Menstrual Disorders Practice Questions

Q: Which of the following is NOT a cause of metrorrhagia?

Intramural fibroid. ***Intramural fibroid*** - **Intramural fibroids** are located within the uterine wall and are **primarily associated with menorrhagia** (heavy or prolonged menstrual bleeding during regular periods) rather than metrorrhagia. - Their main effect is to increase the endometrial surface area and impair uterine contractility, leading to **heavy regular menstrual flow**. - While they can occasionally cause irregular bleeding if complicated by degeneration or severe distortion, this is **not their typical presentation**, making them the **least characteristic cause** of metrorrhagia among the given options. *Polyp* - **Endometrial polyps** are **classic causes of metrorrhagia** because their friable surface bleeds irregularly, especially with hormonal fluctuations or minor trauma. - They commonly present with **intermenstrual spotting** and post-coital bleeding, making them a typical cause of irregular bleeding. *CA endometrium* - **Endometrial carcinoma** is a **frequent cause of metrorrhagia**, particularly in postmenopausal women, due to irregular shedding of friable malignant tissue. - The abnormal vascular supply and tissue breakdown in cancer results in **unpredictable, irregular bleeding episodes** characteristic of metrorrhagia. *IUD* - **Intrauterine devices** are **well-known causes of metrorrhagia**, particularly copper IUDs, which cause endometrial irritation and increased prostaglandin release. - Both copper and hormonal IUDs frequently cause **spotting and irregular intermenstrual bleeding**, especially in the first 3-6 months after insertion.

Q: Oligomenorrhoea means ?

Cycle longer than 35 days. ***Cycle longer than 35 days*** - **Oligomenorrhea** is defined by menstrual cycles that are **infrequently occurring**, specifically lasting longer than 35 days. - This condition is distinct from **amenorrhea**, which is the complete absence of menstruation. *Cycle < 20 days* - A menstrual cycle lasting less than 20 days is considered **polymenorrhea**, indicating abnormally frequent menstruation. - This is the opposite of oligomenorrhea, which refers to infrequent menstruation. *Cycle more than 45 days* - While a cycle longer than 45 days would technically fall under **oligomenorrhea**, the general definition begins at an interval longer than **35 days**. - Cycles significantly longer than 45 days might also point to **amenorrhea**, depending on the exact duration and pattern. *Cycle more than 28 days* - A cycle lasting more than 28 days is within the **normal range** for many individuals, as the average cycle length is 21-35 days. - Therefore, this duration alone does **not define oligomenorrhea**.

Q: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Insufficient progesterone due to anovulation. ***Insufficient progesterone due to anovulation*** - Anovulation prevents the formation of a **corpus luteum**, which is responsible for producing progesterone. - The lack of progesterone leads to an **unstable, proliferative endometrium** that eventually sheds irregularly, causing abnormal uterine bleeding. - This is the **primary hormonal defect** in anovulatory DUB. *Excess estrogen production from ovarian follicles* - While **unopposed estrogen** is present in anovulatory cycles, the primary issue is the *absence of progesterone*, not necessarily excess estrogen production. - Estrogen levels may be normal or even low, but without progesterone to stabilize the endometrium, irregular shedding occurs. - Excess estrogen primarily leads to **endometrial hyperplasia** rather than irregular bleeding. *Hypothalamic dysfunction affecting ovulation* - Hypothalamic dysfunction (e.g., due to stress, extreme exercise) can be an *underlying cause* of anovulation. - However, the *primary hormonal mechanism* of the bleeding itself is the subsequent lack of progesterone, not the hypothalamic dysfunction directly. *High levels of progesterone due to luteal phase defect* - A **luteal phase defect** involves *insufficient* progesterone production or response, not high levels. - High progesterone levels would stabilize the endometrium and promote regular shedding, preventing DUB.

Q: What is the most common age range for women experiencing dysfunctional uterine bleeding?

40-45 years. ***40-45 years*** - This age range typically represents the **perimenopausal period**, where fluctuating hormones (estrogen and progesterone) often lead to anovulatory cycles and thus, **dysfunctional uterine bleeding (DUB)**. - As women approach menopause, ovarian function becomes irregular, leading to inconsistent ovulation and endometrial instability. - This is the **most common age range** for DUB due to hormonal instability. *50-55 years* - While some women may still experience DUB into their early 50s, this range is more commonly associated with **menopause itself**, where bleeding generally ceases. - Persistent bleeding in this age group may signal other pathologies rather than typical anovulatory DUB. *60-65 years* - Bleeding at this age is considered **postmenopausal bleeding** and is always a red flag for serious underlying conditions such as **endometrial hyperplasia** or **endometrial cancer**, and is not attributed to DUB. - The ovaries have typically ceased functioning, and there should be no normal menstrual bleeding. *20-25 years* - DUB can occur in this age range due to factors like **polycystic ovary syndrome (PCOS)** or **immature hypothalamic-pituitary-ovarian axis** (especially in adolescents). - However, it is **less common** than during the perimenopausal period and often stems from different underlying causes.

