periods

Question 1

when is follicular phase of menstruation and what happens

Answer 1

day 1-14 // raised FSH + oestrogen –> follicle growth // endometrium thickens and mucous thins

Question 2

what day is ovulation

Answer 2

day 14

Question 3

when is the luteal phase and what happens

Answer 3

day 14-28 // corpus luteum forms which secretes progesterone // endometrium is mainteined and mucous thicks // eventually tissue sheds when no hCG is produced

Question 4

effect of FSH on hormones

Answer 4

stimulates follicle growth + granulosa cells –> oestrogen

Question 5

effect of LH on hormones

Answer 5

stimulates theca cells to convert cholesterol –> androgens

Question 6

what is mittelschmerz

Answer 6

ovulation pain in middle of the cycle

Question 7

when does PMS occur

Answer 7

luteal phase (just before period)

Question 8

symtoms PMS

Answer 8

anxiety, stress, fatigue, mood swings // bloating, breast pain

Question 9

lifestyle advice PMS

Answer 9

good sleep + exercise // limit smoking + alcohol // eat frequent meals, rich in carbs

Question 10

medication for PMS

Answer 10

new generation COCP // if severe SSRI (continuously or in luteal phase)

Question 11

what is dysmenorrhoea

Answer 11

excessive pain during mentruation

Question 12

what is Primary dysmenorrhoea

Answer 12

no underlying pathology

Question 13

when is Primary dysmenorrhoea most common

Answer 13

within 1-2 years of menarche (excessive PGE)

Question 14

symptoms Primary dysmenorrhoea

Answer 14

pain just before or just after staring period // suprapubic cramps –> radiate down back into thighs

Question 15

mx Primary dysmenorrhoea

Answer 15

1 = NSAIDs eg mefenamic acid (inhibit PGE) // 2 = COCP // (IUS)

Question 16

causes Secondary dysmenorrhoea

Answer 16

endometriosis // adenomyosis // PID // IUD (copper not IUS) // fibroid

Question 17

onset Secondary dysmenorrhoea

Answer 17

years after menarche // pain starts 3-4 days before periods

Question 18

mx Secondary dysmenorrhoea

Answer 18

refer to gynae

Question 19

what is menorrhagia

Answer 19

total blood loss >80ml

Question 20

causes menorrhagia

Answer 20

DUB (most common) // anovulatory cycles // fibroids // hypothyroid // copper coil (IUD) // PID // bleeding disorder

Question 21

what is dysfunction uterine bleeding

Answer 21

most common cause menorrhagia - no underlying pathology

Question 22

invx menorrhagia

Answer 22

FBC

Question 23

what further testing is used in menorrhagia and when is it indicated

Answer 23

TVUS // IMB, PCB, abnormal abdo exam)

Question 24

mx for patient with menorrhagia who does not what contraception

Answer 24

1 = tranexamic acid 1g // 2 = mefenamic acid 500mg (esp if pain)

Question 25

mx for patient with menorrhagia who DOES what contraception

Answer 25

1 = IUS (mirena) // 2 = COCP or // 3 = long acting progesterone // 4 = GnRH analogue

Question 26

short term rapid mx of heavy periods

Answer 26

norethisterone

Question 27

mx menstrual migraines

Answer 27

mefanamic acid OR aspirin, paracetamol, caffeine // triptan in acute