18 - Menstrual Disorders (endometriosis, adenomyosis, endometrial polyps, HMB, amenorrhoea, PCOS, DUB)

Question 1

what is the length of a menstrual cycle?

Answer 1

the time from the first day of a woman’s period to the day before her next period

Question 2

what is the normal loss of blood during a cycle?

Answer 2

less than 80 ml over 7 days (16 tsp)

Question 3

what is the avergae loss of blood during a cycle?

Answer 3

30-40 ml (6-8tsp)

Question 4

how long is the average cycle?

Answer 4

28 days (average 24-35 days)

Question 5

what is the average menarche?

Answer 5

average -12 years

10-16 years

Question 6

when is the average onset of menopause?

Answer 6

50-55years

Question 7

describe days 1-5 of a 28 day cycle in terms of uterus lining?

Answer 7

uterus lining breaks down due to no implantation and menstruation occurs

Question 8

describe days 6-10 of a 28 day cycle in terms of uterus lining?

Answer 8

uterus lining begins to thicken again

Question 9

describe days 11-18 of a 28 day cycle in terms of uterus lining?

Answer 9

ovulation occurs - usually @ day 14

Question 10

describe days 19-28 of a 28 day cycle in terms of uterus lining?

Answer 10

uterine line continues to thicken to prepare for implantation

Question 11

define frequent periods?

Answer 11

taking place every <24 days

Question 12

define infrequent periods?

Answer 12

taking place every >38 days

Question 13

define regular periods?

Answer 13

<20 days variation in 12 m

Question 14

define irregular periods?

Answer 14

> 20 days variation in 12 m

Question 15

define prolonged periods?

Answer 15

> 8 days

Question 16

define shortened periods?

Answer 16

< 2 days

Question 17

define normal duration periods?

Answer 17

2-7 days

Question 18

define a heavy period?

Answer 18

> 80 ml

Question 19

define a normal flow/ volume period?

Answer 19

5-80 ml

Question 20

describe a light period?

Answer 20

<5 ml

Question 21

describe 5 uterine and ovarian pathologies for heavy menstrual bleeding?

Answer 21

Uterine fibroids

Endometrial polyps

Endometriosis and adenomyosis

Pelvic inflammatory disease and pelvic infection

PCOS

Question 22

describe 3 systemic diseases and how they cause heavy menstrual bleeding?

Answer 22

coagulation disorders

hypothyroidism

renal disease

Question 23

describe 3 iatrogenic causes for heavy menstrual bleeding?

Answer 23

Anticoagulant treatment

Herbal supplements

Intrauterine contraceptive device(CU IUD)

Question 24

define fibroids?

Answer 24

Non cancerous growths made of muscle and fibrous tissue. also called myoma or lieomyoma

Question 25

name 4 possible symptoms of fibroids?

Answer 25

pressure symptoms HMB backache asymptomatic

Question 26

diagnosis of fibroids?

Answer 26

US scan

Question 27

management of fibroids?

Answer 27

symptom-based

Question 28

describe treatment of small fibroids?

Answer 28

COCP POP Mirena

Question 29

describe treatment of large fibroids?

Answer 29

fibroid embolisation myomectomy

Question 30

describe treatment of submucosal fibroids?

Answer 30

Hysteroscopic fibroid resection

Question 31

describe treatment for failed medical treatment and fertility preservation is not required?

Answer 31

hysterectomy

Question 32

define endometriosis?

Answer 32

endometrial tissue present outside the lining of uterus - during menstruation this ectopic tissue behaves the same as endometrium and bleeds

Question 33

who does endometriosis affect?

Answer 33

women of reproductive age

Question 34

how does endometriosis present? | 7 symptoms

Answer 34

pelvic pain HMB menstrual cramps which get worse pain during/ after sex painful bowel movements/ peeing abmormal bleeding/ spotting between periods diarrhoea/ nausea/ bloating multi-systemic presentation

Question 35

what can endometriosis cause?

Answer 35

infertility fatigue and systemic symptoms

Question 36

4 differential diagnoses for endometriosis?

Answer 36

PCOS fatigue thyroid issues IBS

Question 37

how many stages of endometriosis?

Answer 37

4

Question 38

describe stage 1 of endometriosis?

