Menstrual Disorder

Question 1

name the 3 phases of the menstrual cycle

Answer 1

follicular phase
FSH stimulates ovarian follicle development & granulosa cells to produce oestrogens
rising oestrogen & inhibin by dominant follicles inhibit FSH production
Declining FSH levels cause atresia of all but dominant follicles

Ovarian phase
Prior LH surge
Dominant follicle ruptures and release oocyte

luteal phase
Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation

Question 2

name the endometrial events in the menstrual cycle and explain what happens in each (3)

Answer 2

Proliferative phase
oestrogen induced growth of endometrial glands and stoma

Luteal phase
Progesterone induced glandular secretory activity
Decidualisation in late secretory phase
endometrial apoptosis and subsequent menstruation

Menstruation
arteriolar constriction and shedding of functional endometrial layer
fibrinolysis inhibits scar tissue formation

Question 3

when does menstruation usually occur in the cycle?

Answer 3

between days 1-6

Question 4

give definitions for the following terms:
Menorrhagia
Metrorrhagia
Polymenorrhoea
Polymenorrhagia
Menometrorrhagia
Amenorrhoea
Oligomenorrhoea

Answer 4

• prolonged and increased menstrual flow
• regular inter menstrual bleeding
• menses occurring at <21 day interval
• increased bleeding and frequent cycle
• prolonge menses and inter menstrual bleeding
• absence of menstruation > 6 months
• Menses at intervals of > 35 days

Question 5

Causes of menorrhagia? 
local disorders (12)
Systemic disorders (5)

Answer 5

Local disorders:
Fibroids
Adenomyosis 
Endocervical/Endometrial polyp
cervical eversion
endometrial hyperplasia
IUCD
PID
endometriosis
malignancy of the cervix or uterus 
Hormone producing tumours 
trauma 
other, e.g. arteriovenous malformations

systemic:
Endocrine disorders (Hyper/hypothyroidism, DM, adrenal disease, PRL disorders)
Disorders of haemostasis
(Von Willebrand’s disease, ITP, Factor II, V, VII and XI)
Liver disorders
renal disease
Drugs (anticoagulants)

Question 6

Dysfunctional Uterine Bleeding

• name the 2 types
• when does each occur?
• why do each occur?
• what are the characteristics of each?

Answer 6

-Anovulatory & Ovulatory

Anovulatory

• occurs at extremes of reproductive life and is more common in obese women
• you get an irregular cycle

Ovulatory

• more common in women aged 35-45 years
• regular heavy periods
• inadequate progesterone production by the corpus luteum

Question 7

Name the investigations done in DUB (7) and why they are carried out?

Answer 7

FBC (anaemia)
smear
TSH
Coagulation screen
Renal function/LFTs
Transvaginal US (endometrial thickness, presence of fibroids and other pelvic masses)
Endometrial sampling (Pipelle biopsies, hysteroscopic directed, Dilatation & curettage

Question 8

Management of DUB?

• non-surgical?
• surgical

Answer 8

-Medical
progestogens
COC
Danazol 
GnRH analogues
NSAIDs
Anti-Fibrinolytics
Capillary wall stabilisers
Mirena IUS

-Endometrial resection/ablation
Transcervical resection TCRE
Rollerball endometrial ablation REA 
Bipolar mesh endometrial ablation (Novasure)
Thermal balloon ablation (thermachoice)
thermal hydroablation (hydroblate) 

hysterectomy
sub-total hysterectomy
vaginal hysterectomy
LASH/LAVH/TLH

Question 9

What is Tranexamic acid used for?

Answer 9

used to prevent excessive blood loss in heavy menstruation