Menstrual Dysfunction & DUB

Question 1

What is menorrhagia?

Answer 1

Prolonged and increased menstrual flow

Question 2

Metorrhagia?

Answer 2

Regular intermenstrual bleeding

Question 3

Polymenorrhoea?

Answer 3

Menses occurring at <21 day interval

Question 4

Polymenorrhagia?

Answer 4

Increased bleeding and frequent cycle

Question 5

Menometrorrhagia?

Answer 5

Prolonged menses and intermenstrual bleeding

Question 6

Amenorrhoea?

Answer 6

Absence of menstruation of >6 months in someone who has previously had period (secondary) or if girl hasn’t had period by age 16

Question 7

Oligomenorrhoea?

Answer 7

Menses at intervals of >35 days

Question 8

Organic causes of menorrhagia (local)?

Answer 8

• Fibroids
• Adenomyosis
• Polyps
• Cervical eversion
• Endometrial hyperplasia
• IUD
• PID
• Endometriosis
• Malignancy
• Hormone producing tumours
• Trauma
• AVM of endometrium

Question 9

Systemic organic causes of mennorhagia?

Answer 9

Hypothyroidism
Prolactin disorders 
Adrenal disease 
Bleeding disorders 
PCOS

Question 10

Pregnancy related organic causes of menorrhagia?

Answer 10

• Miscarriage
• Ectopic pregnancy
• Gestational trophoblastic disease
• Post partum haemorrhage

Question 11

What type of diagnosis is dysfunctional uterine bleeding?

Answer 11

Diagnosis of exclusion and usually caused by hormonal imbalance and disturbed oculation

Question 12

2 main types of DUB?

Answer 12

Anovulatory

Ovulatory

Question 13

What is anovulatory DUB?

Answer 13

Irregular cycle
|
More common in obese women
|
No ovulation = isn't adequate changes in hormone levels to cause proper menstruation so can get build up

Question 14

Ovulatory DUB?

Answer 14

• More common in 34-45 y/o

- Regular heavy periods due to inadequate progesterone production by corpus luteum

Question 15

Investigation of DUB?

Answer 15

• FBC
• Cervical smears
• TSH
• Coagulation screens
• Renal function
• LFTs
• Transvaginal US
• Pipelle biopsies

Question 16

Medical management of DUB?

Answer 16

• Oral progesterones
• COCP
• Tranexamic acid
• Mefenamic acid
• GnRH analogues
• Mirena coil

Question 17

What does oral progesterone do?

Answer 17

Taken days 6-26 as progesterone stops bleeding then get withdrawal bleeding

Question 18

What s tranexamic acid?

Answer 18

Antifibrinolytic- only needs to be taken during menstruation

Question 19

What is mefenamic acid?

Answer 19

NSAID

Reduces bleeding because inhibits prostaglandins which endometrium produces a lot during menstruation

Question 20

GnRH is good for reducing risk of?

Answer 20

Osteoporosis

Question 21

When is surgical treatment considered for DUB?

Answer 21

Only if drug treatment and mirena coil have been tried?

Question 22

2 main surgical options?

Answer 22

Endometrial ablation

Hysterectomy

Question 23

Endometrial ablation is 1st line surgical treatment. True or false?

Answer 23

True: fewer complications and shorter recovery

Question 24

What will patient need for and after endometrial ablation?

Answer 24

Smear tests as cervix remains 
Combined HRT (microscopic endometrium may be still left)

Question 25

What would be a risk if combined HRT wasnt taken after endometrial ablation?

Answer 25

Endometrial carcinoma

Question 26

What HRT can a person take if total hysterectomy?

Answer 26

Oestrogen only

Question 27

What is DUB?

Answer 27

Irregular intrauterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to endometrial lining (no organic cause for bleeding)

Question 28

Most cases of DUB happen because of?

Answer 28

Anovolutary cycles

Question 29

Organic causes of AUB?

Answer 29

Enodmetrium: Endometriosis, polyps, miscarraige Myometrium: Adenomyosis, leiomyoma