Answer 38

MINIMAL - mall patches, surface lesions or inflammation around the organs in pelvic cavity

Question 39

describe stage 2 of endometriosis?

Answer 39

MILD - more widespread and starting to infiltrate pelvic organs

Question 40

describe stage 3 of endometriosis?

Answer 40

MODERATE - peritoneum (pelvic side walls) - also scarring and adhesions

Question 41

describe stage 4 of endometriosis?

Answer 41

SEVERE - infiltrative and affecting many pelvic organs

Question 42

diagnosis of endometriosis?

Answer 42

US scan and diagnostic laparoscopy

Question 43

3 management options for endometriosis?

Answer 43

medical surgical analgesic

Question 44

give 2 examples of medical management of endometriosis?

Answer 44

COCP (combined oral contraceptive pill) POP

Question 45

give 2 examples of surgical management of endometriosis?

Answer 45

Ablation Hysterectomy

Question 46

define adenomyosis?

Answer 46

condition where endometrium becomes embedded in myometrium

Question 47

2 symptoms of adenomyosis?

Answer 47

HMB | significant dysmenorrhea painful periods

Question 48

treatment for adenomyosis?

Answer 48

may respond to hormones partially definitive treatment - hysterectomy

Question 49

define endometrial polyps?

Answer 49

Overgrowth of endometrial lining can lead to formation of pediculated structures called polyps which extend into endometrium

Question 50

diagnosis of endometrial polyps?

Answer 50

US or Hysteroscopy

Question 51

management of endometrial polyps?

Answer 51

polypectomy

Question 52

give 2 examples of medical treatments for HMB?

Answer 52

Tranexamic acid Mefenamic acid (both reduce blood loss)

Question 53

give an example of hormonal treatment for HMB?

Answer 53

COCP oral progesterones

Question 54

3 ways in which a hysterectomy can be undertaken?

Answer 54

abdominally vaginally laparoscopically

Question 55

name 3 risks associated with hysterectomy?

Answer 55

infection DVT altered bladder function

Question 56

what does a hysterectomy guarantee?

Answer 56

amenorrhoea

Question 57

what procedure removes the fallopian tubes and the ovaries?

Answer 57

Salpingo-oophorectomy

Question 58

name one advantage and one disadvantage of oophorectomy?

Answer 58

adv - reduced risk of ovarian cancer dis - immediate menopause - HRT until age 50

Question 59

define oligo/ amenorrhoea?

Answer 59

Infrequent, absent or abnormally light menstruation

Question 60

4 lifestyle causes of oligo/ amenorrhoea?

Answer 60

stress eating disorders obesity intense exercise

Question 61

3 hormonal causes of oligo/ amenorrhoea?

Answer 61

POP mirena depot injection

Question 62

4 medical causes of oligo/ amenorrhoea?

Answer 62

Primary ovarian insufficiency Polycystic ovarian syndrome Hyperprolactinemia Grave's Disease

Question 63

define PCOS?

Answer 63

Metabolic syndrome with diagnosis confirmed if 2 of 3 criteria met

Question 64

name the criteria which must be met for PCOS to be diagnosed?

Answer 64

Clinical hyperandrogenism oligomenorrhoea hirsuitism acne infertility obesity

Question 65

conservative management of PCOS?

Answer 65

symptom-based treatment aim to achieve normal BMI

Question 66

hormonal treatment of PCOS?

Answer 66

COCP/ POP/ mirena IUS or norethisterone - used to achieve At least 3 withdrawl bleeds required per year to prevent hyperplasia

Question 67

define DUB - dysfunctional uterine bleeding?

Answer 67

common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases

Question 68

cause of DUB?

Answer 68

ovarian hormonal dysfunction

Question 69

what are the common causes to rule out for DUB and other mentrual disorders?

Answer 69

P - polyp A - adenomyosis L - leiomyoma/ fibroid M - malignancy ``` C - coagulopathy O - ovulation dysfunction E - endometrium/hyperplasia I - iatrogenic N - not yet classified ```

Question 70

what is a good treatment for bridging pre-menopausal women with DUB?

Answer 70

GnRh analogues - these are anti-oestrogen and they create a pseudo-menopause

Question 71

conservative management of DUB?

Answer 71

based on severity of symptoms and patient's wishes