WEEK 12 MENSTRUAL HISTORY

Question 1

When should one take a menstrual history?

Answer 1

• when taking a full gynaecological or obstetric history
• when a patient presents with a problem related to their menstrual cycle
• when a female patient presents with abdominal pain
• when a female patient presents with symptoms suggestive of pregnancy/fertility problems
• when you are considering a particular endocrine cause for a female patient’s symptoms
• when you are considering a complication from blood loss such as iron deficiency anaemia

Question 2

define menarche

Answer 2

onset of first menstruation

Question 3

define menopause

Answer 3

final menstrual period

Question 4

define amenorrhea

Answer 4

absence of menstruation

Question 5

define oligomenorrhea

Answer 5

infrequent periods with fewer than 9 cycles in 1 year

Question 6

define abnormal uterine bleeding

Answer 6

uterine bleeding of abnormal quantity, duration or schedule

Question 7

define heavy menstrual bleeding

Answer 7

excessive menstrual bleeding that interferes with physical, emotional quality of life

Question 8

define dysmenorrhea

Answer 8

painful menstrual bleeding

Question 9

What questions do you ask in a menstrual history for the presenting complaint?

Answer 9

• age at menarche / date of menopause
• date of the start of last menstrual period
• menstrual cycle length - no of days between periods
• are cycle lengths regular or irregular
• assessment of bleeding pattern
• pain associated with period
• any recent changes to menstrual cycle
• pregnancy history, no of pregnancies, miscarriages, births

Question 10

What is a normal cycle length (no of days between periods)

Answer 10

21-42 days

Question 11

how many days does menstruation normally last?

Answer 11

4-7 days

Question 12

what is total blood loss per period?

Answer 12

30-80 mls

Question 13

What are example questions to ask?

Answer 13

when was the first day of your last period?
how many days do your periods typically last?
how many days is it between your periods?
is your cycle length regular?
how often do your periods occur?
is there any bleeding between your periods?
are your periods particularly painful or does the pain interrupt your daily activities?
How old were you when you had your first period?
How old were you when you went through menopause?

Question 14

How can you quantify heavy menstrual bleeding in a history?

Answer 14

how frequently do you change pads or tampons?
are you passing blood clots larger than a 50c coin?
have you been flooding through your sanitary protection?
has there been a change in the flow of your periods? have they become heavier than normal recently?

Question 15

What questions might you have to ask regarding a pregnancy history?

Answer 15

• have you had any pregnancies in the past?
• how many pregnancies have you had?
• dates of pregnancies
• birth weight of any live births
• any assisted reproductive therapies?
• what was the outcome of the pregnancy ?
• any complications during the pregnancy or during delivery?
• means of delivery