menstrual disorders

Question 1

What is a menstrual cycle

Answer 1

time from the first day of period to the day before her next period

Question 2

What is the normal blood loss in menstruation

Answer 2

less than 80ml over 7 days

Question 3

How long does a cycle last

Answer 3

28 days

Question 4

When is the menarche (first menstrual period)

Answer 4

10-16 years - 12 years average

Question 5

When is menopause usually

Answer 5

Lat period - 50-55 years

Question 6

Describe the menstrual cycle with regards to hormones

Answer 6

FSH which is released from the pituitary gland which then causes the production of estrogen

The follicles of the ovary start to develop but only one begins to mature – the dominant follicle

There is a LH surge which causes ovulation

Following the LH surge, the estrogen starts to decrease while the progesterone begins to increase

Question 7

What is a sign that someone is having heavy menstrual bleeding

Answer 7

Clots are seen in the menstrual bleeding

Question 8

What are the causes of heavy menstrual bleeding

Answer 8

Uterine fibroids

Endometrial polyps

Endometriosis and adenomyosis
Pelvic inflammatory disease or infections e.g chlamydia

Endometrial hyperplasia or carcinoma

Polycystic ovary syndrome

Coagulation disorders

Hypothyroidism

Renal or liver disease

Question 9

What are fibroids

Answer 9

Non cancerous growths made of muscle or fibrous tissue - also known as a myoma

Question 10

What are the symptoms caused by fibroids

Answer 10

Heavy menstrual bleeding, Pelvic pain, urinary symptoms, pressure symptoms, backache, infertility and miscarriage

Asymptomatic

Question 11

How are fibroids diagnosed

Answer 11

Ultrasound

Question 12

What is the treatment for large fibroids with preservation of fertility desired

Answer 12

Fibroid embolisation or myomectomy

Question 13

What is the treatment for submucosal fibroids

Answer 13

Hysteroscopic fibroid resection

Question 14

What is the treatment for Heavy menstrual bleeding and small fibroids

Answer 14

COCP

POP

Mirena

Question 15

What is a myomectomy

Answer 15

Surgery to remove uterine fibroids

Question 16

What is endometriosis

Answer 16

Endometrial tissue present outside the lining of the uterus - this tissue behaves like the endometrium during menstruation and bleeds

Question 17

What are the symptoms of endometriosis

Answer 17

Heavy menstrual bleeding, painful menstrual clamps that progressively get worse, infertility, fatigue and systemic symptoms, painful bowel movements or urination, pain during or after intercourse, abnormal bleeding or spotting in between menstrual periods, diarrhoea, nausea and bloating, lower back pain

Question 18

Describe the stage 1 of endometriosis

Answer 18

Minimal - surface lesions or inflammation around pelvic organs in the pelvic cavity

Question 19

Describe stage 2 of endometriosis

Answer 19

Mild - infiltrating pelvic organs and more widespread than stage 1

Question 20

Describe stage 3 endometriosis

Answer 20

Moderate - Peritoneum (pelvic side walls) and other structures affected - sometimes there is scarring

Question 21

Describe stage 4 endometriosis

Answer 21

Infiltrative and affecting many pelvic organs and ovaries often with distortion of the anatomy

Question 22

What is the treatment for endometriosis

Answer 22

Analgesia

COCP, POP, Mirena IUS, GnRH analogues

Surgical - ablation, hysterectomy endometrioma excision, pelvic clearance, hysterectomy

Question 23

What is adenomyosis

Answer 23

Condition in which the endometrium becomes embedded in the myometrium

Question 24

What are the symptoms of adenomyosis

Answer 24

Heavy menstrual bleeding

Dysmenorrhoea

Partial response to hormones

Question 25

What is the definitive treatment for adenomyosis

Answer 25

Hysterectomy

Question 26

What are endometrial polyps

Answer 26

Overgrowth of endometrial lining leading to pediculated structures called polyps which extend into the endometrium

Question 27

How are endometrial polyps diagnosed

Answer 27

Mainly ultrasound

Question 28

What is the management of polyps

Answer 28

Polypectomy

Question 29

What is the function of tranexamic acid

Answer 29

Reduces blood loss by 60%

Question 30

What is the function of mefenamic acid

Answer 30

Reduces blood loss 30% and pain

Question 31

What is the function of the combined oral contraceptive pill (COCP) with regards to periods

Answer 31

Makes periods lighter, regular and less painful

Question 32

What is the function of LNG IUS and Depo-provera

Answer 32

Reduces bleeding but can cause irregular bleeding and make some women amenorrhoeic

Question 33

What is the function of oral progesterone with regards to periods

Answer 33

reduce bleeding and regulate period

Question 34

What is hysterectomy

Answer 34

Surgical removal of the uterus

Question 35

What does hysterectomy guarantee with regards to periods

Answer 35

Amenorrhoea

Question 36

What is a salpingo-oophorectomy

Answer 36

Removal of tubes and ovaries

Question 37

What are the advantages and disadvantages of oophorectomy

Answer 37

Disadvantage - Immediate menopause Advantage - reduced risk ovarian cancer

Question 38

What is oligomenorrhoea

Answer 38

Infrequent periods

Question 39

What is amenorrhoea

Answer 39

Absent periods

Question 40

What is polycystic ovary syndrome

Answer 40

2/3 of the following: Ultrasound appearance of ovary Clinical hyperandrogegism e.g excess facial hair Biochemical hyperandrogegism

Question 41

What is polycystic ovarian syndrome linked with

Answer 41

Infertility and obesity

Question 42

What is the treatment for polycystic ovarian syndrome

Answer 42

Symptom based treatment: COCP, POP, Mirena IUS

Question 43

Why are 3 periods required a year at least for polycystic ovarian syndrome

Answer 43

To prevent endometrial hyperplasia

Question 44

What is dysfunctional uterine bleeding

Answer 44

Common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or systemic disease