Disorders of Menstruation

Question 1

What is amenorrhoea?

Answer 1

Primary = failure to establish menstruation by 16

Secondary = cessation of previously normal menstruation

Causes = preg, pathology at various endocrine levels

Question 2

Outline oligomenorrhoea

Answer 2

Infrequent menstruation

4-9x a year

Question 3

What is menorrhagia?

Answer 3

Excessive menstrual blood loss over consecutive cycles

Or >80ml per cycle

Causes = fibroids, polyps, endometrial cancer, copper IUCD, drugs (warfarin)

Question 4

Outline some causes of irregular vaginal bleeding

Answer 4

Change in usual pattern

Causes = STIs, cervical ectopy, endometrial pathology, ovarian cyst (hormone secreting type)

Question 5

What is dysmenorrhoea?

Answer 5

Painful

Primary = idiopathic

Secondary = endometriosis, obstructed menses

Question 6

What is endometriosis?

Answer 6

Endometrial lining is in the incorrect place

Question 7

What is dysfunctional uterine bleeding (DUB)?

Answer 7

Heavy irregular menstrual bleeding secondary to an ovulation

Question 8

What is premenstrual syndrome (PMS)?

Answer 8

Physical or phycological symptoms that resolve with onset of menstruation

Question 9

Outline pre menstrual dysphoric disorder

Answer 9

Severe form of PMS

Extreme mood symptoms

Question 10

Outline some common causes for the disorders of menstruation

Answer 10

Hormonal = HPO axis

Chromosomal = Turners syndrome (ovary not responding to FSH/LH), congenital adrenal hyperplasia

Structural = polyps, agenesis at any level of genital tract, leiomyoma (fibroids), imperforate hymen, cervical stenosis

Drugs

Thyroid disease

Chronic illness

Question 11

What questions are important in a history when investigating disorder of menstruation?

Answer 11

Age

Onset of puberty

Pain – cyclical or not

Menstrual history – volume, cycle

Sexual history

Medical history

Question 12

What factors should be examined when investigating disorders of menstruation?

Answer 12

General

Abdo

Speculum

Bimanual

Secondary sexual characteristics

Appearance of chromosomal abnormalities

Swelling, discharge, pattern of hair growth

Question 13

Outline the investigations used when investigating disorders of menstruation

Answer 13

Bloods = FSH, LH, karyotype, thyroid function test, FBC

Imaging = USS, MRI

Hysteroscopy = camera inside uterus

Laparoscopy = camera inside the abdo, panoramic view of the pelvis