Menstrual Disorders

Question 1

What are causes of Heavy Menstrual Bleeding (HMB)?

Answer 1

• uterine + ovarian pathologies
• uterine fibroids
• endometrial polyps
• endometriosis/adenomyosis
• pelvis inflammatory disease/pelvic infection
• endometrial hyperplasia/carcinoma
• PCOS
• systemic diseases + disorders
• coagulation disorders
• hypothyroidism
• liver/renal disease
• iatrogenic causes
• anticoagulant treatment
• herbal supplements
• IUD

Question 2

What are fibroids?

Answer 2

• not cancerous growths
• made of muscle or fibrous tissue
• myoma or lieomyoma

Question 3

What are the symptoms of fibroids?

Answer 3

• asymptomatic
• HMB
• pelvic pain
• urinary symptoms
• pressure symptoms
• backache
• infertility
• miscarriage

Question 4

What is the investigation for fibroids?

Answer 4

• US

Question 5

What is the management of fibroids?

Answer 5

Small fibroids + HMB:

• COCP
• POP
• Mirena

Large fibroids (fertility preservation):

• fibroid embolisation
• myomectomy

Submucosal fibroids:

• hyteroscopic fibroid resection

Declined/failed treatment (no fertility preservation):

• hysterectomy

Question 6

What is endometriosis?

Answer 6

• endometrial tissue present outside the lining of the womb. During menstruation this ectopic tissue, behaves the same way as endometrium and, bleeds
• 1.5 million affected in UK

Question 7

What are the symptoms of endometriosis?

Answer 7

• HMB
• pelvic pain
• infertility
• fatigue
• systemic symptoms
• multi-system involvement
• severe affect on QoL

Question 8

What are the investigations for endometriosis?

Answer 8

• pelvic exam
• US
• diagnostic laparoscopy

Question 9

What are the sites for endometriosis?

Answer 9

• uterus
• fallopian tube
• ovary
• bladder
• rectouterine pouch
• small intestine
• large intestine
• rectum

Question 10

What are the 4 stages of endometiosis?

Answer 10

1. minimal- small patches, surface lesions or inflammation on or around organs in pelvic cavity
2. mild- more widespread and starting to infiltrate pelvic organs
3. moderate- peritoneum or other structures. Sometimes scarring and adhesions
4. severe- infiltrative and affecting many pelvic organs and ovaries, often with the distortion of anatomy and adhesions

Question 11

What is the management for endometriosis?

Answer 11

• analgesia
• COCP, POP, MIrena, Depot provera, GnRH analogues
• surgical ablation, hysterectomy, endometrioma excision, pelvic clearance

Question 12

What is adenomyosis?

Answer 12

• endometrium becomes embedded in myometrium
• HMB, dysmenorrhoea
• may repond to hormones partially
• hysterectomy definitive

Question 13

What are endometrial polyps?

Answer 13

• overgowth of endometrial lining, causing pediculated structures (polyps) which extend into endometrum
• mostly benign
• US, hysteroscopy
• polypectomy

Question 14

What are the investigations of Heavy Menstrual Bleeding (HMB)?

Answer 14

• pelvic examination
• clotting profile, thyroid function
• pelvis US
• laparoscopy (endometriosis)
• endometrial biopsy (< 44 years + failed treatment)

Question 15

What is the management of Heavy Menstrual Bleeding (HMB)?

Answer 15

• hormonal
• COCP
• POP
• Mirena
• Depot provera
• non-hormonal
• GnRH analogues
• mefenamic acis
• tranexemic acid
• surgery
• endometrial ablation
• hysterectomy
• salpingoopherectomy

Question 16

What are causes of oligo/amenorrhoea?

Answer 16

• stress, diet, weight, exercise
• POP, Mirena, injection
• primary ovarian insufficiency
• PCOS
• hyperprolactinaemia
• prolactinomas
• thyroid disorders
• obstruction of uterus/cervix/vagina

Question 17

What is dysfunctional uterine bleeding (DUB)?

Answer 17

• excessive uterine bleeding, affecting premenopausal women, not caused by pregnancy or any other uterine or systemic disease
• ovarian hormone dysfunction
• Gnrh, HRT, surgery