Menstruation

Question 1

What is Myometrium?

Answer 1

muscle layer underneath the endometrium

Question 2

Describe the proliferative stage of the menstrual cycle?

Answer 2

The proliferative phase begins at the onset of menses until ovulation takes place. Folliculogenesis takes place during this phase. A dominant follicle is selected from the pool of growing follicles that will be destined. The growth of these follicles is dependent on FSH. The growth of this follicle triggers local production of oestrogen from granulosa cells. Oestrogen stimulates the endometrium to thicken.

Question 3

Describe the ovulatory phase of the menstrual cycle

Answer 3

At the peak of follicular growth ovulation takes place in response to a large surge in LH this in turn requires levels of oestrogen above 200pg/ml for at least 50hours. For the oocyte to be released from the follicle several proteolytic enzymes and prostaglandins are activates leading to the digestion of the follicle wall collagen. The fallopian tube is responsible for picking it up where it will await fertilisation.

Question 4

Describe the secretory phase of the menstrual cycle

Answer 4

The secretory phase during this phase the remaining granulosa cells that are not released with the oocytes during the ovulation process enlarge and acquire lutein (carotenoids) which is yellow in colour. These granulosa cells are now called the corpus luteum and predominantly secrete progesterone. Peak progesterone production is noted one week after ovulation takes place. The life span of the corpus luteum and hence progesterone production will depend on continues LH support from the anterior pituitary. If a pregnancy will maintain the corpus luteum.

Question 5

What happens when a pregnancy fails to happen?

Answer 5

If a pregnancy fails to happen, luteolysis takes place and the corpus luteum is converted to a white scar called the corpus albicans.

Question 6

What causes bleeding in menstruation?

Answer 6

During menstruation, the spiral arteries in the endometrium squash up reducing blood flow resulting in the death of the endometrium and the shedding of this lining.

Question 7

What is the normal range of lengths and volume for menstruation?

Answer 7

Length 24-32 days, most regular between 20-40 years, longer after menarche and shorter in pre-menopause. Medium blood loss is 37-43ml per cycle mostly occurring in the first 48hours. 9-14% lose > 80ml/cycle and 60-70% of them are anaemic.

Question 8

List the common causes of menorrhagia?

Answer 8

Heavy periods – menorrhagia. Pathology: fibroids and IUCD (intrauterine contraceptive device. Medical disorders: cancer, progesterone contraception.

Question 9

What are fibroids and where can they be?

Answer 9

Fibroids – benign growth in the uterine cavity – present with very heavy periods. Different types – intracavitary, intramural, submucosa, subserosal, intracavity and pedunculated.

Question 10

What is DUB?

Answer 10

Dysfunctional Uterine Bleeding

DUB (60%) – no other cause found to explain the heavy periods.

Question 11

How do you discover endometrial cancer and what is one treatment option?

Answer 11

Hysteroscopy and ultra sound scan can be used to test for these.
Potential to treat with Endometrial Ablation of the endometrium. Burn away some of the endometrium to reduce the amount that falls away in menses.

Question 12

What causes irregular periods?

Answer 12

Irregular bleeding, such as bleeding between periods, is common during the first three months of starting hormonal contraceptives such as: combined pill, progesterone pill, contraceptive patch, contraceptive implant or injection and intrauterine system.

Missed combined or progesterone pills. Vomiting diarrhoea on the COCP (combine oral contraceptive pill). Certain prescription medicines or St John’s Wort (a herbal remedy) whilst using the pill, patch, ring or implant.

Question 13

What is the difference between primary and secondary amenorrhoea?

Answer 13

Primary – no menses ever and no 2nd sexual characteristics by 14 or 2nd sexual characteristics by 16. Secondary is when menses stops after they’ve stopped and it isn’t menopause.

Question 14

What are some common causes of primary amenorrhoea?

Answer 14

• Prepubertal
• Uterine/Endometrial blockage or atresia
• Ovarian dysgenesis- Turner’s syndrome
• Androgen insensitivity disorders and receptors dysfunction for FSH and LH
• Congenital adrenal hyperplasia
• Hypothalamic problems can only be Kallmann’s syndrome if primary

Question 15

What are some common causes of secondary amenorrhoea?

Answer 15

• Uterine adhesions
• Pituitary
• Hypothalamic.
• Pregnancy (14-44), menopause and polycystic ovary syndrome
• Hypothalamic problems – problems with weight
• Pituitary problems – Inadequate FSH leading to low oestrogen and so no endometrium formation

Question 16

What is PMS?

Answer 16

PMS – Premenstrual syndrome this describes the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman’s monthly period. It’s also known as premenstrual tension (PMT).

Question 17

What is dysmenorrhea?

Answer 17

Dysmenorrhoea – menstruation is painful

Question 18

What is oligomenorrhoea?

Answer 18

Oligomenorrhoea – menses occurring at greater than 35 days apart

Question 19

What are the common symptoms of PMS?

Answer 19

There are many different symptoms of PMS, but typical examples are: bloating, breast pain, mood swings, feeling irritable and loss of interest in sex. These symptoms usually improve when the period starts and disappear a few days afterwards. Nearly all women of childbearing age have some premenstrual symptoms, but women in their late 20s to their early 40s are most likely to experience PMS. A few have such bad symptoms they cannot continue with life normally.

Question 20

What are the general impact of menstrual disorders?

Answer 20

Physical – tiredness and anaemia
Psychological – depression, irritability, mood swings and anxiety
Social – impact on ability to socialise/swim/perform sports