Menstrual cycle + bleeding

Question 1

Which hormone is responsible for ovulation?

Answer 1

LH

Question 2

What day does ovulation occur at? Which hormone is responsible?

Answer 2

day 14. Released about 36h after surge in LH

Question 3

What stimulates maturation of only one follicle?

Answer 3

Increase in FSH –> maturation follicle –> production oestrogen –> suppress FHS –> stops maturation of any other follicles

Question 4

What happens once the corpus luteum is formed?

Answer 4

It releases inhibit, progesterone and oestrogen.

Progesterone –> inhibits GnRH + induces secretory changes in endometrium

Question 5

First line Tx in HMB?

Answer 5

levonorgestrel-releasing IUS (coil) - persevere for at least 6 cycles. If trying for baby - 1st line = NSAIDs or tranexamic acid

Question 6

First line Tx for IMB?

Answer 6

COCP or IUS

Question 7

Potential causes of postcoital bleeding?

Answer 7

Cervical polyps = most common >40y, Tx –> avulsion

Cervical ectropion –> Tx cryotherapy

Question 8

Dx criteria for PCOS?

Answer 8

At least 2 of..

• PCO on USS (12+ follicles size 2-9mm on an enlarged ovary with volume >10ml)
• Irregular periods - olig/amen
• Hirsuitism

Question 9

What is the main SE of HRT?

Answer 9

Weight gain

Question 10

What are the main risks associated with HRT?

Answer 10

Increased risk endometrial cancer - only if women with a uterus take oestrogen only HRT
Risk of breast cancer - if take combined HRT
Risk VTE 2x. Also gallbladder disease
Risk ovarian cancer if taken long term (>5y)

Question 11

When is HRT contraindicated?

Answer 11

If previous Hx of breast cancer, VTE, or recent MI/Stroke/angina