5: Menstrual disorders

Question 1

What are the two important gonadotrophins?

Answer 1

FSH

LH

Question 2

Where are FSH and LH produced?

Answer 2

Posterior pituitary gland

Question 3

In the first 12 days of the menstrual cycle, which hormones

a) stimulate development of ovarian follicles
b) trigger ovulation?

Answer 3

a) FSH

b) LH

Question 4

What hormone is produced by the corpus luteum?

Answer 4

Progesterone

Question 5

How long does an average menstrual cycle last?

Answer 5

28 days

Question 6

Which hormone, produced in the proliferative phase of the menstrual cycle, stimulates thickening of the endometrium?

Answer 6

Oestrogen

Question 7

Why does menstruation occur?

Answer 7

Endometrium outgrows blood supply

Question 8

How long does menstruation last?

Answer 8

4 - 6 days of 28 day menstrual cycle

Question 9

When does peak menstruation occur?

Answer 9

Days 1 - 2 of menstruation

Question 10

Menstruation should be (light / heavy).

Answer 10

light

< 80ml

Question 11

Menstrual loss should not contain ___.

Answer 11

clots

Question 12

What is menorrhagia?

Answer 12

Prolonged, increased menstrual bleeding

Question 13

What is metrorrhagia?

Answer 13

Regular intermenstrual bleeding

Question 14

What is amenorrhoea?

Answer 14

No menstruation for > 6 months

Question 15

What is oligomenorrhoea?

Answer 15

Menstruations more than 35 days apart

Question 16

What is polymenorrhoea?

Answer 16

Menstruations less than 21 days apart

Question 17

In the context of menorrhagia, what is dysfunctional uterine bleeding?

Answer 17

Non-organic menorrhagia

No organic cause or pathology

Question 18

What is meant by a local cause of organic menorrhagia?

Answer 18

Limited to genital tract

Question 19

What is the usual causal organism of pelvic inflammatory disease?

What structures does it tend to affect?

Answer 19

Chlamydia

Fallopian tubes

Question 20

Which malignancies commonly cause menorrhagia?

Answer 20

Cervical carcinoma

Uterine carcinoma

Question 21

Which specific lining of the uterus may develop carcinomas?

Answer 21

Endometrium

Question 22

What is endometriosis?

Answer 22

Growth of endometrial tissue OUTWITH the uterus

Question 23

Which hormone, which thickens the endometrial lining in the uterus, does endometriosis grow in response to?

Answer 23

Oestrogen

Question 24

Organic causes of menorrhagia can be ___ or ___.

Answer 24

local or systemic

Question 25

What **endocrine** disease notably causes amenorrhoea and menorrhagia?

Answer 25

**Hyperprolactinaemia**

Question 26

systemic causes of amenorrhoea

Question 27

Why can **liver disease** cause menorrhagia?

Answer 27

**Damaged liver doesn't produce as much clotting factors**

Question 28

Which class of drug, used to treat cardiovascular disease, may cause **menorrhagia**?

Answer 28

**Anticoagulants** e.g warfarin, NOACs

Question 29

Which **abnormal pregnancy outcomes** may cause **menorrhagia**?

Answer 29

**Miscarriage** **Ectopic pregnancy** **Molar pregnancy**

Question 30

**Dysfunctional uterine bleeding** is a diagnosis of \_\_\_.

Answer 30

diagnosis of exclusion

Question 31

dysfunctional uterine bleeding

Question 32

When are the ovaries' best quality eggs released?

Answer 32

**Teens / 20s**

Question 33

Why does **ovulatory DUB occur**?

Answer 33

**Defective corpus luteum doesn't secrete as much progesterone, so secretory phase ends sooner and endometrium sheds more often**

Question 34

What **investigations** should be done for a woman with **dysfunctional uterine bleeding**?

Answer 34

**FBC** (including coagulation. LFTs) **Cervical smear test** **Liver, renal and thyroid function tests** **USS** (transvaginal) **Endometrial biopsy**

Question 35

What are the two most common **endometrial** causes of organic menorrhagia?

Answer 35

**Cervical/Endometrial? carcinoma** **Fibroids**

Question 36

What device is used to perform an endometrial biopsy?

Answer 36

**Pipelle**

Question 37

revise anatomy re: differentiating cervix and upper uterus

Question 38

Which device can be used to look inside the uterine cavity for polyps or tumours?

Answer 38

**Hysteroscope**

Question 39

pharma management of DUB

Question 40

give progestrogen five days into cycle i.e five days after cycle stop at 25 days repeats

Question 41

combined oral contraceptive pill also contains progestrogen makes periods **lighter** and **more frequent**

Question 42

Which **NSAID** is often used for dysfunctional uterine bleeding? Why?

Answer 42

**Mefenamic acid** Inhibits prostaglandin production

Question 43

Which device can be fitted to slowly release progesterone to treat dysfunctional uterine bleeding?

Answer 43

**Intrauterine coil**

Question 44

What are two **surgical treatments** for dysfunctional uterine bleeding?

Answer 44

**Resection / ablation of endometrium** **Hysterectomy** (surgical removal of the uterus)

Question 45

sub-total hysterectomy - cervix retained, body of uterus removed

Question 46

What is a consequence of doing a **hysterectomy** for DUB?

Answer 46

**Infertility**

Question 47

What is the technical name for bleeding after giving birth?

Answer 47

**Post-partum haemorrhage**

Question 48

Performing a hysterectomy renders a woman \_\_\_.

Answer 48

**infertile**

Question 49

Giving a patient excessive oestrogen (why would you do this)?? increases the risk of what?

Answer 49

**Endometrial carcinoma**