Q: A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?

Asherman's syndrome. ***Asherman's syndrome*** - This syndrome is characterized by the formation of **intrauterine adhesions** or scar tissue following uterine trauma, often from repeated **Dilation and Curettage (D&C)** procedures. - The adhesions can prevent the normal growth and shedding of the **endometrial lining**, leading to **secondary amenorrhea** and infertility. *Hypothyroidism* - While hypothyroidism can cause menstrual irregularities, including **amenorrhea**, it would not typically be linked to a history of **repeated D&C procedures**. - The mechanism involves **hormonal imbalances** (e.g., elevated **TRH leading to elevated prolactin**), not scarring of the uterus. *Kallman syndrome* - This is a rare genetic condition causing **hypogonadotropic hypogonadism** and **anosmia** (loss of smell), leading to **primary amenorrhea**. - It does not involve uterine scarring and is not associated with D&C procedures or **secondary amenorrhea**. *Sheehan's syndrome* - Sheehan's syndrome is **postpartum hypopituitarism** caused by **ischemic necrosis of the pituitary gland** after severe hemorrhage during or after childbirth. - It would present with symptoms like **lactation failure** and could cause **secondary amenorrhea**, but it is not related to repeated D&C procedures.

Q: Which of the following drugs is not commonly used for menorrhagia?

Clomiphene. ***Clomiphene*** - **Clomiphene citrate** is a selective estrogen receptor modulator used primarily to **induce ovulation** in women with infertility, not to treat menorrhagia. - Its mechanism involves blocking estrogen receptors in the hypothalamus, leading to increased release of **gonadotropins (FSH and LH)**. - It has no role in the management of heavy menstrual bleeding. *Methergin* - **Methergine (methylergonovine)** is an ergot alkaloid that causes sustained uterine contractions. - It is primarily used for **postpartum hemorrhage** and control of bleeding after abortions (acute obstetric bleeding). - While it can control acute uterine bleeding, it is **not used for chronic menorrhagia management** due to its side effects and availability of better alternatives. - It is an acute intervention, not a treatment for cyclic heavy menstrual bleeding. *GnRH* - **GnRH agonists** (e.g., leuprolide) are used to treat menorrhagia by inducing a **hypoestrogenic state**, which leads to endometrial atrophy and reduced menstrual bleeding. - They are often used as a temporary measure before surgery or for short-term management due to potential side effects like **hot flashes and bone loss**. *NSAIDS* - **Nonsteroidal anti-inflammatory drugs (NSAIDs)**, such as ibuprofen or naproxen, reduce prostaglandin production, which can decrease **menstrual blood loss** by affecting uterine contractility and vasoconstriction. - They are a common first-line treatment for menorrhagia, especially when associated with **painful periods (dysmenorrhea)**.

Q: Preferred treatment for menorrhagia in reproductive age group?

OCPs. ***OCPs*** - **Combined oral contraceptives (OCPs)** are a common and effective first-line treatment for menorrhagia in reproductive-aged women, particularly when contraception is also desired. - They work by stabilizing the **endometrial lining**, reducing menstrual blood loss and regulating cycles. *NOVA T* - NOVA T is a type of **copper IUD (intrauterine device)**, which is known to potentially *increase* menstrual bleeding and dysmenorrhea, making it unsuitable for menorrhagia. - Its primary function is contraception, not the management of heavy menstrual bleeding. *Cu IUD* - The **copper intrauterine device (Cu IUD)** is generally contraindicated in women with menorrhagia because it can exacerbate heavy menstrual bleeding. - While an effective contraceptive, it does not offer therapeutic benefits for managing heavy periods. *Hysterectomy* - **Hysterectomy** is a surgical procedure for removing the uterus and is considered a definitive treatment for menorrhagia. - However, it is an **invasive procedure** with irreversible loss of fertility, typically reserved for severe cases where conservative treatments have failed or when other uterine pathology is present.

Q: Which IUD is preferred for menorrhagia?

Mirena. ***Mirena*** - The **Mirena** IUD contains **levonorgestrel**, a progestin, which significantly reduces menstrual blood loss by causing endometrial atrophy. - It is FDA-approved for the treatment of **menorrhagia** and is highly effective in reducing heavy menstrual bleeding. *NOVA T* - **NOVA T** is a **copper IUD**, which can actually *increase* menstrual blood loss and dysmenorrhea, making it unsuitable for menorrhagia. - Copper IUDs work primarily by inducing a **local inflammatory reaction** in the uterus that is spermicidal and prevents fertilization. *Cu IUD* - Like NOVA T, **copper IUDs (Cu IUDs)** are known to exacerbate **heavy menstrual bleeding** and cramping. - They are used for contraception but are generally contraindicated in women with pre-existing menorrhagia. *Gynefix* - **Gynefix** is a frameless copper IUD designed to reduce the side effects of traditional T-shaped copper IUDs. - While it may cause less cramping than other copper IUDs, it still contains copper and can **increase menstrual flow**, making it a poor choice for menorrhagia.

