menstrual disorder

Question 1

what occurs in the follicular phase of menstrual cycle

Answer 1

FSH stimulate ovarian follicle development and granulose cells to produce oestrogen
tasing oestrogen and inhibit by dominant follicles inhibit FSH production
declining FSH levels cause atresia of all but the dominant follicle

Question 2

what occurs in the ovulation phase of menstrual cycle

Answer 2

prior LH surge

dominant follicle ruptures and releases oocyte

Question 3

what occurs during the luteal phase of menstrual cycle

Answer 3

formation of corpus lute
progesterone production
luteolysis 4 days post-ovulation

Question 4

endometrial events during the proliferative phase

Answer 4

oestrogen-induced growth of endometrial glands and storm

Question 5

endometrial events during the luteal phase

Answer 5

progesterone-induced glandular secretory activity
decidualisation in late secretory phase
endometrial apoptosis and subsequent menstruation

Question 6

endometrial events during menstruation

Answer 6

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

Question 7

normal menstrual loss

Answer 7

menstrual loss usually lasting 4-6 days
menstrual flow peaks day 1-2
<80 ml per menstruation
no clots

Question 8

normal menstrual cycle

Answer 8

average 28 day cycle
between 21 - 35 days
no intermenstrual or post-coital bleeding

Question 9

define menorrhagia

Answer 9

prolonged and increased menstrual flow

Question 10

define metrorrhagia

Answer 10

regular intermenstrual bleeding

Question 11

polymenorrhoea

Answer 11

menses occurring at <21 day interval

Question 12

polymenorrhagia

Answer 12

increased bleeding and frequent cycle

Question 13

menometrorrhagia

Answer 13

prolonged menses and intermenstrual bleeding

Question 14

amenorrhoea

Answer 14

absence of menstruation >6 months

Question 15

oligomenorrhoea

Answer 15

meses at interval of >35 days

Question 16

causes of menorrhagia

Answer 16

presence of pathology (organic)

absence of pathology (aka dysfunctional uterine bleeding)

Question 17

local causes of organic menorrhagia

Answer 17

fibroids 
adenomyosis 
endocervical or endometrial poly 
cervical eversion 
endometrial hyperplasia 
intrauterine contraceptive device 
pelvic inflammatory disease 
endometriosis 
malignancy of cervix or uterus 
hormone producing tumours 
trauma
arteriovenous malformations

Question 18

systemic causes of organic menorrhagia

Answer 18

endocrine disorders (hyper-/hypo-thyroidism, DM, adrenal disease, prolactin disorders)
disorders of haemostats (von Willebrand’s disease, ITP factor II, V, VII, and XI def)
liver disorders
renal disease
drugs (anticoagulants)

Question 19

pregnancy related causes of menorrhagia

Answer 19

miscarriage
ectopic pregnancy
gestational trophoblastic disease
postpartum haemorrhage

Question 20

characteristics of anovulatory DUB

Answer 20

85% of DUB
occurs at extremes of reproductive life
irregular cycle
more common in obese women

Question 21

characteristics of ovulatory DUB

Answer 21

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

Question 22

investigation of DUB

Answer 22

FBC
cervical smear
TSH
coagulation screen
renal/liver function tests
transvaginal USS (endometrial thickness, presence of fibroids and other pelvic masses)
endometrial sampling (pipelle biopsies, hysteroscopic directed, D&C)

Question 23

medical management of DUB

Answer 23

progestogens
COCP
danazol
GnRH analogues
NSAIDs
anti-fibrinolytics
capillary wall stabilisers
progesterone-releasing IUCD (mirena IUS)

Question 24

surgical management of DUB

Answer 24

endometrial resection/ablation

hysterectomy