Menstrual Disorders

Question 1

What is Premenstrual syndrome?

Answer 1

Cyclical, physical and behavioural symptoms occuring in the luteal phase (time between ovulation and onset of menstruation)

Question 2

What causes PMS?

Answer 2

A response to changing hormone levels - gonadal steroid hormones

Question 3

What are the risk factors for PMS?

Answer 3

Post pubescent
Pre menopausal
Family history
Mood disorders

Question 4

What are the signs and symptoms for PMS?

Answer 4

Abdominal bloating
Fatigue
Breast tenderness
Headaches
Irritability 
Increased appetite
Forgetful

Question 5

What are the investigations done to diagnose PMS?

Answer 5

Symptom diary
TFTs
FSH
Depression screening

Question 6

What is the management for PMS?

Answer 6

Exercise and relaxation
Diet high in complex carbs
CBT
SSRIs
Surgery
Herbal remedies - gingko, st johns wort

Question 7

What is dysmenorhea?

Answer 7

Painful periods

Question 8

What are the causes of primary dysmenorhea?

Answer 8

Excessive release of prostoglandins - spinal artery vasospasm and myometrial contractions

Question 9

What are the causes of secondary dysmenorhea?

Answer 9

Underlying pelvic pathology - endometriosis, polyps, PID, IUD.

Question 10

What are the risk factors for dysmenorhea?

Answer 10

Early menarche
Long menstrual phase
Heavy periods
Smoking
Nulliparity

Question 11

What are the signs and symptoms of dysmenorhea?

Answer 11

Lower abdominal pain
Crampy pain
Uterine tenderness
Nausea
Dizziness

Question 12

What are the investigations for dysmenorhea?

Answer 12

High vaginal swab

Transvaginal ultrasound

Question 13

What is the management for dysmenorhea?

Answer 13

Primary - stop smoking, analgesia, hormonal therapy, heat pack, TENS machine.
Secondary - treat underlying cause.

Question 14

What is amenorrhea?

Answer 14

Absence of menstrual periods, can be primary (absence of menarche) or secondary (cessation for more than 6 months)

Question 15

What are the causes of amenorrhea?

Answer 15

Hypothalmic - eating disorders, exercise, psychiatric disorders.
Pituitary - prolactinomas, acromegaly, autoimmune disease.
Ovarian - PCOS, turners syndrome.
Adrenal gland - congenital adrenal hyperplasia.

Question 16

What are the risk factors for amenorrhea?

Answer 16

Athletes
Stress
Genital tract abnormality

Question 17

What are the signs and symptoms of amenorrhea?

Answer 17

Hirsutism
Nausea
Vision changes
Headache
Milky discharge from breasts 
Acne

Question 18

What are the investigations to diagnose amenorrhea?

Answer 18

Pregnancy test
FSH + LH
Prolactin
TFTs
Pelvic ultrasound, MRI/CT
Karyotyping

Question 19

What is the management for amenorrhea?

Answer 19

Contraception to regulate periods
HRT
Calcium + Vit D supplements

Question 20

What is PCOS?

Answer 20

Endocrine disorder characterised by excess androgen production and immature follicles on ovaries

Question 21

What is the cause of PCOS?

Answer 21

Excess luteinising hormone from anterior pituitary gland stimulates ovarian production of androgens.
Insulin resistance = increase secretion which decreases sex binding globulin (more androgens circulating in blood)

Question 22

What are the risk factors for PCOS?

Answer 22

Diabetes
Menstruation
Family history

Question 23

What are the signs and symptoms of PCOS?

Answer 23

Oligorrhea 
Amenorhea
Infertility
Hirsutis,
Obesity
Acne
Acanthosis Nigricans
Male pattern hair loss
HTN

Question 24

What are the investigations to diagnose PCOS?

Answer 24

Bloods - testosterone, LH, FSH, progesterone

Ultrasound - peripheral ovarian follicles

Question 25

What is the management of PCOS?

Answer 25

COCP
Manage obesity (if severe orlistat)
Clomifene and metformin (limited use can cause multiple pregnancy)
Antiandrogen medication (cyprotene, spironolactone, fineresteride) for hirsutism