Menstrual problems

Question 1

Dysmenorrhoea - types

Answer 1

1°: no pathological conditions, starts 6-12/12 after menarche

2° - related to pathological conditions

Question 2

Dysmenorrhoea - 2° - DDx

Answer 2

Endometriosis
Adenomyosis
Fibroids
PID
IUD

Question 3

Dysmenorrhoea - Urgent referral

Answer 3

Red flag ➤ abnormal cervix, abnormal bleeding, palpable pelvic / abdo mass

Question 4

Dysmenorrhoea - Ix

Answer 4

case Hx
exam
if sexually active ➤ swab, US

Question 5

Dysmenorrhoea - Tx

Answer 5

OCP
analgesia
NSAIDs
?acunpuncture, osteopathy, aromatherapy, hydrotherapy (hot), TENS

Question 6

PMS - What is it?

Answer 6

Premenstrual syndrome

Condition with distressing physical, behavioural and psychological symptoms in absence of organic or psychiatric disease

Question 7

PMS - When?

Answer 7

luteal phase

Question 8

PMS - When does it improve?

Answer 8

End of menstruation (when periods start)

Question 9

PMS - S&S

Answer 9

depression
anxiety
mood swings
breast P
bloating
decrease cognitive ability
aggression

Question 10

PMS - Severity & associated features

Answer 10

Mild - no interference with personal, social and professional life
Moderate - daily functioning ok but decrease level
Severe - withdraws, premenstrual dysphoric disorder

Question 11

PMS - Causes

Answer 11

Unknown
?psychological, env, genetic, social
?cyclical ovarian activity - effects of estradiol & progesterone on serotonin & alpha-aminobutyric acid

Question 12

Menorrhagia - what is it?

Answer 12

= Excessive heavy menstrual bleeding interfering with QOL

Question 13

Menorrhagia - causes

Answer 13

• No cause - 40-60% = dysfunctional uterine bleeding
• Gynae pathology - fibroids, endometriosis, adenomyosis, PID, polyps, PCOS, endometrial CA
• Systemic - coagulation d/s, hypothyroidism, liver/renal d/s
• Drugs - anticoagulants, chemo, IUD

Question 14

Menorrhagia - Ix

Answer 14

case Hx
exam 
blood (hb, endo) 
US
hysteroscopy

Question 15

Menorrhagia - Tx

Answer 15

➤ cause dpt

Ex: mirena IUD, tranexamic acid, mefanamic acid, NSAIDs, OCP, oral progesterone, depo-provera

Question 16

Amenorrhoea - What is it?

Answer 16

= Absence or cessation of menses

Question 17

1° Amenorrhoea - Infos, causes, Ix, Tx

Answer 17

= Failure to establish menstruation

• 16 yo + normal sexual characteristics ➤ pb ➤ GP
• 14 yo + no 2° sexual characteristics ➤ GP

Causes:

• Physiological - pregnancy, delayed maturation
• Pathological - malformation, ovarian failure, hypothalamic-pituitary dysfunction, hyperprolactinaemia, testicual formation

Ix: case Hx, weight, 2° sexual characteristics, pregnancy test, US, bloods (prolactin, TSH, FSH, testosterone levels)

Tx: referral

Question 18

2° amenorrhoea - definition, causes, Ix, Tx

Answer 18

= Absence of 6-12 months in women who had normal regular menses

Causes:

• Physiological: pregnancy, lactation, menopause, weight loss
• Pathological: PCOS, premature ovarian failure, hyperprolactinaemia, pituitary issues
• Iatrogenic: progesterone, OCP, radiotherapy, chemotherapy, number of medications
• Asherman’s syndrome
• Thyroid disease hypo and hyper

Investigations:

• Pregnancy test
• Weight
• History
• Contraceptive history
• Bloods (FSH, prolactin, TSH, total testosterone)
• USS

Management ➤ Treat the underlying cause

Question 19

Oligomenorrhoea - Def

Answer 19

Menses that occur less frequently than every 35 days (ex: PCOS).

Question 20

Asherman’s syndrome - What is it?

Answer 20

• Fibrosis of the endometrium often caused by dilatation and curettage (D&C)
• Trauma to basal layer

Question 21

Asherman’s syndrome - S&S

Answer 21

infertility
miscarriage
pain
amenorrhoea

Question 22

Asherman’s syndrome - Tx

Answer 22

hysteroscopy