Menstrual Disorders

Question 1

What is the average age range from menarche to menopause?

Answer 1

13-51

Question 2

How is the range in length of a menstrual cycle?

Answer 2

21-35 days

Question 3

What is the mean blood loss during menstruation?

Answer 3

30-40ml

Question 4

Why does menstruation occur?

Answer 4

Triggered by a fall in progesterone 2 weeks after ovulation if not pregnant

Question 5

What is menorrhagia?

Answer 5

Heavy periods (>80ml/cycle)

Question 6

What is dysmenorroea?

Answer 6

Painful menstruation

Question 7

What is oligomenorrhoea?

Answer 7

Infrequent periods

Question 8

What investigations should be considered for menstrual problems?

Answer 8

FBC if menorrhagia 
Endometrial biopsy 
Chalmydia test 
Thyroid function tests 
Coagulation tests 
Pregnancy test 
TV USS
Hysteroscopy 
Laparoscopy

Question 9

What are the likely causes of menstrual problems in early teens?

Answer 9

Anovulatory cycles
Congenital anomaly
Coagulation problems

Question 10

What are the likely causes of menstrual problems in teens - 40?

Answer 10

Chlamydia 
Contraception related 
Endometriosis/ adenomyosis 
Fibroids 
Endometrial or cervical polyps 
Dysfunctional bleeding

Question 11

What are the likely causes of menstrual problems from 40 - menopause?

Answer 11

Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction

Question 12

What is dysfunctional uterine bleeding?

Answer 12

Abnormal bleeding but no structural/ endocrine/ neoplastic/ infectious cause found

Question 13

What is endometriosis?

Answer 13

Endometrial type tissue outside the uterine cavity

Question 14

What are the symptoms of endometriosis?

Answer 14

Premenstrual pain
Dysmenorrhoea
Deep dyspareunia
Subfertility

Question 15

What are the signs of endometriosis?

Answer 15

Tender nodules in rectovaginal septum
Limited uterine mobility
Adnexal mass
Asymptomatic

Question 16

How is endometriosis diagnosed?

Answer 16

Laparoscopy
MRI
USS endometrioma

Question 17

What are the common areas to find endometriosis?

Answer 17

Ovary
Pouch of Douglas
Pelvic peritoneum

Question 18

What are the treatment options for endometriosis?

Answer 18

Progesterone (oral/inject/mirena ius)
Combined pill 3 months at a time
GnRH analogues
Surgical (excision/ diathermy/laser ablation/ hysterectomy/ oophorectomy)

Question 19

What is adenomyosis?

Answer 19

Endometrial tissue found deep in myometrium

Question 20

What are the symptoms and signs of adenomyosis?

Answer 20

Heavy painful periods

Bulky tender uterus

Question 21

How is a diagnosis of adenomyosis made?

Answer 21

USS
Laparoscopy
Hysteroscopy

Question 22

What are the treatment options for adenomyosis?

Answer 22

Mirena

Question 23

What are fibroids?

Answer 23

Smooth muscle growths leiomyoma

Question 24

How is a diagnosis of fibroids made?

Answer 24

Clinical exam
USS
Hysteroscopy

Question 25

What are the different types of fibroids?

Answer 25

Submucous (protrude into uterine cavity)
Intramural (within uterine wall)
Sub serous (project out of uterus into peritoneal cavity)

Question 26

What are the symptoms of fibroids?

Answer 26

Pressure symptoms
Menorrhagia
Intermenstrual bleeding
Pain

Question 27

What are the treatment options for fibroids?

Answer 27

GnRH analogues 
Ulipristal oral antiprogesterone 
Transcervical resection sub mucous fibroids 
Uterine artery embolisation 
Hysterectomy

Question 28

What are some fertility conserving treatments fro DUB menstrual problems?

Answer 28

Tranexamic acid 
Mefanamic acid 
Combined pill 
Mirena 
Oral progesterone

Question 29

What are the treatments used for DUB menstrual disorders if family is complete?

Answer 29

Endometrial ablation

Hysterectomy