Q: Primary amenorrhea is defined as:

Menstruation does not occur even after 15 years of age. ***Menstruation does not occur even after 15 years of age*** - Primary amenorrhea is defined as the **absence of menstruation by age 15** in individuals with normal secondary sexual characteristics. - This definition is crucial for determining when to initiate investigation for underlying causes. *Imperforate hymen exists* - While an imperforate hymen can cause **cryptomenorrhea** (menstruation occurring but not flowing out), it is a specific cause of primary amenorrhea, not the definition itself. - An imperforate hymen is identified by a **bulging, bluish membrane** at the vaginal introitus. *None of the above* - This option is incorrect because the first option accurately defines primary amenorrhea. - The definition of primary amenorrhea is clinically well-established and widely accepted. *Menstruation does not occur even after 18 years* - This age cut-off is **too late** for the definition of primary amenorrhea, as investigations should ideally begin earlier. - Delaying evaluation until age 18 could potentially delay the diagnosis and treatment of underlying conditions affecting fertility and overall health.

Q: Which of the following statements is true regarding menorrhagia?

Heavy and regularly timed episodes of bleeding. ***Heavy and regularly timed episodes of bleeding*** - **Menorrhagia** is defined as **excessive menstrual blood loss** occurring at **regular intervals** (cyclical pattern). - This is the classic definition distinguishing it from other abnormal uterine bleeding patterns. - The key features are: **heavy flow** + **regular timing** (maintains normal cycle length). *Heavy and irregularly timed episodes of bleeding* - This describes **irregular heavy bleeding**, which would fall under abnormal uterine bleeding with irregular timing. - The **irregular timing** is the key differentiator that excludes this from being simple menorrhagia. *Bleeding volume greater than 80 ml per cycle* - While **>80 ml blood loss** is the objective measurement for menorrhagia, this alone doesn't capture the complete definition. - Menorrhagia specifically requires this heavy bleeding to occur at **regular intervals**. - In clinical practice, subjective assessment (soaking through pads/tampons, clots, impact on quality of life) is often more practical than measuring volume. *Menstrual bleeding lasting more than 7 days* - Duration **>7 days** describes **prolonged menstrual bleeding**. - This can occur with menorrhagia but is not the defining feature. - A patient can have menorrhagia with normal duration (3-7 days) if the volume is excessive during that period. - The definition of menorrhagia focuses on **amount** (heavy), not duration (prolonged).

Question 1

Which of the following is NOT a cause of metrorrhagia?

Accepted Answer

Intramural fibroid

Answer

Polyp

Answer

CA endometrium

Answer

IUD

Question 2

Oligomenorrhoea means ?

Accepted Answer

Cycle longer than 35 days

Answer

Cycle < 20 days

Answer

Cycle more than 45 days

Answer

Cycle more than 28 days

Question 3

What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Accepted Answer

Insufficient progesterone due to anovulation

Answer

Excess estrogen production from ovarian follicles

Answer

Hypothalamic dysfunction affecting ovulation

Answer

High levels of progesterone due to luteal phase defect

Question 4

What is the most common age range for women experiencing dysfunctional uterine bleeding?

Accepted Answer

40-45 years

Answer

50-55 years

Answer

60-65 years

Answer

20-25 years

Question 5

A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?

Accepted Answer

Asherman's syndrome

Answer

Hypothyroidism

Answer

Kallman syndrome

Answer

Sheehan's syndrome

Question 6

Which of the following drugs is not commonly used for menorrhagia?

Accepted Answer

Clomiphene

Answer

GnRH

Answer

NSAIDS

Answer

Methergin

Question 7

Preferred treatment for menorrhagia in reproductive age group?

Accepted Answer

OCPs

Answer

Cu IUD

Answer

Hysterectomy

Answer

NOVA T

Question 8

Which IUD is preferred for menorrhagia?

Accepted Answer

Mirena

Answer

NOVA T

Answer

Cu IUD

Answer

Gynefix

Question 9

Primary amenorrhea is defined as:

Accepted Answer

Menstruation does not occur even after 15 years of age

Answer

Imperforate hymen exists

Answer

None of the above

Answer

Menstruation does not occur even after 18 years

Question 10

Which of the following statements is true regarding menorrhagia?

Accepted Answer

Heavy and regularly timed episodes of bleeding

Answer

Bleeding volume greater than 80 ml per cycle

Answer

Heavy and irregularly timed episodes of bleeding

Answer

Menstrual bleeding lasting more than 7 days

Menstrual Disorders — MCQs

Menstrual Disorders — MCQs

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