menstrual disorders

Question 1

menstrual cycle

Answer 1

time from first day of period to day before her next period

Question 2

normal blood loss

Answer 2

<80ml over 7 days (16 tbsp)

average loss 30-40ml (6-8tbsp)

Question 3

average duration of period

Answer 3

2-7 days

Question 4

average length of cyle

Answer 4

~28days (avg 24-35 days)

Question 5

menarche age

Answer 5

10-16yrs

avg 12years

Question 6

menopause age

Answer 6

50-55 yrs

Question 7

changes during menstrual cycle on going at 3 levels

Answer 7

hormonal
ovarian
endometrial lining

Question 8

possible disturbances of mentruation

Answer 8

frequency: infrequent or frequent
irregular bleeding: absent or irregular
abnormal duration of flow: prolonged or shortened
abnormal menstrual volume: heavy or light

Question 9

heavy menstrual bleeding

Answer 9

bleeding >80ml over 7 days

and/or needing to change menstrual products every 1-2hrs

and/or passage clots >2.5cm

and/or bleeding through clothes

and/or v heavy periods affecting her QOL e.g. having to leave work

Question 10

causes of heavy menstrual bleeding: uterine and ovarian pathologies

Answer 10

uterine fibroids
endometrial polyps 
endometriosis and adenomyosis 
PID and pelvic infection 
endometrial hyperplasia/carcinoma
PCOS

Question 11

causes of heavy menstrual bleeding: systemic diseases and disorders

Answer 11

coagulation disorders e.g. vW factor disease

hypothyroidism

liver or renal disease

Question 12

causes of heavy menstrual bleeding: iatrogenic causes

Answer 12

anticoag Rx
herbal supplements e.g. ginseng
IUD

Question 13

fibroids

Answer 13

non-cancerous growths made of muscle and fibrous tissue

can cause HMB, pelvic pain, urinary + pressure symptoms, infertility, backache, misscarriage

Question 14

management of small fibroids

Answer 14

COCP
POP
mirena

Question 15

management of large fibroids

Answer 15

fibroid embolisation and myomectomy

Question 16

management of submucosal fibroids

Answer 16

hysteroscopic fibroid resection

Question 17

failed medical treatment of fibroids and fertility preservation not reqiured

Answer 17

hysterectomy

Question 18

endometriosis

Answer 18

endometrial tissue present outside the lining of the uterus

during menstruation, this ectopic tissue behaves the same as endometrium and bleeds

Question 19

endometriosis presentation

Answer 19

HMB
pelvic main 
multi-system involvement
affecting QOL
infertiilty 
lower back pain
diarrhoea, nausea, painful bowel movements
pain during and after sex

Question 20

diagnosis of endometriosis

Answer 20

pelvic examintion
USS
diagnostic laparoscopy

Question 21

medical management of endometriosis

Answer 21

suppress ovulation and ovaries to prevent endometrial shedding

COCP
POP
mirena IUD
depor provera
GnRH analogues

Question 22

surgical management of endometriosis

Answer 22

ablation
hysterectomy endometrioma excision
pelvic clearance
hysterectomy

Question 23

anednomyosis

Answer 23

condition where endometrium becomes embedded in myometrium

HMB and dysmenorrhoea

Question 24

endometrial polyps

Answer 24

overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium

HMB
irregular menstrual bleeding e.g. post-coital

Question 25

diagnosis and management of endometrial polyps

Answer 25

USS or hysteroscopy

polypectomy

Question 26

investigation of HMB

Answer 26

through history 
pelvic exam - speculum and bimanual 
clotting profile, thyroid function 
pelvic USS
laparoscopy if endometriosis suspected

Question 27

management options for HMB depend on

Answer 27

impact on QOL
underlying pathology
desire for further fertility
woman’s preferences

Question 28

HMB treatments: hormonal

Answer 28

mirena IUS
COCP
POP
depot provera

Question 29

HMB treatments: non-hormonal

Answer 29

mefenamic acid
tranexamic acid 
GnRH analogues
endometrial ablation 
fibroid embolisation 
hysterectomy

Question 30

oligo-/ameno-rrheoa

Answer 30

infrequent, absent or abnormally light menstruation

Question 31

causes of amenorrhoea

Answer 31

life change, stress, ED/malnourishment, obesity, intense exercise 
hormones: POP, mirena
primary ovarian insufficiency 
PCOS
hyperprolactinaemia 
prolactinomas 
thyroid disorders (Grave's) 
obstructions of uterus, cervix and/or vagina

Question 32

polycystic ovarian syndrome

Answer 32

metabolic syndrome with diagnosis confirmed if 2/3 criteria met:

• ultrasound appearance ovary
• bichemical hyperandrogenism
• clinical hyerpandrogenism, with oligomenorrhoea, hirautusms, acne, infertility+ obesity

Question 33

management of PCOS

Answer 33

lifestyle adjustment with aim to acheive normal BMI

symptom based Rx

Question 34

PCOS: how many withdrawal bleeds are required to prevent hyperplasia or endometrial protection and how are they achieved

Answer 34

at least 3

either COCP, POP, mirena IUD or norethistreone

Question 35

dysfunctional uterine bleeding

Answer 35

common disorder of excessive uterine bleeding afffecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases

underlying pathophysiology believed to be due to ovarian hormonal dysfunction

Question 36

Rx options for dysfunctional uterine bleeding

Answer 36

conservative, medical, surgical Rx based on severity of symptoms and patient’s wishes

GnRh analogues?

Question 37

menstrual parameters: frequency

Answer 37

frequent <24 days
normal 24-30 days
infrequent >38 days

Question 38

menstrual parameters: regularity

Answer 38

absent/amenorrhoea - no bleeding
regular <20days variation in 12mo
irregular >20 days variation in 12mo

Question 39

menstrual parameters: duration

Answer 39

prolonged >7days
normal 2-7days
shortened <2 days

Question 40

menstrual parameters: volume

Answer 40

heavy >80ml
normal 5-80ml
light <5ml