Menstrual Cycle Abnormalities

Question 1

List two examples of physiological amenorrhoea

Answer 1

childhood
pregnancy
post-menopausal
breast feeding

Question 2

List three investigations for amenorrhoea

Answer 2

FSH/LH
Androgens
USS (PCOS)

Question 3

What might you see on USS in patient with PCOS?

Answer 3

string of pearls

Question 4

Name two complications of PCOS

Answer 4

subfertility
acne
hirsutism

Question 5

List two investigations for menorrhagia

Answer 5

TFTs
FBC
USS (fibroid)

Question 6

Which fibroid is associated with the most amount of bleeding?

Answer 6

submucosal (Dependent on location of fibroid rather than size and number)

Question 7

Patient with post-menopausal bleeding. What are you worried about?

Answer 7

endometrial cancer- 10% risk
cervical cancer (lower risk)

Question 8

List two investigations for post menopausal bleeding

Answer 8

USS
speculum

Question 9

Post menopausal woman’s endometrium is 2mm thick on USS. Do you biopsy?

Answer 9

> 4 mm no HRT
5mm on HRT
(only biopsy if >3mm)

Question 10

Name one protective factor for endometrial cancer?

Answer 10

marina coil (progestogen only)

Question 11

List the two criteria for primary amenorrhoea

Answer 11

no periods by 16 + secondary sexual characteristics

no periods by 14 + no secondary sexual characteristics

Question 12

How is secondary amenorrhoea defined?

Answer 12

no periods for 6 months with pervious normal menstruation

Question 13

What is thelarche?

Answer 13

breast tissue development

Question 14

What is adrenarche?

Answer 14

pubic hair development

Question 15

Which is the first sexual characteristic to develop?

Answer 15

breast enlargement

Question 16

List two primary hypothalamic causes of amenorrhoea

Answer 16

anorexia nervosa
excessive exercise
stress
kallmann’s syndrome
constitutional delay

Question 17

List two causes of secondary amenorrhea (hypothalamic)

Answer 17

anorexia nervosa
excessive exercise
stress
tumours
infections (TB)

Question 18

Name one cause of anterior pituitary cause of amenorrhoea

Answer 18

hyperprolactinaemia (prolactin has negative feedback effect on hypothalamus)
primary- prolactinoma, pituitary hyperplasia

secondary- Sheehan’s syndrome

Question 19

How does hypothyroidism cause amenorrhoea

Answer 19

Increased TSH promotes prolactin release, therefore negative feedback on GnRH

Question 20

What are the adrenal causes of amenorrhoea?

Answer 20

cushing’s syndrome
androgen secreting syndrome
congenital adrenal hyperplasia (21-hydroxylase deficiency)

Question 21

How does Cushing’s syndrome result in amenorrhoea?

Answer 21

raised cortisol has negative feedback on GNRH, decreasing oestrogen levels

Question 22

What is the most common cause of primary amenorrhoea?

Answer 22

Turner’s syndrome

Question 23

What is the most common cause of secondary amenorrhoea?

Answer 23

PCOS

Question 24

Which criteria is used to diagnosed PCOS?

Answer 24

Rotterdam criteria

Question 25

What does the rotterdam criteria consist of?

Answer 25

2/3 -PCO on US -irregular periods -hirsutism/excessive androgens/ biochemical findings

Question 26

What happens to the levels of LH and FSH in PCOS?

Answer 26

Higher LH relative to FSH

Question 27

Differentials/system for amenorrhoea?

Answer 27

ovarian hypothalamus thyroid adrenal ant pituitary outflow obstruction

Question 28

Name three hormones you would test for in the hormone profile of amenorrhoea

Answer 28

estrogen progesterone FSH LH Prolactin Testoterone TFTs

Question 29

List three types of abnormal uterine bleeding

Answer 29

heavy menstrual bleeding intermenstrual bleeding postcoital bleeding postmenopausal bleeding amenorrhoea

Question 30

List three questions you should ask in the history of patient with heavy menstrual bleeding

Answer 30

how long? how many pads? clots? intermenstrual bleeding? post coital bleeding?

Question 31

List four differentials for heavy menstrual bleeding?

Answer 31

PALM COINE Polyps Adenomyosis Leiomyoma Malignancy and hyperplasia Coagulopathy Ovulatory dysfunction Iatrogenic Not yet classified Endometrial

Question 32

Which is the most common coagulopathy?

Answer 32

von willebrand disease

Question 33

List three investigations for heavy menstrual bleeding

Answer 33

TFTs FBC Coag Transvaginal US Endometrial biopsy

Question 34

List three options for management of heavy menstrual bleeding

Answer 34

tranexamic acid NSAIDs OCP Mirena Myomectomy Hysterectomy Uterine artery embolisation