Menstrual Disorders

Question 1

What is the definition of menorrhagia?

Answer 1

Heavy period of over 80ml per cycle

Question 2

What infection can be a cause of inter menstrual bleeding?

Answer 2

Chlamydia

Question 3

What is the FIGO classification for abnormal uterine bleeding?

Answer 3

PALM-COEIN
P- polyp
A- adenomyosis
L- leiomyoma
M- malignancy/hyperplasia
C- coagulation (von willebrand’s disease)
O- ovarian (polycystic ovaries/anovulatory cycles)
E – endocrine (thyroid)
I- iatrogenic  (warfarin)
N- not yet classified

Question 4

What is dysfunctional uterine bleeding?

Answer 4

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

Question 5

What is endometriosis?

Answer 5

Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature

Question 6

What are the symptoms of of endometriosis?

Answer 6

Dysmenorrhoea
Chronic or cyclic pelvic pain
Dyspareunia
Sub-fertility
Uterosacral ligament nodularity
Pelvic mass
Fixed, retroverted uterus
Depression
Dysuria, flank pain, haematuria
Dyschezia, haematochezia

Question 7

What investigations should be done for endometriosis?

Answer 7

Transvaginal ultrasound (TVUS)
Rectal endoscopic ultrasound
3D ultrasonography
Hysterosalpingography
MRI pelvis
Diagnostic laparoscopy

Question 8

What is the management of endometriosis?

Answer 8

OCP
NSAIDS
Progestogen
GnRH Antagonist
GnRH Agonist
Laparoscopy
Hysterectomy

Question 9

What is adenomyosis?

Answer 9

Presence of endometrial tissue in the myometrium

Question 10

What are the symptoms of adenomyosis?

Answer 10

Menorrhagia
Dysmenorrhoea
Bulky, tender uterus

Question 11

How is adenomyosis diagnosed?

Answer 11

MRI can suggest diagnosis

Uterine histology from hysterectomy is diagnostic

Question 12

How is adenomyosis managed?

Answer 12

Treat symptoms of heavy and painful periods with hormonal contraception
LNG IUS (Mirena)
Progestogens
Combined oral contraceptive pill

Question 13

What tissue are leiomyomas formed from?

Answer 13

Smooth muscle

Question 14

What three types of leiomyoma are there?

Answer 14

Sub mucous-protrude into uterine cavity
Intramural-within uterine wall
Sub serous-project out of uterus into peritoneal cavity

Question 15

What are the symptoms of a leiomyoma?

Answer 15

Asymptomatic
Menorrhagia
Intermenstrual Bleeding
Irregular firm central pelvic mass
Pelvic pain
Pelvic pressure
Dysmenorrhoea
Bloating
Infertility
Urinary complaints
Constipation
Enlarged uterus

Question 16

What investigations are done for a leiomyoma?

Answer 16

Ultrasound
Endometrial biopsy
Sonohysterography
Hysteroscopy
MRI
Laparoscopy

Question 17

What treatment is available for leiomyomas?

Answer 17

Only if symptomatic
Standard menorrhagia treatment if cavity not too distorted
GnRH analogues or Ulipristal acetate may be used temporarily to shrink the fibroids – usually preoperatively
Submucous fibroids: Transcervical resection hysteroscopically
Myomectomy
Uterine artery embolisation
Hysterectomy

Question 18

What treatments are available for dysfunctional uterine bleeding?

Answer 18

Non hormonal: Tranexamic acid or Mefanamic acid
Hormonal: Progestogen only tablets, injections (Depo Provera), Levonorgesterel Intrauterine System, Combined pill
Endometrial ablation
Hysterectomy