Menstrual dysfunction*

Question 1

endometrial events of the menstrual cycle

Answer 1

prolif phase - oestrogen induced growth of endometrial glands and stroma
luteal phase - progesterone induced glandular secretary activity. decidualisation in late secretory phase. endometrial apoptosis and sb=ubsequant menstruation
menstruation - artiolar constriction and shedding of functional endometrial layer. fibrinolytic inhibit scar tissue formation

Question 2

normal menstrual cycle

Answer 2

av 28 day cycle

between 21-35

Question 3

menstual loss

Answer 3

usually lasting 4-6 days
menstrual flow peaks day 1-2
<80ml per menstruation
no clots

Question 4

menorrhagia 
metrorrhagia
polymenorrhoea
polymenorrhagia
menometrorrhagia
amenorrhoea
oligomenorrhoea

Answer 4

prolonged and increased menstrual flow
regular intermenstrual bleeding
menses occurring at <21 day interval 
increased bleeding and frequent cycle
prolonged mended and inter menstrual bleeding 
absence of menstruation >6months
menses at intervals of >35 days

Question 5

causes of organic menohhagia

Answer 5

fibroids
adenomyosis
endocervical or endometrial polyp
cervical expansion
endometrial hyperplasia
intrauterine contraceptive device
PID
endometriosis
malignancy of cervix or uterus
hormone producing tumours
trauma

Question 6

causes of systemic organic menorrhagia

Answer 6

thyroidism, DM, adrenal, prolactin

Von willebrans, ITP
liver disorders
renal
drugs - anti coags

Question 7

causes of organic menorrhagia - preg

Answer 7

miscarriage
ectopic
gestational trophoblastic disease
postpartum haemorrhage

Question 8

causes of non-organic menorrhagia

Answer 8

absence of pathology
50% of cases
also known as dysfunctional uterine bleeding

Question 9

DUB types

Answer 9

anovulatory - 85%, occurs at extremes of reproductive life, irregular cycle, more common in obese woman
ovulatory-35-45 yo, regular heavy periods, due to inadequate progesterone production by CL

Question 10

ix of DUB

Answer 10

FBC
cervical smear
TSH
coag screen
renal/liver function
transvaginal US- endometrial thickens, presence of fibroids and other pelvis masses
endometrial sampling - pipeline biopsies, hysteroscopic directed, dilation and curettage

Question 11

management of DUB non surgical

Answer 11

medical - progestogens, combined pill, danazol, GnRH analogues, NSAIDs, anti fibrinolytics, capillary wall stabilisers

progestogen releasing IUCD - mirena IUS

Question 12

management surgical

Answer 12

endometrial resection/ablation - transcervical endometrial resection, rollerblade endometrial ablation, bipolar mesh endometrial ablation, thermal balloon ablation, thermal hydroablation

hysterectomy - sub total, total abdominal, vaginal, LASH/LAVH, TLH

Question 13

what are the risks with surgical treatment

Answer 13

expensive
anaesthetic risks
complications
very effective however fertility is lost

Question 14

ablation V hysterectomy

Answer 14

A - shorter operating time, shorter recovery, fewer cx, requires cervical smears, combined HRT possible
H - major op, longer operating time, longer recovery, more cx, no cervical smears required for total, oestrogen only HRT unless cervix is retained