Lecture 6: Menstrual irregularities and abnormal vaginal bleeding

A normal menstrual cycle length is [...] to [...] days

21, 35

Normal menstrual bleeding duration is [...] days or less

7

Menstrual blood loss is considered abnormal if it exceeds [...] mL

80

The first half of the menstrual cycle is the [...] phase, dominated by [...]

proliferative, oestrogen

The second half of the menstrual cycle is the [...] phase, dominated by [...]

secretory, progesterone

Ovulation typically occurs [...] days before the next period

14

The HPO axis relies on the [...] release of GnRH from the hypothalamus

pulsatile

In the HPG axis, a sustained high level of oestrogen triggers [...] feedback, causing an LH surge

positive

The absolute first priority in evaluating any reproductive-age woman with AUB is to [...]

exclude pregnancy

A patient reporting soaking through clothes or bedding is experiencing a symptom called [...]

flooding

[...] is the mainstay imaging investigation for evaluating uterine and ovarian pathology

Pelvic ultrasound

Endometrial sampling (Pipelle) is mandatory in AUB patients aged [...] or older

35

Primary amenorrhoea is defined as no menses by age [...] if secondary sexual characteristics are present

15

Primary amenorrhoea is diagnosed at age [...] if secondary sexual characteristics are absent

13

Secondary amenorrhoea is the cessation of menses for [...] months in a woman with previously regular cycles

3

In women with previously irregular cycles, secondary amenorrhoea is defined as no menses for [...] months

6

Asherman Syndrome involves intrauterine [...] causing secondary amenorrhoea

adhesions, scarring

Structural causes of AUB are categorized by the acronym [...]

PALM

Functional/Non-structural causes of AUB are categorized by the acronym [...]

COEIN

A [...] is a structural overgrowth of the endometrium, often diagnosed via hysteroscopy

polyp

[...] is defined as the presence of endometrial glands and stroma within the myometrium

Adenomyosis

The classic clinical triad of adenomyosis includes heavy bleeding, [...], and a globular uterus

dysmenorrhoea

[...] (fibroids) are benign smooth muscle tumors of the uterus

Leiomyomas

The type of fibroid most likely to cause heavy menstrual bleeding is the [...] fibroid

submucosal

Post-coital bleeding (PCB) and foul-smelling discharge are red flags for [...]

cervical cancer

The primary risk factor for endometrial cancer is obesity leading to [...] oestrogen exposure

unopposed

Clues for [...] in AUB include easy bruising, petechiae, and bleeding after dental procedures

coagulopathy

The most common cause of ovulatory dysfunction (AUB-O) in young women is [...]

PCOS

AUB-O in PCOS typically presents as a period of [...] followed by heavy, prolonged bleeding

amenorrhoea

[...] AUB is caused by medications such as anticoagulants or hormonal contraceptives

Iatrogenic

[...] acid is a non-hormonal treatment that reduces bleeding by promoting clot formation

Tranexamic

NSAIDs reduce menstrual blood loss by [...] to [...] percent

30, 40

The [...] is the gold standard medical treatment for AUB-E and AUB-O

Levonorgestrel IUD, Mirena

A [...] is the surgical removal of fibroids that preserves future fertility

myomectomy

[...] is a surgical procedure that destroys the uterine lining and is contraindicated in those desiring fertility

Endometrial ablation

The definitive surgical management for AUB, reserved as a last resort, is [...]

hysterectomy

A 27-year-old with a BMI of 36, hirsutism, and acne most likely has AUB due to [...]

PCOS, ovulatory dysfunction

A 33-year-old with infertility and a 24-week size firm, mobile abdominal mass likely has [...]

leiomyoma, fibroids

Any patient presenting with post-coital bleeding must undergo a [...] and [...] test

Pap smear, HPV

Chronic AUB commonly leads to [...] anaemia, which is investigated with a Full Blood Count

iron deficiency