menstrual cycle and disorders

Question 1

normal limits for:

1) frequency of menses
2) regularity
3) duration of bleeding
4) volume

Answer 1

1) 24-38d
2) <7-9 days
3) <8d
4) a volume of blood that does not interfere with a woman’s life

Question 2

what is abnormal uterine bleeding

Answer 2

Any variation from the parameters of a normal menstrual cycleconstitutes abnormal uterine bleeding (AUB)

Question 3

what is intermenstrual bleeding?

Answer 3

When AUB occurs between well-defined cyclical menses, the symptom is called intermenstrual bleeding (IMB)

Question 4

what is post coital bleeding

Answer 4

Non-menstrual genital tract bleeding immediately (or shortly after) intercourse is called post coital bleeding (PCB)

Question 5

define heavy menstrual bleeding

Answer 5

The National Institute for Care and Excellencedefines heavy menstrual bleeding(HMB) as excessive menstrual blood loss (MBL) that interferes with the physical, social, emotional and/or material quality of life

The classic objective criteria of blood loss >80 mL/cycle

Question 6

what is classified as infrequent menses

Answer 6

> 38days

Question 7

what is classified as frequent menses

Answer 7

<24d

Question 8

3 physiological causes of amenorrhoea

Answer 8

pregnancy
lactation
menopause

Question 9

causes of abnormal uterine bleeding (PALM COEIN)

Answer 9

Structural:
Polyps- endometrial or cervical
Adenomyosis
Leiomyoma
Malignancy or premalignancy

Non-structural:
Coagulopathy e.g. thrombocytopenia
Ovulatory function disorders e.g. PCOS, CAH, Cushing’s disease
Endometrial disorders e.g. endometriosis
Iatrogenic e.g. COCP
Non-structural rare causes e.g. AV malformation

Question 10

Ix for abnormal uterine bleeding

Answer 10

Full blood count
Cervical smear
Pelvic ultrasound
Pelvic infection screening (genital tract swab testing)
Hysteroscopy and biopsy
MRI

Question 11

5 symptoms of gynae cancer

Answer 11

PCB
PMB
IMB
Pelvic mass
cervix lesion

Question 12

when do you need to get an endometrial biopsy?

Answer 12

persistent IMB
>45 with treatment failure
irregular bleeding while on HRT or tamoxifen

Question 13

2 causes of enlarged uterus

Answer 13

fibroids

adenomyosis

Question 14

define polyp

Answer 14

Endometrial polyps are localised hyperplastic overgrowths of endometrial glands and stroma which form projections over the endometrial surface.

Question 15

symptoms of polyps

Answer 15

Dysmenorrhoea
PCB
Menorrhagia- increases surface area of endometrium
Irregular bleeding  
IMB
Infertility- problems with implantation

Question 16

define adenomyosis

Answer 16

Adenomyosis is the presence of endometrial glands and stroma in the myometrium. It causes heavy, painful periods.

Question 17

define fibroids

Answer 17

Uterine fibroids are smooth muscle tumours of the uterus

Question 18

tx of heavy menstrual bleeding and fibroids

Answer 18

contraceptive
tranexamic acid and NSAIDs
hysteroscopic myomectomy
uterine artery ablation
Hysterectomy

Question 19

what is endometrial hyperplasia

Answer 19

Endometrial hyperplasia is defined as a proliferation of glands of irregular size and shape with an increase in the glands/stroma ratio. Atypical hyperplasia progresses to carcinoma in 23% of cases over a mean duration of 4 years

Question 20

4 causes of primary amenorrhoea

Answer 20

Gonadal dysgenesis (43%)
Mullerian agenesis (15%)
Constitutional (14%)
PCOS (7%)

Question 21

3 causes of secondary amenorrhoea

Answer 21

40% ovarian in origin
35% hypothalamic in origin
5% uterine in origin.

Question 22

causes of secondary amenorrhoe

Answer 22

PCOS
POF
Hyperprolactinaemia
weigh related
hypogonadotrophic hypogonadism
hypopituitarism
exercise related

Question 23

Ix for amenorrhoea

Answer 23

Exclude Pregnancy
FSH, LH levels
Prolactin, TFTs
Testosterone, SHBG, Free androgen index, DHEAS levels
TA USS/ TVUS/ MRI
Hysteroscopy
Karyotyping