Menstrual Disorders

Question 1

Name 2 gonadotrohpic hormones.

Answer 1

LH and FSH

Question 2

Name 2 ovarian hormones.

Answer 2

Oestrogen and progesterone

Question 3

What cells make oestrogen?

Answer 3

Granulosa cells

Question 4

What does FSH stimulate?

Answer 4

Ovarian follicle development and the production of oestrogen by granulosa cells

Question 5

What inhibits FSH production?

Answer 5

Raising oestrogen and inhibin by dominant follicles

Question 6

What do declining FSH levels cause?

Answer 6

Atresia of all but dominant follicle

Question 7

When does ovulation occur (in relation to LH surge)?

Answer 7

Ovulation occurs after the LH surge

Question 8

What happens in ovulation?

Answer 8

The dominant follicle ruptures and releases oocyte

Question 9

What does the luteal phase involve the formation of?

Answer 9

Corpus luteum

Question 10

What hormones is produced in the luteal phase?

Answer 10

Progesterone

Question 11

When does luteolysis occur?

Answer 11

14 days post ovulation

Question 12

On what day of ovulation does your period usually start?

Answer 12

14 (when luteolysis occurs)

Question 13

What happens to the endometrium in the proliferative phase?

Answer 13

There is oestrogen-induced growth of endometrial glands and stroma

Question 14

Describe the luteal phase of the menstrual cycle.

Answer 14

• Progesterone-induced glandular secretory activity.
• Decidualisation in LATE SECRETORY phase.
• Endometrial apoptosis and subsequent menstruation.

Question 15

What happens to the endometrium during menstruation?

Answer 15

There is arteriolar constriction, and shedding of the functional endometrial layer

Question 16

What inhibits scar tissue formation during menstruation\?

Answer 16

Fibrinolysis

Question 17

How long does menstrual loss usually last?

Answer 17

4-6 days

Question 18

When does menstrual flow peak?

Answer 18

Days 1-2

Question 19

What volume of blood is lost per menstruation?

Answer 19

<80ml.

Question 20

What is abnormal in terms of bleeding?

Answer 20

Clots and flooding

Question 21

How long does a menstrual cycle usually last?

Answer 21

28 days +/- 7 days

Question 22

Postcoital bleeding is ________

Answer 22

abnormal

Question 23

What is menorrhagia?

Answer 23

Prolonged and increased menstrual flow

Question 24

The causes of menorrhagia can be organic or non-organic

Answer 24

TRUE

Question 25

Organic causes

Answer 25

There is pathology

Question 26

Non-organic causes

Answer 26

No pathology

Question 27

What is 50% of all cases of non-organic causes of menorrhagia?

Answer 27

Dysfunctional uterine bleeding

Question 28

Describe what you would see on a transvaginal USS of someone with endometriosis.

Answer 28

* Red or black spots. * Blood can’t escape, and causes an inflammatory reaction. * CHOCOLATE CYSTS!!!

Question 29

What is a fibrinoid?

Answer 29

Benign tumour of the myometrium which results in the uterus being much larger than normal Don’t usually cause pain, but do result in painful periods

Question 30

What is adenomyosis?

Answer 30

Where there is endometrium present in the muscle of the uterus Bleeding around this tissue each month causes a lot of pain.

Question 31

Describe endometrial hyperplasia.

Answer 31

Excessive proliferation which can go on to cause endometrial carcinoma.

Question 32

Where can endometriosis occur?

Answer 32

Anywhere in the peritoneal cavity, outside the uterus

Question 33

What do tumours of granulosa cells produce?

Answer 33

Oestrogen

Question 34

List local causes of organic menorrhagia.

Answer 34

* Fibrinoid * Adenomyosis * Endocervical/endometrial polyp * Cervical eversion * Endometrial hyperplasia * IUCD * PID * Endometriosis * Malignancy of cervix or uterus * Trauma

Question 35

Name 4 endocrine disorders which can cause organic menorrhagia.

Answer 35

Hyper/hypothyroidism. Diabetes mellitus. Adrenal disease. Prolactin disorders

Question 36

What drugs can cause menorrhagia?

Answer 36

Anticoagulants

Question 37

What proportion of women with abnormal uterine bleeding have DUB?

Answer 37

50%

Question 38

How is the diagnosis of DUB made?

Answer 38

By exclusion

Question 39

DUB can be divided into 2 groups. What are these?

Answer 39

Anovulatory + Ovulatory

Question 40

What percentage of DUB is anovulatory?

Answer 40

85%.

Question 41

When does anovulatory DUB occur?

Answer 41

At extremes of reproductive life

Question 42

What is the cycle like in 'anovulatory DUB'?

Answer 42

Irregular

Question 43

Who gets anovulatroy DUB?

Answer 43

Obese women

Question 44

Who gets ovulatory DUB?

Answer 44

Women aged 35-45 years.

Question 45

What does ovulatory DUB occur due to?

Answer 45

Inadequate progesterone production by the corpus luteum

Question 46

Why is TSH level checked when investigating DUB?

Answer 46

To exclude hyperthyroidism which is associated with amenorrhoea

Question 47

When should you do a transvaginal USS?

Answer 47

If you suspect a pelvic mass

Question 48

What can a transvaginal USS be used for?

Answer 48

Measuring endometrial thickness (to exclude endometrial carcinoma). To identify the presence of fibroids and other pelvic masses.

Question 49

What are the 3 forms of endometrial sampling?

Answer 49

* Pipelle biopsies * Hysteroscopic directed * Dilatation and curettage (D+C)

Question 50

Give examples of medical treatments of DUB.

Answer 50

* Progestogens * Combined oral contraceptive pill * Danazol * GnRH analogues * Non-steroidal anti-inflammatory drugs (NSAIDs) * Anti-fibrinolytics * Capillary wall stabilisers

Question 51

What is the best drug to use in the treatment of DUB?

Answer 51

Tranexamic acid

Question 52

Outline the 1st and 2nd line in the treatment of DUB.

Answer 52

``` 1st line: mirena IUS. 2nd line: Non-hormonal meds e.g. tranexamic acid, NSAIDs. Hormonal meds e.g. COC, POP. ```

Question 53

What are the 2 surgical options in the management of DUB?

Answer 53

Endometrial resection/ablation. | Hysterectomy

Question 54

Endometrial ablation should be offered first, rather than a hysterectomy

Answer 54

TRUE