Menstrual Disorders

Question 1

Give the different terminologies for the abnormalities of uterine bleeding

Answer 1

• Menorrhagia prolonged and increased menstrual flow
• Metrorrhagia regular intermenstrual bleeding
• Polymenorrhoea menses occurring at < 21 day interval
• Polymenorrhagia increased bleeding and frequent cycle
• Menometrorrhagia prolonged menses and intermenstrual bleeding
• Amenorrhoea absence of menstruation > 6 months
• Oligomenorrhoea Menses at intervals of > 35 days

Question 2

what proportion of causes of menorrhagia are non-organic?

What is this also known as?

Answer 2

50%

Dysfunctional Uterine Bleeding

Question 3

what are the investigations for dysfunctional uterine bleeding?

Answer 3

• Full blood count
• Cervical smear
• TSH
• Coagulation screen
• Renal/Liver function tests
• Transvaginal ultrasound scan

Endometrial thickness

Presence of fibroids and other pelvic masses

•Endometrial sampling

Pipelle biopsies

Hysteroscopic directed

Dilatation & curettage (D & C)

Question 4

what is the mangement of DUB?

Answer 4

•Medical Therapy

Progestogens

Combined oral contraceptive pill

Danazol

GnRH analogues

Non-steroidal anti-inflammatory drugs (NSAIDs)

Anti-fibrinolytics

Capillary wall stabilisers

•Progestogen-releasing IUCD

Mirena IUS

• Endometrial resection/ablation
• Hysterectomy

Question 5

what are the causes of organic menhorragea?

Answer 5

Fibroids

Adenomyosis

Endocervical or Endometrial polyp

Cervical eversion

Endometrial hyperplasia

Intrauterine contraceptive device (IUCD)

Pelvic inflammatory disease (PID)

Endometriosis

Malignancy of the cervix or uterus

Hormone producing tumours

Trauma