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Gynaecology > Menstruation > Flashcards

Menstruation Flashcards

1
Q

What hormone dominates follicular phase?

A

oestrogen

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2
Q

What hormone dominates luteal phase?

A

Progesterone

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3
Q

How long is the luteal phase?

A

Always 14 days

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4
Q

What does the inter-cycle rise in FSH during the follicular phase lead to?

A

follicle selection

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5
Q

What hormone does the dominant follicle produce

A

oestrogen

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6
Q

What hormone does the Corpus luteum produce?

A

Progesterone

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7
Q

What is menopause

A

the permanent. cessation of menstruation due to loss of ovarian follicular function.

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8
Q

when do you define menopause in someone above 50 years.

A

12 months after the last period

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9
Q

When do you define menopause in someone less than 50 years?

A

24 months after the last period

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10
Q

When is premature menopause defined as?

A

if the woman is younger than 40

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11
Q

What are the menopause symptoms such as change in length of menstrual cycles, dysfunctional uterine bleeding may occur and hot flushes etc. caused by?

A

falling oestrogen levels

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12
Q

What is primary amenorrhoea

A

failure to start menstruating by the age of 16. can be due to structural or genetic reasons.

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13
Q

What is secondary amenorrhoea

A

periods absent for more than 6 months other than due to pregnancy.

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14
Q

What is oligomenorrhea (infrequent periods) usually caused by? (3)

A

PCOS, premature menopause and hyperprolactinaemia

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15
Q

What is primary dysmenorrhea?

A

painful periods without organ pathology

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16
Q

What is secondary dysmenorrhea?

A

painful periods with associated pathology

17
Q

What is the normal secondary hypothalamic causes of oligomernorrhea

A

low body fat / anorexia / excess excercise

18
Q

How would you treat hyperprolactinaemia

A

Dopamine agonist (e.g. bromocryptine)

19
Q

What are the congenital reasons for oligomenorrhoea

A

Turner’s syndrome (45XO) and disorders of sexual differentiation

20
Q

What do you investigate in oligo-menorrhoea?

A
  1. exclude pregnancy with urinary or serum bhCG
  2. FSH + oestrodiol
  3. Prolactin, thyrdoi function tests
  4. Androgen levels (raised in PCOS)
  5. USS or vaginal and uterus for structural abnormalaties
21
Q

What does low E2 with high FSH indicate

A

Ovarian problem

22
Q

What does low E2 with low FSH indicate

A

pituitary or hypothalamic problem

23
Q

When is menorrhagia defined as?

A

> 80 ml of blood loss

24
Q

What are the most common causes of menorrhagia (2)

A

Dysfunctional uterine bleeding (DUB)

Anovulatory cycles

25
Q

Investigations for menorrhagia

A
  1. exclude pregnancy - urinary or serum bhCG
  2. check Hb
  3. TFTs for hypothyroidism or clotting factors
  4. transvaginal US - endometrial thickness and exclude fibroids + polyps
  5. biopsy
26
Q

What do you give if the woman does not need contraception for menorrhagia

A

tranexamic acid / NSAIDs (e.g. mefenamic acid)

27
Q

What do you give if the woman does need contraception for menorrhagia?

A

1st line - Mirena (levonorgestrel-releaseing intrauterine system IUS)
2nd line - COC
3rd line = long acting progesterone (e.g. Depo-Provera)

28
Q

What can IMB (inter-menstrual bleeding) be cuased by?

A

ectopic pregnancy

anatomical structures

29
Q

What infections can cause IMB?

A

chlamydia, gonorrhoea

30
Q

What is post-coital bleeding mostly indicative of?

A

Cervical carcinoma

31
Q

What do you do if cervical smear is positive?

A

Colposcopy to check for intra-epithelial neoplasia

32
Q

What is dysmenorrhea associaeted with?

A

High prostaglandin levels in the endometrium due to contraction and uterine ischaemia

33
Q

What causes menstruation to happen

A

withdrawal of oestrogen and progesterone following the degeneration of CL

34
Q

What is the first line management of DUB

A

progesterone (oral or IUD)

35
Q

What does E2 cuases?

A

increases fallopian tube contractility

endometrial proliferation and vascularity

Gynaecology (4 decks)

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