Menstraul disorders

Question 1

What hormone acts as a positive inducer at the Anterior pituitary gland to induce the LH surge?

Answer 1

Oestrogen

Question 2

What are the two phases of the menstrual cycle?

Answer 2

Proliferative phase (aka Follicular phase)

Secretory phase (aka Luteal phase)

Question 3

What is the other term for Primary Menorrhagia?

Answer 3

Dysfunctional Uterine Bleeding (DUB)

• Definition = Heavy menstrual bleeding with no recognisable pelvic pathology, pregnancy or general bleeding disorders.
  [diagnosis of exclusion]

Question 4

What are the possible causes of Menorrhagia?

Answer 4

Uterine pathology = Uterine fibroids; Endometriosis / Adenomyosis; IUCD; Pelvic inflammatory disease; Polyps

Abnormal clotting = Von Willebrand disease; Thrombocytopenia; Coagulation disorders (Eg Haemophilia?); Leukaemia’s

Medical disorders = Hypothyroidism; Liver disease

Other = Cancer / Hyperplasia

Dysfunctional uterine bleeding

Remember PALM > Polyps, Adenomyocosis, Leiomyoma, Malignancy

Question 5

What are considered the risk factors for the ‘High risk group’ of Menorrhagia / HMB?

Answer 5

Age >45
IMB
Suspected pathology
Risk factors for endometrial cancer

Question 6

What are the risk factors for Endometrial cancer?

Answer 6

Increased oestrogen exposure = Tamoxifen; Nulliparity; Early menarche-late menopause; PCOS

BRCA 1/2 mutations [Strong FHx breast cancer]

Increasing age

Endometrial polyps

Obesity; Diabetes

Parkinsons disease

Question 7

What are considered the factors for the ‘Low risk group’ of Menorrhagia / HMB?

Answer 7

Age <45
No IMB
No risk factors for endometrial cancer

Question 8

What are the assessment steps for the ‘Low risk group’ of Menorrhagia?

Answer 8

History + Examination
FBC

Question 9

What are the assessment steps for the ‘High risk group’ of Menorrhagia?

Answer 9

History + Examination
FBC
USS (Transvaginal???)
Hysteroscopy + Biopsy

Question 10

What is the management for Menorrhagia?

Answer 10

Medical management:
Symptomatic = Tranexamic acid (+ Mefenamic acid)
Fibroids = GnRH analogues (or Ulipristal acetate)
Hormonal = Progesterone only [Mirena coil if they want contraception; also POP, Implant]; COCP can be used if younger patients want normal bleeds

Surgical management:
Polyps = Hysteroscopic removal of polyps (MYOSURE)
Fibroids = Myomectomy
Family complete + Conservative = Endometrial ablation (NOVASURE)
Family complete + Definitive = Hysterectomy

Emergency treatment of HMB = Norethisterone or GnRH analogues