Menstrual problems

Question 1

What is the average age of menarche?

Answer 1

13-14

Question 2

What is the average age of menopause?

Answer 2

51

Question 3

What is a period triggered by?

Answer 3

Fall in progesterone 2 weeks after ovulation if not pregnant

Question 4

What is the average blood loss during a period?

Answer 4

30-40ml

Question 5

What is a subtotal hysterectomy?

Answer 5

Take uterus, but leave cervix

Question 6

What is a total hysterectomy?

Answer 6

Take entire uterus

Question 7

What is a total hysterectomy with BSO?

Answer 7

Take uterus, fallopian tubes and ovaries

Question 8

What is a Wertheim’s hysterectomy?

Answer 8

Take uterus with margins, fallopian tubes and ovaries

Question 9

What is recommended if removing the ovaries?

Answer 9

HRT until age 50

Question 10

What are the risks of a hysterectomy?

Answer 10

Infection
DVT
Bladder, bowel or vessel injury
Altered bladder function
Adhesions

Question 11

What should be asked in abhistory with menstrual problems?

Answer 11

Clots, flooding, how often changing
Pain
Effect on lifestyle and quality of life

Question 12

What examinations should be done with menstrual problems?

Answer 12

General
Abdo
Bimaual
Speculum

Question 13

What investigations should be done for heavy periods?

Answer 13

FBC
Thyroid function and coagulation if history suggestive
Endometrial biopsy if >45, persistent IMB or obesity

Question 14

What should be tested for with inter menstrual bleeding and post coital bleeding?

Answer 14

Chlamydia

Question 15

When should a hysteroscopy be carried out?

Answer 15

Persistent IMB

Suspected endometrial pathology on US

Question 16

What are the common causes of menstrual problems in early teens?

Answer 16

Anovulatory cycles

Coagulation problems

Question 17

What are the common causes of menstrual problems in teens-40 yo?

Answer 17

Chlamydia
Contraception related
Endometriosis
Adenomyosis
Fibroids
Endometrial/cervical polyps
Dysfunctional bleeding

Question 18

What are the common causes of menstrual problems from 40 to the menopause?

Answer 18

Chlamydia
Contraception related
Endometriosis
Adenomyosis
Fibroids
Endometrial/cervical polyps
Dysfunctional bleeding
Perimenopausal an ovulation
Endometrial cancer
Warfarin
Thyroid dysfunction

Question 19

What is dysfunctional uterine bleeding?

Answer 19

Abnormal bleeding without known structural, endocrine, neoplastic or infectious cause

Question 20

What is the treatment of dysfunctional uterine bleeding?

Answer 20

Reassure
Hormonal- progestogen, Mirena, combined OCP
Non hormonal- tranexamic acid, medanamic acid
Surgical- endometrial ablation, hysterectomy

Question 21

What does tranexamic acid do?

Answer 21

Reduces blood loss

Question 22

What does medanamic acid do?

Answer 22

Reduced blood loss and pain

Question 23

What is endometriosis?

Answer 23

Endometrial type tissue outside uterine cavity

Oestrogen dependent chronic condition

Question 24

Where is endometriosis usually found?

Answer 24

Ovary

Pouch of Douglas, pelvic peritoneum

Question 25

What are the signs and symptoms of endometriosis?

Answer 25

``` Asymptomatic Premenstrual pelvic pain Dysmennorhoea Deep dyspareunia Subfertility Tender nodules in rectovaginal septum Limited uterine mobility Adnexal mass ```

Question 26

What investigations are done for endometriosis?

Answer 26

Laprascopy MRI for deep disease US

Question 27

What is the medical treatment of endometriosis?

Answer 27

Progestogen Combined OCP GnRH analogues

Question 28

What are the surgical treatment options of endometriosis?

Answer 28

Excision of deposits Diathermy/laserablation of deposits Removal of ovaries with or without hysterectomy

Question 29

What is adenomyosis?

Answer 29

Endometrial tissue in myometrium

Question 30

Who is adenomyosis usually sen in?

Answer 30

Parous women

Question 31

What are the signs and symptoms of adenomyosis?

Answer 31

Heavy, painful periods | Bulky, tender uterus

Question 32

What investigations are done for adenomyosis?

Answer 32

MRI | Histology of uterine muscle

Question 33

What is the treatment of adenomyosis?

Answer 33

Hormonal- Mirena, progestogens, combined OCP | Hysterectomy

Question 34

What are the types of fibroids?

Answer 34

Submucosal- protrude into uterine cavity Intramural- within uterine wall Sub serous- project unto peritoneal cavity

Question 35

What are the signs and symptoms of fibroids?

Answer 35

Asymptomatic Pressure symptoms Menorrhagia Intermenstrual bleeding

Question 36

What are the signs and symptoms of fibroids in pregnancy?

Answer 36

Pain Malpresentation Obstruction

Question 37

What investigations are done for fibroids?

Answer 37

EXamination US Hysteroscopy if inside uterine cavity

Question 38

When are fibroids treated?

Answer 38

If symptomatic

Question 39

What are the treatment options for fibroids?

Answer 39

``` Hormonal GnRH analogues or ulipristal acetate Transcervical resection Myomectomy Uterine artery embolisation Hysterectomy ```

Question 40

WHt is the use of GnRH analogues and ulipristal acetate in fibroids?

Answer 40

Shrink fibroids preoperatively

Question 41

Ammonorrhea causes

Answer 41

``` Life change (stress, eating disorders, obesity, intense exercise) Hormonal issues Primary ovarian insufficiency Polycystic ovarian syndrome Hyperprolactineamia Prolactinomas Thyroid disorders Uterine, cervical and/or vaginal blockages ```

Question 42

What is PALM COEIN?

Answer 42

Polyps Adenomyosis Leiomyoma Malignancy ``` Coagulopathy Ovulatory disorder Endometrial dysfunction Iatrogenic Not known ```

Question 43

Mesonephric duct cyst names

Answer 43

Epoophoron - under ovary Paraoophoron - next to ovary Gartners cyst - close to vagina

Question 44

Paramesonephric duct abnormalities

Answer 44

``` Duplication Improper fusion Bicornate uterus Septate uterus Arcuate uterus ```