O&G written - Menstrual disorders

Question 1

Causes of abnormal uterine bleeding

Answer 1

PALM COEIN

Polyps
Adenomyosis
Leiomyoma (fibroids)
Malignancy

Coagulopathy
Ovulatory dysfunction - PCOS, hypothyroid
Endometriosis
Iatrogenic
Not classified

Question 2

Medical management of menorrhagia / heavy menstrual bleeding

Answer 2

1st line = LNG-IUS

If wanting fertility / 1st line not suitable

• Antifibrinolytic e.g., Tranexamic acid
• NSAIDs e.g. mefenamic acid

Other contraceptive options:

• COCP
• oral progestogens e.g. norethisterone - will cause withdrawal bleed
• GnRH agonists - use limited to 6 months unless add back HRT used

Question 3

Medical management of primary dysmenorrhoea

Answer 3

1st line = NSAIDs (or paracetamol if contraindicated)

Alternative (if not desiring fertility) = COCP

2nd line = NSAIDs + Paracetamol

Question 4

Medical management options for Pre-menstrual syndrome

Answer 4

COCP
Oestrogen HRT patches (100ug)
Cyclical oral or vaginal progestogens
GnRH agonists + add back oestrogen HRT

SSRI - continuous or luteal

Question 4

Medical management options for Pre-menstrual syndrome

Answer 4

COCP
Oestrogen HRT patches (100ug)
Cyclical oral or vaginal progestogens
GnRH agonists + add back oestrogen HRT

SSRI - continuous or luteal

Question 5

Conservative Tx of pre-menstural syndrome

Answer 5

Exercise, diet
Reduce smoking, EtOH, alcohol
Evening primrose oil - breast tenderness
Pyridoxine (vitamin B6)

CBT?