menstrual disorders

Question 1

where are FSH and LH released from

Answer 1

anterior pituitary

Question 2

how many eggs stimulated each month to grow by FSH and LH

Answer 2

15-50

Question 3

when is the surge of LH over 28 day cycle leading to ovulation

Answer 3

14 days before onset of menstruation (day 14)

Question 4

what is day 1 of cycle

Answer 4

first day of menstruation

Question 5

what hormone is high in the first 4 days of cycle

Answer 5

FSH- stimulates development of primary follicle in ovary. produces oestrogen

Question 6

what happens if the ovum is not fertilised

Answer 6

corpus luteum breaks down, spiral arteries in the endothelial lining constrict and lining sloughs

Question 7

where does the embryo embed

Answer 7

decidua

Question 8

what are the phases

Answer 8

proliferation, secretion

Question 9

what is primary amenorrhoea

Answer 9

failure to start menstruating, investigate in 15 or 14 year old if no breast tissue

Question 10

what is secondary amenorrhoea

Answer 10

periods stop for >6 months, other than due to pregnancy

Question 11

causes

Answer 11

hypothalamic pituitary ovarian causes; endo; ovarian; uterine

Question 12

hypothalamic pituitary ovarian causes amenorrhoea

Answer 12

stress, incr exercise, weight loss

Question 13

endocrine causes amenorrhoea

Answer 13

hyperprolactinaemia, thyroid, severe systemic disease

Question 14

ovarian causes amenorrhoea

Answer 14

PCOS, tumours, insuffieicny/failure- chemo, radiotherapy

Question 15

uterine causes amenorrhoea

Answer 15

pregnancy, ashermans syndrome, post pill

Question 16

tests in amenorrhoea

Answer 16

BHCG, free androgen, FSH/LH- reduced in hypothalamic pituitary ovarian; prolactin; TFT; testosterone

Question 17

what can cause increased prolactin levels

Answer 17

stress, hypothyroid, drugs, prolactinoma

Question 18

treatment amenorrhoea

Answer 18

related to the cause. ovarian failure- hormone replacement, hypothal axis - clomifene

Question 19

what is oligomenorrhoea

Answer 19

infreq periods- common at extremes of reproductive life- infrequent ovulation

Question 20

what is a common cause oligomenorrhoea

Answer 20

PCOS

Question 21

what is dysmenorrhoea

Answer 21

painful periods +- N+V

Question 22

primary and secondary dysmenrrhoea

Answer 22

primary- in absence of pathology, secondary - pathology

Question 23

what can cause secondary dysmenorrhoea

Answer 23

adenomyosis, endometriosis, fibroids

Question 24

what is classified as post menopausal bleeding

Answer 24

bleeding >1y after last period. endometrial carcinoma until proven otherwise

Question 25

causes post menopausal bleeding

Answer 25

vaginitis, FB, carcinoma of cervix or vulva, polyps, oestrogen withdrawal

Question 26

causes menorrhagia

Answer 26

girls- pregnancy, functional uterine bleeding; older- IUCD, fibroids, adenomyosis, pelvic infection, polyps, endometriosis, hypothyroid

Question 27

tests menorrhagia

Answer 27

FBC, TFT, clotting studies, ultrasound, laparoscopy, endometrial sampling, hysteroscopy

Question 28

what is dysfunctional uterine bleeding

Answer 28

heavy and/or irregular bleeding in absence of recognisable pathology- common at extremes of reproductive age

Question 29

medical management menorrhagia

Answer 29

Mirena (IUS), tranexamic acid (antifibrinolytic), mefenamic acid (anti prostaglandin), COC

Question 30

surgical management menorrhagia

Answer 30

hysterectomy, myomectomy, endometrial ablation and resection