Ovulation disorders

Question 1

oligomenorrhagia definition

Answer 1

<9 period in a year

either irregular or regular and infrequent

Question 2

menorrhagia definition

Answer 2

prolonged and increased menstrual flow

Question 3

metrorrhagia definition

Answer 3

regular intermenstrual bleeding

Question 4

polymenorrhagia definition

Answer 4

cycles <21 days (hence more in a year = poly)

Question 5

menometrorrhagia definition

Answer 5

prolonged menstruation and intermenstrual bleeding

Question 6

amenorrhoea definition

Answer 6

absence of menstruation >6 months

Question 7

what is it called when there is no pathological cause found for menorrhagia

how is it diagnosed

Answer 7

dysfunction uterine bleeding

diagnosis of exclusion

Question 8

aetiology of menorrhagia (6)

Answer 8

dysfunctional uterine bleeding - no pathological cause 
fibroids 
endocervical polyps 
PID 
endometriosis 
trauma 
loads of things...

Question 9

investigations for menorrhagia (3)

Answer 9

transvaginal US
FBC
pregnancy test

Question 10

first line treatment for menorrhagia

Answer 10

mirena coil

Question 11

second line treatment for menorrhagia

Answer 11

mefenamic acid (NSAI= decrease blood flow) AND tranexamic acid (antifibrinolytic = increase blood clotting)

Question 12

third line treatment for menorrhagia (after mirena coil and mefenamic acid and tranexamic acid)

Answer 12

progesterone

Question 13

last line treatment for menorrhagia (after all medications)

Answer 13

surgery - endometrial ablation/resection or hysterectomy

Question 14

definition of primary amenorrhoea

Answer 14

a female >16yo that’s never had a period

Question 15

definition of secondary amenorrhoea

Answer 15

a female with cessation of periods for >6 months but previous menstruation

Question 16

first line investigation in amenorrhoea

Answer 16

pregnancy test!

Question 17

common physiological cause of amenorrhoea

Answer 17

menopause

Question 18

causes of primary amenorrhoea

Answer 18

congential - turners syndrome, kallmans syndrome, congenital adrenal hyperplasia
anatomical - imperforate hymen

Question 19

causes of secondary amenorrhoea (2 categories, 3 in each)

Answer 19

primary hypogonadism - PCOS, POF, uterine adhesions

secondary hypogonadism - hyperprolactinaemia (drugs), hypopituitarism (pituitary tumour), hypothalamic dysfunction

Question 20

difference between primary and secondary hypogonadism as causes of secondary amenorrhoea

Answer 20

primary hypogonadism - problem in ovaries

secondary hypogonadism - problem higher up than ovaries eg hypothalamus/pituitary

Question 21

causes of hypothalamic dysfunction that cause secondary amenorrhoea

Answer 21

weight loss
over exercise
low BMI
stress

Question 22

most common cause of secondary amenorrhoea

Answer 22

PCOS

Question 23

primary amenorrhoea with anosmia

Answer 23

kallmans

anosmia = loss of smell

Question 24

secondary amenorrhoea with hirsutism and acne

Answer 24

PCOS

Question 25

cause of amenorrhoea with hypopituitarism

Answer 25

drugs (causing hypopituitarism)

Question 26

investigations for amenorrhoea (3)

Answer 26

pregnancy test (hCG)
LH, FSH and oestrogen - then progesterone challenge to confirm
TVUS - biopsy if abnormal

Question 27

high LH, FSH and low oestrogen

what type; hyper/hypogonadotrophic hypogonadism

examples

Answer 27

primary hypogonadism causing amenorrhoea - problem is in the ovaries bc FSH and LH are high (theyre working fine)

hypergonadotrophic hypogonadism

eg PCOS, POF

Question 28

low LH, FSH and oestrogen

what type; hyper/hypogonadotrophic hypogonadism

examples

Answer 28

secondary hypogonadism causing amenorrhoea
problem is higher up than the ovaries, bc pituitary is not responding to low oestrogen (LH and FSH would be high if it was)

hypogonadotrophic hypogonadism

eg hyperprolactinaemia, hypopituitarism

Question 29

what is the progesterone challenge

what is the result in primary hypogonadism

what is the result in secondary hypogonadism (problem higher up)

Answer 29

give progesterone for 5 days to see if bleed

if no bleed = ovaries aren’t fine = primary hypogonadism

if bleed = ovaries are fine = problem is further up = secondary hypogonadism

Question 30

what hormone is primarily lacking in kallmans syndrome

Answer 30

GnRH = hypopituitarism = hypogonadism

Question 31

turners genotype

Answer 31

XO

Question 32

presentation of turners (XO) (6)

Answer 32

horseshoe kidney
short stature 
webbed neck 
wide spaced nipples 
amenorrhoea 
infertility