Menstrual disorders

Question 1

Define menorrhagia

Answer 1

Heavy periods; often given as 80ml or more of blood loss but any bleeding that is heavy enough to affect quality of life can be termed menorrhagia

Question 2

What is the differential diagnosis for menorrhagia?

Answer 2

Hypo/hyperthyroidism
Polycystic ovaries
Local pathology;
 - fibroids, polyps, adenomyosis, infection
Malignancy
Pregnancy (/miscarriage)
Cushing's 
Clotting disorder
Drug-induced bleeding
Dysfunctional uterine bleeding

Question 3

What are fibroids?

Answer 3

Benign tumours of the myometrium (leiomymas)

Question 4

Give four sites where fibroids may be found

Answer 4

Intramural
Submucous
Subserous
Cervical

Question 5

Describe the clinical effects of fibroids

Answer 5

Often asymptomatic
Symptomatic if they distend the uterus and/or put pressure on surrounding organs
Possible effects include:
 - menstrual dysfunction
 - infertility
 - miscarriage
 - dyspareunia
 - pelvic discomfort
 - urinary symptoms

Question 6

What is endometriosis?

Answer 6

The presence of endometrium outside the uterine cavity. And endometrioma is a large cyst of endometrium, e.g. on the ovaries.

Question 7

What are the major symptoms of endometriosis?

Answer 7

(Often asymptomatic)

Pelvic pain and swelling, particularly pre-menstrual pain

Question 8

What are the medical management options for endometriosis?

Answer 8

Combined oral contraceptive pill
Progesterone-only pill
Danazol

Question 9

What are the surgical management options for endometriosis?

Answer 9

Laser ablation of small lesions

Complete hysterectomy

Question 10

What is adenomyosis?

Answer 10

The presence of endometrial tissue deep in the myometrium

Question 11

How does adenomyosis usually present?

Answer 11

Presents with heavy, painful periods and a bulky, tender uterus