Menstruation Disorders

Question 1

what does FSH stimulate

Answer 1

ovarian follicle development and granulosa cells to produce oestrogens

Question 2

what inhibits FSH production

Answer 2

raising oestrogen and inhibin by dominant follicles

Question 3

what stimulates ovulation

Answer 3

prior LH surge

Question 4

what happens in the proliferative phase

Answer 4

oestrogen induced growth of endometrial glands and stroma

Question 5

what happens in the luteal phase

Answer 5

progesterone induced glandular secretory activity

endometrial apoptosis and subsequent menstruation

Question 6

menstruation

Answer 6

arteriolar constriction and shedding of functional endometrial layer
fibrinolysis inhibits scan tissue formation

Question 7

how much is lost during menstruation

Answer 7

30-40ml in normal menstruation

heavy bleeding is 80ml or more

Question 8

what is menorrhagia

Answer 8

prolonged and increased menstruation flow

Question 9

metrorrhagia

Answer 9

irregular, frequent bleeding or varying amounts but not excessive

Question 10

polymenorrhoea

Answer 10

meses occurring at <21 day interval

Question 11

polymenorrhagia

Answer 11

increased bleeding and frequent cycling

Question 12

amenorrhoea

Answer 12

absence of menstruation >6 months

Question 13

oligomenorrhoea

Answer 13

menses at intervals of >35 days

Question 14

what are the causes of menorrhagia

Answer 14

presence of pathology-organic
non-organic-absence of pathology
also known as dysfunctional uterine bleeding

Question 15

what are the organic causes of menorrhagia

Answer 15

fibroids 
adenomyosis 
endocervical or endometrial polyp 
cervical eversion 
endometrial hyperplasia 
intrauterine contraception device (IUCD) 
pelvic inflammatory disease (PID)
endometriosis 
malignancy of the cervix of uterus

Question 16

adenomyosis

Answer 16

condition in which the inner lining of the uterus breaks through the muscle wall-presence of endometrial tissue within the myometrium

Question 17

what is dysfunctional uterine bleeding

Answer 17

50% of women with abnormal uterine bleeding

diagnosis made by exclusion

Question 18

what are the 2 types of dysfunctional uterine bleeding

Answer 18

anovulatory and ovulatory

Question 19

how is DUB diagnosed

Answer 19

it is a diagnosis of exclusion 
full blood count 
cervical smear
TSH 
coagulation screen 
renal/liver function tests 
transvaginal ultrasound scan 
endometrial sampling

Question 20

what is the management of DUB

Answer 20

progesterogens 
combined oral contraceptive pill 
danazol 
GnRH analogue 
NSAIDS
antifibrinolytics 

progestogen-releasing IUCD

Question 21

what is danazol

Answer 21

giving testerone as a way of reducing oestrogen

Question 22

what is the surgical management of DUB

Answer 22

endometrial resection/ablation

hysterectomy

Question 23

what are the benefits of medical treatments

Answer 23

cheaper
no waiting list 
no anaesthetic risks 
adverse effects non-permanent 
fertility is preserved

Question 24

what are the possible causes of heavy bleeding

Answer 24

endometrial cancer 
PCOS
underactive thyroid gland
DUB 
pelvic infections

Question 25

how does tranexaminc acid work

Answer 25

it can reduce the heaviness of bleeding by reducing the breakdown of clots in the womb

Question 26

what does tranexamic acid not do

Answer 26

reduce the number of days of bleeding or period pain

Question 27

is it still possible to get pregnant if you are perimenopausal

Answer 27

yes

Question 28

what is more common anovultaory or ovulatory DUB

Answer 28

anovulatroy 85%

Question 29

when does anovulatory DUB occur

Answer 29

at extremes of reproductive life, irregular cycle

Question 30

what is more common in obese people ovulatory or anovulatory DUB

Answer 30

anovulatory

Question 31

at what ages is ovulatory DUB more common

Answer 31

women 35-45

regular heavy periods

Question 32

what is ovulatory DUB caused by

Answer 32

inadequate progesterone production by corpus luteum