abnormal bleeding

What triggers the shedding of the uterine lining through the vagina in a normal menstrual cycle? [2]

Menstruation occurs due to progesterone withdrawal following failure of fertilisation, causing the uterine lining to shed.

What is the average rhythm (cycle length) of normal menstruation, and what is considered a regular range? [2]

Average: 28 days.Regular range: 21–35 days.

What is the normal duration of menstrual bleeding? [2]

3–7 days.

What is the typical volume of blood lost during a normal menstrual period? [3]

30–50 ml.

What are the characteristic features of normal menstrual flow? [3]

It is non-clotted fluid blood.

How is Menorrhagia defined? [5]

Heavy or prolonged menstrual bleeding, characterized by a loss of more than approximately 80 ml of blood or bleeding lasting > 7 days.

What is the definition of Metrorrhagia? [6]

Intermenstrual bleeding; bleeding that occurs between periods and is not associated with the menstrual cycle.

What is Polymenorrhea? [7]

A menstrual cycle abnormality where uterine bleeding occurs at intervals of less than 21 days.

What is Oligomenorrhea? [8]

Infrequent menstrual periods occurring at long intervals of > 35 days (resulting in fewer than six to eight periods per year).

What was Abnormal Uterine Bleeding (AUB) previously called, and what is its primary cause? [10]

Formerly called Dysfunctional Uterine Bleeding (DUB).Main cause: Imbalance in sex hormones.

AUB is broadly divided into which two categories based on the ovulation cycle? [10]

1. Ovulatory bleeding.2. Anovulatory bleeding.

What are the common causes of Ovulatory AUB? [11]

Luteal phase defects, irregular corpus luteum function, and imbalanced progesterone.

Describe the pathophysiology of Anovulatory AUB. [12]

The corpus luteum does not form, resulting in no progesterone secretion. Estrogen acts unopposed, causing continuous endometrial proliferation until it outgrows its blood supply, leading to irregular or heavy bleeding.

At which stages of reproductive life is Anovulatory AUB most common? [13]

At the extremes of reproductive age, including early puberty and perimenopause.

In younger patients, which system’s disorders often contribute to anovulatory bleeding? [13]

The hypothalamic–pituitary system.

What is the “Important Note” regarding the first step in managing any woman of reproductive age with abnormal bleeding? [15]

Rule out pregnancy first.

What are the three broad categories of causes for abnormal bleeding? [16]

Organic causes, Iatrogenic causes, and Systemic disease.

What is Polycystic Ovary Syndrome (PCOS)? [17]

A common disorder where ovaries contain multiple fluid-filled follicles that fail to ovulate, causing anovulation and hormonal imbalance.

Which clinical sign is associated with excess androgen in PCOS? [17]

Hirsutism (excess facial or body hair).

According to the Rotterdam criteria, how many criteria must be met to diagnose PCOS? [18]

2 out of 3 criteria after excluding other diagnoses.

What are the specific cycle length requirements for irregular cycles under the Rotterdam criteria? [18]

Cycles > 35 days or < 21 days, < 8 cycles/year, or > 90 days for any single cycle.

What are the three Rotterdam criteria for PCOS diagnosis? [18]

Irregular cycles, hyperandrogenism (clinical or biochemical), and polycystic ovarian morphology on ultrasound or high AMH.

At what time in the menstrual cycle should initial hormonal investigations be completed? [19]

During the early follicular phase (Day 2–4).

What are the suggested initial investigations for suspected PCOS? [19]

Prolactin, TSH, LH, FSH, estradiol, β-hCG, 17-OHP, testosterone, AMH, and transvaginal ultrasound.

What is the surgical gold standard for managing symptomatic uterine polyps? [29]

Hysteroscopic polypectomy.