Irregular Menstruation Flashcards by Unknown J

A 46 year old female presents with 4 months amenorrhoea, negative pregnancy test and a history of night sweats and hot flushes do you..

A. Diagnose the perimenopause and offer advice?

B. Suggest a check of FSH to clarify diagnosis and arrange review appointment?

C. Prescribe clonidine or SNRI as a safe option for VMS?

A. Diagnose the perimenopause and offer advice?

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A 52 year old lady with a history of 14 months amenorrhoea presents with a single episode of spotting (tiny pv bleed) 4 weeks ago, with no recurrence. You perform a normal vagina and speculum examination. Do you : -

A. Reassure her and ask her to report any further episodes

B. Arrange urgent ultrasound examination and follow up appointment

C. Do an urgent, suspected cancer referral

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A 31 year old lady presents with a 3 month history of pelvic pain, dyspareunia and occasional post-coital bleeding. The likeliest cause is : -

A. Pelvic inflammatory disease

B. Cervical cancer

C. Ectropion

D. Endometrial cancer

B. Cervical cancer

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A 48 year old lady has a history of infrequent periods and vaginal dryness and occasional stress incontinence. Which of the following are the best treatment options.

A. a daily oestrogen tablet

B. an oestrogen patch

C. an anticholinergic tablet

D. a topical oestrogen pessary

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A 13 year old girl is complaining of heavy, painful periods. Which of the following treatments is least suitable for her

A. the combined oral contraceptive pill

B. tranexamic acid

C. mefenamic acid

B. Tranexamic acid may help to reduce blood loss but is unlikely to help pain.

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A 53 year old lady with a history of oestrogen dependent breast cancer is getting severe vasomotor symptoms. Which of the following treatments are suitable (there are more than one)

a. topical oestrogen pessary
b. a sequential HRT patch
c. gabapentin
d. clonidine
e. Bendroflumethiazide

c. gabapentin

d. clonidine

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Post menopausal bleeding is a common feature of which gynaecological cancer?

a. endometrial cancer
b. ovarian cancer
c. cervical cancer

a. endometrial cancer

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Menorrhagia diagnosis is based on a greater than 80mls menstrual loss per month - vrai ou faux?

False – it is a clinical diagnosis based on patients history

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Progestogen only therapy can be used to reduce excessive menstrual loss - vrai ou faux?

true

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Tranexamic acid is a non-steroidal anti-inflammatory - vrai ou faux?

False it is an anti-fibrinolytic

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Naproxen can be an effective treatment for dysmenorrhoea- vrai ou faux?

true

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Dysfunctional uterine bleeding can be associated with anovulatory cycles - vrai ou faux?

Vrai

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A 42 year old lady presents with heavy, regular, menstrual bleeding, urinary frequency, and stress incontinence, which is the likeliest diagnosis?

a. endometrial cancer
b. dysfunctional uterine bleeding
c. leiomyomata (fibroids)
d. bladder cancer
e. ovarian cancer

c. leiomyomata (fibroids)

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Which of the following is most likely to cause post-coital bleeding?

a. cervical ectropion (erosion)
b. dysfunctional uterine bleeding
c. endometrial polyp
d. ovarian cancer

a. cervical ectropion (erosion)

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Which of the following treatments would be most suitable for a 56 year old female with a history of hysterectomy,hyperlipidaemia and severe vasomotor symptoms?

a. sequential HRT tablets
b. topical oestrogen pessaries
c. clonidine
d. oestrogen only patches

d. oestrogen only patches

she is suitable for unopposed oestrogen. Patches may reduce her risk of cardiovascular complications compared to tablets

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Which one of the following statements is true?

a. a raised FSH level is needed to diagnose HRT
b. PCOS can cause DUB
c. HRT should always be discontinued after 5 years to reduce the risk of breast cancer
d. The mirena – IUS would be a first line treatment in a 14 year old female with DUB.

b. PCOS can cause DUB

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List 5 features of normal menstruation.

Menarche 10-16

Menopause > 45 years

Menstruation < 8 days in length

Cycle length 23-35 days

Blood loss < 80ml

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How long does menstruation usually last?

< 8 days in length

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How long does a menstrual cycle usually last?

23-35 days

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How much blood is usually lost in a menstrual period?

< 80ml

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List 5 features of an abnormal Menstruation

Precocious puberty (before 10)

Premature menopause (before 45)

Absent or long (amenorrhea/oligomenorrhea)

Irregular

Heavy (menorrhagia)

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What is menorrhagia?

Heavy menstrual bleeding

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What is dysmenorrhoea?

Painful menstrual bleeding

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What is oligomenorrhoea?

Infrequent periods > 35 days - 6 months between bleeds

What is primary amenorrhoea?

Periods never start

What is secondary amenorrhoea?

Periods stop for ≥ 6 months (not menopause)

What is metrorrhagia?

Irregular bleeding whereby periods out with range of 23-35 days with variability of > 7 days between shortest and longest cycles

What is intermenstrual bleeding?

