Menstrual disorder

Question 1

What stimulates FSH and LH release?

Answer 1

GnRH

Question 2

Effects of FSH secretion

Answer 2

Stimulates follicular development, and stimulates granulosa cells to secrete oestrogen

Question 3

What effect does oestrogen secretion have on FSH in the follicular phase and what is the consequence of this?

Answer 3

Negative feedback. Causes atresia of all but the dominant follicle

Question 4

What causes ovulation?

Answer 4

LH surge

Question 5

Main hormone secreted by the corpus luteum

Answer 5

Progesterone

Question 6

When does luteolysis occur and what happens as a result of this?

Answer 6

Around 14 days post ovulation; causes menstruation to begin

Question 7

Menorrhagia

Answer 7

Prolonged and increased menstrual blood loss

Question 8

Increased bleeding and frequent cycle

Answer 8

Polymenorrhagia

Question 9

Amenorrheoa

Answer 9

Absence of menstruation for more than 6 months

Question 10

Oligomenorrhoea

Answer 10

Menses at intervals of more than 35 days

Question 11

Causes of organic menorrhagia (local) (6)

Answer 11

Fibroids
IUCD
Pelvic inflammatory disease
Endometriosis
Tumours
Adenomyosis

Question 12

What is adenomyosis?

Answer 12

Presence of glandular tissue within the myometrium

Question 13

Systemic causes of menorrhagia (2)

Answer 13

Hypothyroidism

Disorders of haemostasis

Question 14

Pregnancy related causes of menorrhagia (2)

Answer 14

Miscarriage

Ectopic pregnancy

Question 15

What is dysfunctional uterine bleeding?

Answer 15

Heavy and/or abnormal bleeding in absence of known pathology

Question 16

Two subtypes of DUB

Answer 16

85% anovulatory- extremes of reproductive life.

15% ovulatory- regular heavy periods due to inadequate secretion by corpus luteum

Question 17

Specific investigations in menorrhagia

Answer 17

FBC
Cervical smear
TSH
Coagulation
Transvaginal ultrasound
Endometrial sampling

Question 18

First-line medical therapy for DUB

Answer 18

Mirena (IUS)

Question 19

Second-line medical therapy for DUB (3)

Answer 19

Combined oral contraceptive
Antifibrinolytics
Antiprostaglandins

Question 20

Tranexamic acid is an example of a…

Answer 20

Antifibrinolytic

Question 21

Mefanamic acid is an example of a

Answer 21

Antiprostaglandin

Question 22

Third-line medical therapy for DUB

Answer 22

GnRH analogues

Question 23

Surgical management of DUB (2)

Answer 23

Endometrial resection/ablation

Hysterectomy

Question 24

Physiological causes of amenorrhoea? (4)

Answer 24

Pregnancy
Lactation
Menopause
Pre-menarche

Question 25

Hypothalamic cause of amenorrhoea?

Answer 25

Anorexia

Question 26

Pituitary causes of amenorrhoea? (2)

Answer 26

Pituitary adenoma (non-functioning)
Prolactinoma

Question 27

Ovarian causes of amenorrhoea? (2)

Answer 27

Premature ovarian failure

Polycystic ovarian syndrome

Question 28

Criteria for the diagnosis of polycystic ovarian syndrome? (3)

Answer 28

Two out of:

Polycystic ovaries on imaging (pelvic ultrasound)
Oligo- or amenorrhoea
Biochemical or symptomatic evidence of androgen excess

Question 29

Why should some form of progesterone be prescribed for patients with PCOS? What form can this take?

Answer 29

Unopposed high levels of oestrogen predispose to endometrial cancer

Mirena IUS
COCP (if not contraindicated)
Three-monthly medroxyprogesterone to induce a withdrawal bleed