Menstrual disorders

Question 1

Dysfunctional uterine bleeding usually seen at extremes of fertility and associated with irregular cycles?

Answer 1

Anovulatory DUB

Question 2

due to irregularity of cycles in anovulatory DUB, the endometrium is not regularly shed and thus when bleeding happens it tends to be….?

Answer 2

Heavy

Question 3

DUB caused by poor quality egg and follicle which fails to produce enough progesterone ?

Answer 3

Ovulatory

Question 4

management of DUB/menorraghia:
Symptom control:
1) for blood loss?
2) for pain?

Answer 4

1) Transexamic acid (anti fibrinolytic)

2) Mefanamic acid (anti-prostaglandin)

Question 5

Management of menorraghia (to control the periods) actual treatment ?
1st line?

Answer 5

mirena coil

Question 6

2nd line treatment of menorraghia after
mirena coil?
3rd?
4th?

Answer 6

COCP

IM progestogens

GnRH analogues (Danazol) (damoen axis - medical menopause)

Question 7

surgical treatment options for menorraghia ?

Answer 7

endometrial ablation

hysterectomy

Question 8

failure to start period by 16 ?

Answer 8

primary amenorrhoea

Question 9

secondary amenorrhoea?

Answer 9

loss of mesntruation for 6 months after period had previously been there

Question 10

primary amenorrhoea, girl with short stature, webbed nick, shield shaped chest?

Answer 10

turners syndrome

Question 11

child well, development normal, but primary amenorrhoea?

Answer 11

Imperforate hymen

Question 12

female phenotype, male genotype and rimary amenorrhoea - cause ?

Answer 12

testicular feminization

Question 13

lifestyle factors that can induce secondary amenorrhoea?

Answer 13

stress, sudden weight loss, over exercising, obesity

Question 14

other causes of secondary amenorrhoea ?

Answer 14

PCOS, pregnancy, menopause, drugs, genetic disorders, systemic disease (thyroid dysfunction), pituitary disease

Question 15

Patient with secondary amenorrhoea - Ix???

Answer 15

urine hcg
FSH, LH, oestrogen, progesterone, prolactin, TFTs, androgens
Genetic - karyotyping
Imaging - head MRI (if pituitary tumour suspected)

Question 16

to asses hypo/hyper gonadism - check oestrogen, progesterone, FSH and LH:
high levels of FSH and LH due to ovaries failing to produce enough osetrgen =?

Answer 16

hyper gonadotrophic 
(seen in ovarian failure - early or normal menopause)

Question 17

low levels of FSH and LH (hypothalamic axis interupted) ??

Answer 17

Hypo gonadotrophic
(pituitary problems, physiological causes)

Question 18

Dx criteria for PCOS ??

Answer 18

polycystic ovaries
oligomenorrhoea or amenorrhoea
hyperandrogenism: acne, hirsutism, male pattern baldness

Question 19

associations with PCOS??

Answer 19

obesity
hypertension
hyperlipidaemia
insulin resistance

Question 20

Ix in PCOS?

Answer 20

as for amenorrhoea +

oral glucose tolerance test
fasting lipid panel
pelvic US

Question 21

Dx Ix for PCOS?? (2)

Answer 21

raised free testosterone (increased testosterone + decreased SHBG)

> 12 ovarian follicles or ovarian volume >10cm

Question 22

lifestly advice in PCOS?

Answer 22

lose weight stop smoking and exercise

Question 23

with PCOS monitor for and treat what associated conditions?

Answer 23

DM
HT
Hyperlipidaemia

Question 24

Treatment to control periods and treat hirsutism in PCOS??

Answer 24

COCP

Question 25

Treatment in PCOS to improve insulin resistance and ovulatory function??

Answer 25

Metformin

Question 26

Fertility management in PCOS - before treatment BMI needs to be what??

Answer 26

BMI <35

Question 27

fertility management in PCOS;
1st line ?
2nd line?

then??

Answer 27

clomifene citrate (stimulates ovulation)
metformin

gonadotrophins
IVF

Question 28

causes of IMB??

Answer 28

pregnancy related
hormonal contraception
infection (chlamydia and PID)
cervical (ectropian,polyps,cancer)

Question 29

causes of PCB??

Answer 29

vaginitis
infection (chlamydia)
endometrial (carcinoma)
cervical (ectropion, polyp, malignancy)

Question 30

PMB is what until proven otherwise ?

Answer 30

endometrial cancer

Question 31

other causes of PMB?

Answer 31

oestrogen withdrawl
vaginal (atrophic vaginitis, malignancy)
cervical (polyp, malignancy)
uterine (endometrial hyperplasia,malignancy, polyp, fibroid)
ovarian (malignancy)

Question 32

most common cause of PMB is actually what?

Answer 32

atrophic vaginitis

Hx and Ix should always aim to rule out cancer however
PV + speculum
Hysteroscopy
TVUS +/- biopsy