Menstrual Conditions

Question 1

What is the maximum number of days variation that should be allowed between a woman’s shortest and longest cycle?

Answer 1

9 days

Question 2

Above how many days is an abnormal bleeding period?

Answer 2

9+

Question 3

Symptoms of PMD can be physical, psychological and behavioural.

How is it investigated and in what time period must they occur to count as PMD?

Answer 3

Symptom diary for min. 2 cycles

Cyclic and in luteal phase

Question 4

What is PMD?

Answer 4

Pre-menstrual disorders - many subtypes

When pre-menstrual symptoms impact daily life

Question 5

What is the first line treatment for PMD?

Answer 5

COC (combined oral contraceptive)

Question 6

What drug can be used to manage depressive symptoms?

Answer 6

SSRIs - can be given continuously or just in luteal phase

Question 7

What is the definition of heavy menstrual bleeding?

Answer 7

NOT defined by blood vol. loss

Just if a women believes it to be severe enough to be interfering with daily life

Question 8

What must be excluded before treatment`can begin for heavy menstrual bleeding?

Answer 8

Must try find an underlying cause first

Exclude

• pregnancy
• cervical exam -> cancer and polyps
• USS -> fibroids (>3cm) and polyps
• Swab -> infection

Question 9

What is the most common cause of heavy menstrual bleeding?

Answer 9

Fibroids

Question 10

What is the first line treatment of heavy menstrual bleeding if no abnormality is found?

How would this change if the patient was wanting to conceive?

Answer 10

Mirena coil

Tranexanic acid - anti-fribrinolytic (makes blood thicker)

Question 10

Define each of the following terms:

• Metrorrhagia
• Polymenorrhoea
• Polymenorrhagia
• Menometrorrhagia
• Amenorrhoea
• Oligomenorrhoea

Answer 10

Metrorrhagia - regular intermenstrual bleeding

Polymenorrhoea - period <21 day cycle

Polymenorrhagia - increased bleeding and frequent cycle

Menometorrhagia - prolonged menses and intermenstrual bleeding

Amenorrhea - absence of periods >6mnths
Oligomenorrhoea - infrequent periods - >35 day cycle

Question 11

AUB = abnormal uterine bleeding

Question 12

What term used to be used to describe heavy menstrual bleeding?

What does dysmenorrhoea mean?

Answer 12

Menorrhagia

Painful bleeding

Question 13

When assessing thickness of endometrium on TVUS (trans vaginal US) is it just anterior or posterior thickness measured?

Answer 13

BOTH - thickness = anterior and posterior myometrium

Question 14

How do we sample the endometrium (2 methods)

Answer 14

Endometrial pipelle - outpatient procedure

Dilation and cutterage - more substantial sample obtained

Question 15

Tamoxifen is an anti-oestrogen drug in the breast used to treat breast cancer.

How does this cause AUB?

Answer 15

Has a pro-oestrogen effect on the uterus - can cause proliferation of endometrium

Question 16

Name one factor that has to be given alongside endometrial sample

Answer 16

Number of pregnancies