Menstrual Disorders & PCOD — Practice

Question 1

A 15-year-old has had heavy but regular periods since menarche, with haemoglobin 8.2. What should be excluded?

Accepted Answer

B

Question 2

A 52-year-old woman with a uterus is prescribed menopausal hormone therapy. What must be included?

Accepted Answer

B

Question 3

A 17-year-old, 2 years post-menarche, has irregular cycles and hirsutism. Ultrasound shows polycystic-appearing ovaries. How should this be interpreted?

Accepted Answer

B

Question 4

A 30-year-old with secondary amenorrhoea has a follicle stimulating hormone of 48 IU/L. Where is the defect?

Accepted Answer

A

Question 5

Which is an absolute contraindication to combined oral contraception?

Accepted Answer

B

Question 6

Why is anovulatory bleeding typically painless while ovulatory heavy bleeding is painful?

Accepted Answer

Because dysmenorrhoea is generated by prostaglandins, and prostaglandin production in the endometrium depends on progesterone withdrawal.

In an ovulatory cycle the corpus luteum produces progesterone, which primes the endometrium and, when it is withdrawn at the end of the luteal phase, triggers release of prostaglandins, principally prostaglandin F2 alpha. These cause intense myometrial contraction and vasoconstriction, producing both the cramping pain and the coordinated haemostasis that limits blood loss.

In an anovulatory cycle there is no corpus luteum, so there is no progesterone and no withdrawal. Prostaglandin release is minimal, so the bleeding is painless. But the same absence removes the coordinated vasoconstriction, which is one reason anovulatory bleeding is heavy as well as irregular. The two features share a single explanation.

Question 7

How does insulin resistance produce the reproductive features of polycystic ovary syndrome?

Accepted Answer

B

Question 8

A 17-year-old has primary amenorrhoea, normal breast development, absent uterus on ultrasound and a normal female phenotype. What single test distinguishes the two main possibilities?

Accepted Answer

B

Question 9

A 41-year-old with heavy regular periods, a normal cavity on ultrasound and completed family wants effective treatment but prefers to avoid surgery. What is the best option?

Accepted Answer

B

Practice — Menstrual Disorders & PCOD

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