Menstrual Disorders

Question 1

What happens in the Follicular phase?

Answer 1

FSH stimulates pvarian follicle and granulosa cells to produce oestrogens raising oestrogen and inhibin by dominant follicles inhibit FSH production
Declining FSH levels cause atresia of but dominant follicle

Question 2

What happens at ovulation?

Answer 2

Prior LH surge

Dominant follicle ruptures and release oocyte

Question 3

What happens in the Luteal phase?

Answer 3

Formation of corpus luteum
Progesterone production
Luteolysis 14 days post-ovulation

Question 4

What other 3 things happen at the luteal phase?

Answer 4

Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation

Question 5

What happens at the proliferative phase?

Answer 5

Oestrogen-induced growth of endometrial glands and stroma

Question 6

What happens at menstruation?

Answer 6

Arteriolar constriction and shedding of functional endometrial layer
Fibrinolysis inhibits scar tissue formation

Question 7

Describe menstrual loss

Answer 7

Usually lasts 4-6 days
Menstrual flow peaks at day 1-2
<80ml per menstruation
No clots

Question 8

What is the normal menstrual cycle?

Answer 8

Average 28 day cycle
Between 21-35 day cycle
No IMB or PCB

Question 9

What is Menorrhagia?

Answer 9

Prolonged and increased menstrual flow

Question 10

What is Metorrhagia?

Answer 10

Regular intermenstrual bleeding

Question 11

What is Polymenorrhoea?

Answer 11

Menses occuring at <21 day interval

Question 12

What is Polymenorrhagia?

Answer 12

Increased bleeding and frequent cycle

Question 13

What is Menometrorrhagia?

Answer 13

Prolonged menses and intramenstrual bleeding

Question 14

What is Amenorrhoea?

Answer 14

Absence of menstruation >6 months

Question 15

What is Oligomenorrhoea?

Answer 15

Menses at intervals of >35 days

Question 16

What is the non-organic cause of menorrhagia called?

Answer 16

Dysfunctional uterine bleeding

Question 17

What are the local disorders leading to organic menorrhagia?

Answer 17

There’s loads, look at lectures

Question 18

What endocrine disorders can cause organic menorrhagia?

Answer 18

Hyper/hypothyroidism
Diabetes mellitus
Adrenal disease
Prolactin disorders

Question 19

What disorders of haemostasis can cause organic menorrhagia?

Answer 19

von Willebrand’s disease
ITP
Factor II, V, VII and XI def

Question 20

What drugs can cause organic menorrhagia?

Answer 20

Anticoagulants

Question 21

What issues regarding pregnancy cause organic menorrhagia?

Answer 21

Miscarriage
Ectopic
Gestational trophoblastic disease
Postpartum haemorrhage

Question 22

What are the two subcategories of Dysfunctional Uterine Bleeding?

Answer 22

Anovulatory
and
Ovulatory

Question 23

Describe the Anovulatory Dysfunctional Uterine Bleeding?

Answer 23

85% of cases
Occurs at extremes of reproductive life
Irregular cycle
More common in obese women

Question 24

Describe the ovulatory Dysfunctional Uterine Bleeding?

Answer 24

More common aged 35-45
Regular heavy periods
Due to inadequate progesterone production by corpus luteum

Question 25

How do you investigate Dysfunctional Uterine Bleeding?

Answer 25

FBC
Cervical smear
TSH
Coagulation screen
Renal/Liver function tests
Transvaginal ultrasound

Question 26

What would be seen on a transvaginal ultrasound scan of Dysfunctional Uterine Bleeding?

Answer 26

Endometrial thickness

Presence of fibroids and other pelvic masses

Question 27

What would be looked for with endometrial sampling with Dysfunctional Uterine Bleeding?

Answer 27

Pipelle biopsies
Hysteroscopic directed
Dilation and cutterage

Question 28

What are non-surgical therapies for Dysfunctional Uterine Bleeding?

Answer 28

Progestogens
Combined oral contraceptive pill
Danazol
GnRH analogues
NSAIDs
Anti-fibrolytics
Capillary wall stabilisers

Question 29

What is surgical management of Dysfunctional Uterine Bleeding?

Answer 29

Transverse endometrial resection (TCRE)
Rollerball endometrial ablation (REA)
Bipolar mesh endometrial ablation (Novasure)
Thermal balloon ablation (Thermachoice)
Thermal hydroablation (Hydroblate)

Question 30

What types of hysterectomy are available?

Answer 30

Sub-total
Total abdominal
Vaginal
LASH/LAVH/TLH