Menstrual Disorders

Question 1

What is “normal” menstruation volume?

Answer 1

<80mls over 7 days

2-7 days

Question 2

What are the common disturbances of menstruation?

Answer 2

Disturbed menstrual frequency
Irregular menstrual bleeding
Abnormal duration of flow
Abnormal volume

Question 3

What is a prolonged menstruation?

Answer 3

> 8 days

Question 4

What is a shortened menstruation?

Answer 4

<2 days

Question 5

What is a frequent menstruation?

Answer 5

<24 days

Question 6

What is a infrequent menstruation?

Answer 6

> 38 days

Question 7

What is heavy menstrual bleeding?

Answer 7

Bleeding >80mls over 7 days
Need to change products every 1/2hrs
Passage of clots >2.5cm
Bleeding through clothes 
"described as very heavy"

Question 8

What are the types of causes of heavy menstrual bleeding?

Answer 8

Uterine/ovarian Pathologies
Systemic Disorders
Iatrogenic causes

Question 9

What are the Uterine/ovarian Pathologies causing heavy menstrual bleeding?

Answer 9

Uterine Fibroids
Endometrial polyps
Endometriosis/adenomyosis
PID
Endometrial hyperplasia/cancer
PCOS

Question 10

What are the Systemic disorders causes of heavy menstrual bleeding?

Answer 10

Coagulopathy (von Willebrand)
Hypothyroidism
Liver renal disease

Question 11

What are the Iatrogenic causes of heavy menstrual bleeding?

Answer 11

Anticoagulants
Herbal supplements
IUD

Question 12

How do uterine fibroids present?

Answer 12

HMB
Dysmenorrhoea
Pelvic pain

Question 13

How do endometrial polyps present?

Answer 13

HMB

Intermenstrual bleeding

Question 14

How do endometriosis/adenomyosis present?

Answer 14

HMB
Lower back pain
Dysmenorrhoea 
Dyspareunia 
Pelvic pain
Pain during/after sex
Painful bowel movements
Difficulty conceiving

Question 15

How does PID present?

Answer 15

HMB
Discharge
Pelvic pain
IM/postcoital bleeding
Fever

Question 16

How does endometrial hyperplasia present?

Answer 16

HMB
Postcoital bleed
IM bleeding
Pelvic pain

Question 17

Which herbal supplements are associated with HMB?

Answer 17

(alter estrogen levels)
Soya
Ginseng
Ginkgo

Question 18

What are fibroids?

Answer 18

Leiomyomae

Question 19

How are fibroids diagnosed?

Answer 19

USS

Question 20

How are fibroids managed?

Answer 20

Symptomatic
Embolisation
Myomectomy
Hysterectomy

Question 21

What are the stages of endometriosis?

Answer 21

1 (minimal) Small patches, surface lesions
2 (mild) More widespread, infiltrating pelvic organs
3 (moderate) peritoneum, scarring, adhesions
4 (severe) Infiltrative, anatomical distortion

Question 22

How is endometriosis diagnosed?

Answer 22

Pelvic examination

USS/laparoscopy

Question 23

How is endometriosis managed medically?

Answer 23

Analgesia
Mirena IUS
GnRH analogues
Depot provera

Question 24

How is endometriosis managed surgically?

Answer 24

Ablation
Hysterectomy
Excision
Hysterectomy

Question 25

Surgical management of endometriosis may be required due to what?

Answer 25

Fertility treatment

Question 26

What is adenomyosis?

Answer 26

Endometrium embedded within the myometrium

Question 27

How does adenomyosis present?

Answer 27

Heavy menstrual bleed | Dysmenorrhoea

Question 28

How is adenomyosis treated?

Answer 28

?hormones | Hysterectomy

Question 29

What are endometrial polyps?

Answer 29

Overgrowth of endometrial lining

Question 30

How are endometrial polyps diagnosed?

Answer 30

USS/Hysteroscopy

Question 31

How are endometrial polyps managed?

Answer 31

Polypectomy

Question 32

How is HMB managed?

Answer 32

``` History Pelvic exam Clotting profile Thyroid function USS Laparoscopy (endometrosis) ```

Question 33

Management of HMB depends on what?

Answer 33

Impact on QoL Underlying pathology Desire for further fertility

Question 34

Endometrial biopsy is indicated in which women?

Answer 34

Women >44y/o with HMB

Question 35

Which non-hormonal therapies are indicated for HMB?

Answer 35

Mefenamic acid Tranexamic acid GnRH analogues (Surgery)

Question 36

What risks are associated with hysterectomy?

Answer 36

Infection DVT Bladder/bowel issues Adhesions

Question 37

What are the disadvantages of Oophorectomy?

Answer 37

Immediate menopause | Recommended HRT til 50

Question 38

What are the causes of amenorrhoea?

Answer 38

``` Life changes Hormones Primary ovarian insufficiency PCOS Hyperprolactinaemia Prolactinomas Grave's disease Obstructions of uterus/cervix ```

Question 39

How is PCOS diagnosed?

Answer 39

2 of 3: - USS ovary - Biochemical hyperandrogenism - Clinical hyperandrogenism

Question 40

PCOS is associated with what?

Answer 40

Infertility Obesity Oligo/amenorrhoea

Question 41

How is hyperplasia prevented in PCOS?

Answer 41

Minimum 3 withdrawal bleeds per year | COCP, POP, Mirena IUS

Question 42

What is dysfunctional uterine bleeding?

Answer 42

Excessive bleeding in premenopausal women not due to any disease

Question 43

What is the cause of dysfunctional uterine bleeding?

Answer 43

Ovarian hormonal dysfunction

Question 44

How is dysfunctional uterine bleeding managed?

Answer 44

Conservative based on symptoms/patient wishes GnRH analogues HRT