Menstrual Dysfunction

Question 1

How long does a normal menstrual cycle typically last?

Answer 1

28 days

Question 2

What are the 3 stages of the menstrual cycle?

Answer 2

Proliferative/follicular phase
Luteal phase
Menstrual phase

Question 3

Which layer of the uterus is shed during menstruation, causing bleeding?

Answer 3

Endometrium

Question 4

Define “menorrhagia”

Answer 4

Prolonged and increased menstrual flow

Question 5

Define “metrorrhagia”

Answer 5

Regular menstrual bleeding between menstrual periods

Question 6

Define “polymenorrhoea”

Answer 6

Menstrual bleeding occurring at 21 day interval of cycle

Question 7

Define “polymenorrhagia”

Answer 7

Increased bleeding and increased frequency of cycles

Question 8

Define “menometrorrhagia”

Answer 8

Prolonged menstrual cycle and bleeding between cycles

Question 9

Define “amenorrhoea”

Answer 9

Absence of menstrual cycle for more than 6 months

Question 10

What is the difference between organic and non-organic causes of menorrhagia?

Answer 10

Organic - pathology present

Non-organic - no obvious/observable pathology identified

Question 11

List some local organic causes of menorrhagia

Answer 11

Fibroids
Adenomyosis
Polyps
Hyperplasia, carcinoma
Pelvic inflammation
Contraceptive devices
Endometriosis
Trauma
AV malformations

Question 12

What is adenomyosis?

Answer 12

Endometrium present in myometrium, causing irritant blood to pool and intense pain

Question 13

What 2 other organic groups of causes of menorrhagia must be considered?

Answer 13

Systemic

Pregnancy

Question 14

Non-organic (dysfunctional) menstrual bleeding makes up 50% of cases. True/False?

Answer 14

True

Question 15

Which type of dysfunctional menstrual bleeding (DUB) is more common - anovulatory or ovulatory?

Answer 15

Anovulatory

Question 16

What can be assessed on a transvaginal ultrasound scan?

Answer 16

Endometrial thickness

Presence of fibroids + pelvic masses

Question 17

How can endometrial sampling be done?

Answer 17

Pipelle biopsy
Hysteroscopy
Dilate and curettage

Question 18

How can dysfunctional menstrual bleeding be managed medically?

Answer 18

Progestogens
Combined OCP
GnRH analogues
NSAIDs
Capillary stabilisers
Progesterone-releasing intra-uterine contraceptive

Question 19

What are the main surgical interventions for dysfunctional menstrual bleeding?

Answer 19

Endometrial resection/ablation

Hysterectomy

Question 20

At what endometrial thickness is biopsy indicated?

Answer 20

Greater than 4mm in postmenopausal

16mm in premenopausal