Menstrual Disorder

Question 1

FSH stimulates granulosa cells to produce what hormone?

Answer 1

Oestrogen

Question 2

An increase in oestrogen and inhibit has what effect on FSH production?

Answer 2

Inhibits it

Question 3

There is a surge in what hormone before ovulation?

Answer 3

LH

Question 4

Formation of corpus lute up occurs in what phase?

Answer 4

Luteal phase

Question 5

Corpus Luteum produces what?

Answer 5

Progesterone

Question 6

What prevents scar tissue formation in endometrium during menstruation?

Answer 6

Fibrinolysis

Question 7

How long does menstruation normally last?

Answer 7

4-6 days

Question 8

Roughly how much blood on average is lost during menstruation?

Answer 8

<80ml

Question 9

Are clots normal in menstruation?

Answer 9

No

Question 10

How long does a menstrual cycle last ?

Answer 10

21-35 days - average is 28 days

Question 11

Menorrhagia?

Answer 11

Prolonged and increased menstrual flow

Question 12

Metorrhagia?

Answer 12

Regular intermenstrual bleeding

Question 13

Polymenorrhoea?

Answer 13

Menses occurring at <21 day intervals

Question 14

Polymenorrhagia?

Answer 14

Increased bleeding and frequent cycle

Question 15

Menometorrhagia?

Answer 15

Prolonged menses and intermenstrual bleeding

Question 16

Amenorrhoea?

Answer 16

Absence of menstruation for >6 months

Question 17

Oligomenorrhoea?

Answer 17

Menses at intervals of >35 days

Question 18

Two classifications of causes of menorrhagia?

Answer 18

Organic (pathology)

Non-organic (absence pathology -DUB)

Question 19

List causes of organic menorrhagia - local disorders

Answer 19

Fibroids
Adenomyosis 
Endocervical or endometrial polyps 
Cervical eversion 
Endometrial hyperplasia 
Intrauterine contraceptive device 
PID
Endometriosis
Malignancy of cervix or uterus 
Hormone producing tumours 
Trauma

Question 20

List causes of organic menorrhagia - systemic disorders

Answer 20

Endocrine disorders - hyper/hypothyroidism, diabetes mellitus, adrenal disease, prolactin disorders
Disorders of homeostasis - Von Willebrands disease, ITP, factor II, V, VII, XI deficiency
Liver disorders
Renal disease
Drugs - anticoagulants

Question 21

List causes of organic menorrhagia- pregnancy

Answer 21

Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
Postpartum haemorrhage

Question 22

DUB can be subdivided into…?

Answer 22

Anovulatory and ovulatory

Question 23

Features of anovulatory DUB?

Answer 23

Occurs at extremes of reproductive life
Irregular cycle
More common in obese women

Question 24

Features of ovulatory DUB?

Answer 24

Common aged 35-45
Regular heavy periods
Inadequate progesterone production by corpus Luteum

Question 25

How would you investigate DUB?

Answer 25

``` FBC Cervical smear TSH Coagulation screen Renal /LFTs Transvaginal USS Endometrial sampling ```

Question 26

Non-surgical management of DUB?

Answer 26

``` Progestogens COC pill Danazol GnRH analogues NSAIDs Anti fibrinolytics Capillary wall stabilisers Progestogen-releasing IUCD ```

Question 27

Surgical management of DUB?

Answer 27

``` Endometrial resection/ ablation Hysterectomy - sub total hysterectomy - total abdominal hysterectomy - vaginal hysterectomy - LASH / LAVH / TLH ```

Question 28

What is the consequence of treating DUB with surgery?

Answer 28

Fertility is lost