Menstrual Disorders

Question 1

define endometriosis

Answer 1

a disorder causing the growth of endometrium-like tissue on the outside the uterine cavity

Question 2

risk factors of endometriosis

Answer 2

early menarche 
late menopause 
delayed childbearing 
FH of endometriosis 
late first sexual encounter

Question 3

clinical features of endometriosis

Answer 3

dysmenorrhoea 
dyspareunia (painful intercourse)
subfertility 
chronic pelvic pain
cyclical GI and/or urinary symptoms

Question 4

possible examination findings in endometriosis

Answer 4

reduced organ motility + enlargement
tender modularity of posterior vaginal fornix
visible vaginal endometriotic lesions

Question 5

investigations of endometriosis

Answer 5

bloods (FBC, U+Es + β-hCG)
transvaginal US
MRI pelvis
laparoscopy

Question 6

medical management of endometriosis

Answer 6

analgesia 
artificial menopause (e.g. COCP or GnRH agonists)

Question 7

surgical management of endometriosis (preserving fertility)

Answer 7

laparoscopic excision via a laparoscopic diathermy and adhesiolysis

Question 8

surgical management of endometriosis (no preservation of fertility)

Answer 8

hysterectomy with salpingo-oopherectomy

Question 9

define menorrhagia

Answer 9

episodes of regular excessive blood loss that cause interference with a patient’s daily life

Question 10

define excessive blood loss in cases of menorrhagia

Answer 10

a loss of 80ml or more or a menstrual cycle lasting >7 days
having to change menstrual products every 1-2hrs
passage of clots >2.54cm

Question 11

clinical features of menorrhagia

Answer 11

excessive heavy blood flow
intermenstural bleeds
post-coital bleeds +/- dyspareunia
pelvic pain

Question 12

additional questions to ask those experiencing menorrhagia

Answer 12

cycle regularity and length 
menarche age 
cervical screening history 
sexual history 
medical history 
drug history

Question 13

investigations of menorrhagia

Answer 13

bloods (FBC + U+Es)

transvaginal US

Question 14

additional investigations of menorrhagia if have specific clinical suspicion

Answer 14

TFTs
clotting factors
hysteroscopy
vaginal or cervical swab

Question 15

medical management of menorrhagia if no underlying pathology or fibroids < 3cm

Answer 15

levonogestrel intrauterine system (e.g. Mirena Coil)
tranexamic acid
cyclical oral progestogen

Question 16

medical management of menorrhagia if fibroids > 3cm

Answer 16

specialist referral
tranexamic acid + NSAID
myomectomy or hysterectomy

Question 17

define premature ovarian insufficiency syndrome (POI)

Answer 17

the development of menopause in women below 40yrs of age

Question 18

describe the characteristic symptoms of POI

Answer 18

amenorrhoea
elevated gonadotrophins
oestrogen insufficiency

Question 19

clinical features of POI

Answer 19

amenorrhoea
hot flushes
vaginal dryness
vasomotor symptoms

Question 20

investigations of POI

Answer 20

bloods (FBC, TFTs, serum FSH, estradiol, prolactin + AMH)

DXA bone scan

Question 21

common findings in FSH levels in POI

Answer 21

FSH > 40IU/L in two samples taken 4wks apart

Question 22

conservative management of POI

Answer 22

education of patient

advise healthy lifestyle and dietary measures (e.g. Vitamin D and calcium)

Question 23

medical management of POI

Answer 23

HRT until menopausal age