Bleeding between periods

What is post-coital bleeding?

Bleeding after sexual intercourse

What is post-menopausal bleeding?

Bleeding 1 year after menopause

What is premenstrual syndrome?

Psychological and physical symptoms in luteal phase

State the two types of amenorrhoea.

1º = never had menses by 16 2º = absence of menses for ≥ 6 months

What is the female triad with regards to amenorrhoea?

Excessive sports Eating disorders Amenorrhoea

Give 3 common causes of amenorrhoea.

- PCOS - Hyper-PRL - Premature menopause - POI - Pregnancy

Which investigation would you order in a patient presenting with amenorrhoea?

- FSH - LH - GnRH - TSH - PL - ß-hCG - Androgens Imaging: TV-US/MRI

Outline 3 causes of menorrhagia.

Idiopathic POCS Fibroids (leiomyomas) Polyps Dysfunctional Uterine Bleeding Pelvic Inflammatory Disease Obstetric Pathology Endometrial cancer Cervical cancer Ovarian cancer

What is the gold standard investigation for uterine fibroid diagnosis?

TV-US

State the main treatment for uterine fibroids.

Myomectomy Uterine artery embolisation Hysterectomy

State 3 red flag signs in a patient with uterine fibroids.

Acute pain, irregular bleeding, increased in size post-menopausal

Outline the two types of Dysmenorrhoea.

1) 1º Dysmenorrhoea: No pathology, increased prostaglandins in menstrual fluid  - Within 2 years of menarche   - Severity on day 1 of bleeding  - Cramping in lower abdominal pain, radiates to lower back and legs   - Associated Sx: GI nausea, vomiting, fatigue, headache Rx:   - NSAIDs (reduce PG)  - COCP/Depot (reduce ovulation)   - Mirena coil (reduce bleeding and pain) 2) 2º Dysmenorrhoea:  - Many years after menarche  - Starts in luteal phase and continues throughout menstruation   - Cramping in lower abdominal pain, radiates to lower back and legs   - Associated Sx: GI nausea, vomiting, fatigue, headache, deep dyspareunia  - Associated with pathology: Endometriosis, chronic PID, fibroids, adenomyosis, polyps, copper coil Rx: Underlying cause as mainly 1º dysmenorrhoea

Give a differential for menorrhagia, apart from uterine fibroids, which is loosely defined

Dysfunctional Uterine Bleeding (DUB)

Give 3 differentials for a patient with metrorrhagia

Endometriosis PCOS Fibroids Adenomyosis Chronic infection Cysts

Give 3 types of non-menstrual vaginal bleeding

Intermenstrual bleeding Post-coital bleeding Post-menopausal bleeding

List 3 common causes of post-coital bleeding

``` - Infection  - Cervical ectropion   - Trauma/sexual abuse  - Vaginal atrophy   - Cervical cancer ```

List 3 common causes of post-menopausal bleeding

- Endometrial cancer  - Endometrial polyps   - Endometrial hyperplasia  - Cervical cancer

What is the menopause?

Last menstrual period due to reduced oestrogen and oocyte supply diminished with 12 months of cessation of periods occurring after 45 years, mean age 51

Outline the 3 time periods of menopause.

Perimenopause (months/years before menopause) Menopause (last menstrual period/oocyte supply diminished) Post-menopause (reduced circling oestrogen)

List 3 symptoms of perimenopausal symptoms.

``` Hot flushes Night sweats Low mood/depression Reduced concentration Reduced libido Vaginal atrophy Irregular menses Vaginal drones Dry skin Dry hair ```

List 3 vasomotor Sx of Menopause.

``` Headaches Hot flushes Night sweats Palpitations Insomnia ```

List 3 psychological Sx of Menopause.

``` Poor concentration Irritability Depression Reduced short-term memory Lethargy Reduced libido ```

List 3 urogenital Sx of Menopause.

``` Urethral Sx Uterine prolapse Stress/urge incontinence Dyspareunia Atrophic vaginitis Irregular menses ```

List 3 cutaneous Sx of Menopause.

Vaginal dryness Dry skin Dry hair Brittle nails

State 3 potential complications of Menopause.

CVD CVI OP Breast Ca risk reduced

Outline the different ways of managing the Menopause.

COCP SSRIs Low-dose vaginal oestrogen Testosterone CBT Weight-loss and exercise Diet change

Why is oestrogen given with progesterone in menopause?

COCP as oestrogen unopposed would increase risk of endometrial hyperplasia/cancer

List 3 potential risks of HRT

``` Vaginal bleeding Breast tenderness VTE Breast Ca Stroke ```

What are the risk factors for post-menopausal bleeding?

- Obesity   - Early menarche  - Late menopause   - Nulliparity   - Unopposed oestrogen  - Tamoxifen  - FHx Ca   - PCOS

What are the red flags in Gynaecology?

- Bloating - Abdominal pain - Irregular bleeding - Intermenstrual bleeding - Mass