Menstrual cycle and its disorders

Question 1

What are the possible causes of menorrhagia?

Answer 1

Copper coil
Coming off the pill
Endometriosis
Adenomyosis
Hypothroidism
Fibroids
Idiopathic (most common cause)
Anti-coagulants
Endometrial hyperplasia and endometrial cancer

Question 2

What investigations are done for cases of menorrhagia?

Answer 2

FBC: Signs of anaemia
TFT
Ultrasound: Signs of fibroids
Pipelle/Endometrial biopsy: TRO endometrial hyperplasia

Question 3

What is the first line treatment for menorrhagia, according to NICE?

Answer 3

Levonorgestrel Intrauterine device - Minera coil, which works by releasing a progestin hormone called Levonorgestrel and maintaining a thin endometrial lining

Question 4

What are the non-hormonal treatments for menorrhagia?

Answer 4

Tranexamic acid or Mefenamic acid, NSAIDs

Question 5

What is the surgical option for women who have menorrhagia and have <10 week size uterus and fibroids <3cm?
What other consideration is taken into account when offering this treatment option?

Answer 5

Endometrial ablation/resection.
Women must have completed their family, although there is still a fair chance of becoming pregnant even after the operation.

Question 6

What are the surgical treatment options for women with menorrhagia and have >10 weeks size uterus and fibroids >3cm? What considerations are taken into account for each?

Answer 6

Myomectomy or uterine artery embolisation if patient still wish to retain fertility.

(Vaginal) hysterectomy if patient does not intend to retain fertility.

Question 7

What is the diagnostic criteria for menopause and perimenopause?

Answer 7

Menopause: retrospective diagnosis when the woman has not had a period for 12 months, and is not using hormonal contraception. If she does not have a uterus, diagnosis is done based on symptoms.

Perimenopause is diagnosed if a woman experiences vasomotor symptoms and has irregular periods.

Question 8

What are the symptoms of menopause?

Answer 8

Vasomotor symptoms: Night sweats and hot flushes
Mood: Low mood and irritability, mood swings
MSK problems: Muscle and joint aches
Urogenital symptoms: Vaginal dryness
Sexual difference: Decreased libido
May also experience insomnia, memory and concentration loss.

Question 9

In which age group of women should diagnosis of premature ovarian insufficiency be considered?

Answer 9

In women <40 yo

Question 10

What is the diagnosis of Premature Ovarian Insufficiency based on?

Answer 10

Menopausal symptoms, including amenorrhoea or infrequent periods + elevated follicle stimulating hormone levels on 2 blood samples taken 4-6 weeks apart.

Question 11

What are the treatments available for vaginal dryness?

Answer 11

Moisturisers and lubricants, Vaginal oestrogen (Ovestin which is a 0.1% oestriol vaginal cream; or vaginal tablets)

Question 12

What are the 3 types of HRT that can be offered to women with menopause?

Answer 12

1. Continuous combined HRT: will not bleed. Only for women with uterus, and aged >54.
   Or if there is no period for >1 year if aged >50, or for 2 years if aged <50.
2. Sequential combined HRT: will result in bleed. Only for women with uterus.
3. Oestrogen only: Only for women without uterus.

Question 13

POI is highly associated with which 3 autoimmune conditions?

Answer 13

Diabetes Mellitus, Hypothyroidism and Addison’s disease.