menstrual disorders

Question 1

name some pathological causes of heavy menstrual bleeding

Answer 1

fibroids
polyps
adenomyosis
coagulopathy
malignancy

Question 2

what are fibroids

Answer 2

benign smooth muscle tumours of the uterus

Question 3

what is adenomyosis

Answer 3

non-neoplastic endometrial glands and stroma in the myometrium

Question 4

what is associated with adenomyosis

Answer 4

C-section, surgical termination of pregnancy, increasing age, oestrogen exposure

Question 5

what is the most common coagulopathy

Answer 5

von willebrand disease

Question 6

what are the 2 main risk factors for heavy menstrual bleeding

Answer 6

age (menarche and approaching menopause) and obesity

Question 7

what is the most clinically useful investigation for assessing the endometrium and overies

Answer 7

TVUS

Question 8

what are some indications for endometrial biopsy for heavy menstrual bleeding

Answer 8

persistent intermenstrual bleeding, >45, failure of pharm treatment

Question 9

1st line pharm management for heavy menstrual bleeding

Answer 9

mirena coil

Question 10

what can be taken during menses to reduce bleeding

Answer 10

tranexamic acid

Question 11

what is menorrhagia

Answer 11

prolonged and increased menstrual flow

Question 12

what is metrorrhagia

Answer 12

regular - heavy intermenstrual bleeding

Question 13

what is polymenorrhoea

Answer 13

menses occurring at <21 day interval

Question 14

what is menometrorrhagia

Answer 14

abnormally heavy, prolonged and irregular uterine bleeding

Question 15

what is amenorrhoea

Answer 15

absence of menstruation >6 months

Question 16

what is oligomenorrhoea

Answer 16

menses at intervals >35 days

Question 17

what is dysfunctional uterine bleeding

Answer 17

abnormal uterine bleeding with no organic causes

Question 18

what is the most common cause of dysfunctional uterine bleeding

Answer 18

anovulatory cycles

Question 19

what is post-menstrual bleeding

Answer 19

abnormal uterine bleeding >1 year after the cessation of menstruation

Question 20

name some prepubertal causes of abnormal uterine bleeding

Answer 20

precocious puberty, anovulatory cycles, bleeding/coagulation disorders

Question 21

name some causes of AUB in reproductive years

Answer 21

pregnancy/miscarriage, polyps, leiomyoma, bleeding disorders, hyperplasia or neoplasia

Question 22

name some post-menopausal causes of AUB

Answer 22

endometrial atrophy, polyps, exogenous hormones, endometritis

Question 23

how can we assess endometrial thickness

Answer 23

TVUS

Question 24

what endometrial thickness, in both pre and postmenopausal women, indicates biopsy is needed

Answer 24

> 4mm post
16mm pre

Question 25

when does premenstrual syndrome occur

Answer 25

during the luteal phase of the menstrual cycle

Question 26

name some physical symptoms of premenstrual syndrome

Answer 26

breast tenderness, bloating, skin disorder, headache, fatigue

Question 27

name some psychological symptoms of premenstrual syndrome

Answer 27

mood swings, anger, tension, loneliness, suicidal ideation

Question 28

name some behavioural symptoms of premenstrual syndrome

Answer 28

change in sleep, appetite, concentration

Question 29

investigations for premenstrual syndrome

Answer 29

record symptoms over 2 cycles using a symptom diary

Question 30

1st line management for premenstrual syndrome

Answer 30

exercise, CBT, vit B6 COCP low dose SSRIs (continuous or luteal phase)

Question 31

name some other management options for premenstrual syndrome

Answer 31

estradiol patches, higher dose SSRIs, GnRH analogues + HRT

Question 32

what is endometritis

Answer 32

inflammation of the lining of the uterus

Question 33

what are the 2 main types of endometritis

Answer 33

acute and chronic

Question 34

name 3 common bacterial causes of endometritis

Answer 34

E.coli, group B strep, staph aureus

Question 35

what are 2 STIs that can cause endometritis

Answer 35

chlamydia and gonorrhoea

Question 36

3 risk factors for developing endometritis

Answer 36

post partum period recent intrauterine procedures e.g. IUD insertion history of STIs

Question 37

name 2 serious complications of untreated endometritis

Answer 37

PID and sepsis