral irreg pattern –> anovulatory vasomotor disturbance (sweats, palpations, flushes) atrophy of oest dependant tissue (nipples, breasts, vag, less pubes) vag dryness - UTI/ sore sex / prolapse osteoporosis DD - thyroid disorder, psych disorder I - 2 FSH levels >30 is suggestive of menopause T - HRT (oestrogen helps with atrophy + vasomotor symp) used in combo with progesterone reduces risk if uterus still present HRT: PRO - symptom relief +urinary relief + decreased risk of osteoporosis CON - increased risk of breast, endometrial CA / increased stroke risk and VTE risk / weight increase / PMS

Question 8

Intermenstral Bleeding / breakthrough bleeding - c

Answer 8

• cervical - ectopic preg/CIN / CA / post treatment - uterine - polyp / CA - infection - cervicitis/ vaginitis - hormonal - contraception (OCP, POP, IUD) / tamoxifen - also NON-GYN : vWf disease, hypothyroid, hypersplenism, cirrhosis

Question 9

post-menopasual - c

Answer 9

HRT / atrophic vaginitis / cervical CA / endometrial CA / infection