6) Abnormalities of Menstruation

Question 1

What arteries supply the endometrium?

Answer 1

Radial, straight and spiral arteries from uterine artery

Question 2

What artery supplies the myometrium?

Answer 2

Arcuate artery

Question 3

What causes death of the endometrium?

Answer 3

As menses occurs, arteries shrink and blood supply to endometrium is lost

Question 4

When is the menstrual cycle shortest and longest?

Answer 4

Shorter in pre menopause

Longer after menarche

Question 5

What volume of blood loss is likely to lead to anaemia?

Answer 5

> 80ml/cycle

Question 6

What are some causes of menorrhagia (heavy periods)?

Answer 6

Abnormal clotting
Fibroids
Cancer
Infection

Question 7

What are uterine fibroids?

Answer 7

Benign tumours of smooth muscles occurring in myometrium

Question 8

How can suspected endometrial cancer be investigated?

Answer 8

Ultrasound (thickened endometrium)

Hysteroscopy (rough endometrium)

Question 9

How can menorrhagia be treated?

Answer 9

Endometrial ablation - internal laser to burn lining of endometrium to thin layer and reduce bleeding

Question 10

What can cause irregular bleeding during the menstrual cycle?

Answer 10

Hormonal contraceptives (common during first 3 months)
Missed pills
Vomiting/diarrhoea whilst on pill (COCP)
Certain prescription medicines or St John’s Wort whilst on pill

Question 11

What can cause primary amenorrhoea?

Answer 11

Androgen insensitivity, gonadal dysgenesis

Question 12

What can cause secondary amenorrhoea?

Answer 12

Pregnancy or menopause
Stress
Sudden weight loss
Thyroid disease
HPO axis failure

Question 13

What is dysmenorrhoea and what can cause it?

Answer 13

Painful periods

Endometriosis, fibrosis, pelvic inflammatory disease

Question 14

What are the symptoms of pre-menstrual syndrome and when do these occur?

Answer 14

Bloating, breast pain, mood swings, irritability

2 weeks before period