Perimenopause, Menopause and Post-Menopausal Bleeding MCQs

Ans. is 'b' i.e., Jejunal polyp Organic causes of constipation are : i) Intestinal: Hirschprung disease, Anal/rectal stenosis, Anal fissure, anteriorly displaced anal opening, strictures. ii) Drugs: Narcotics, vincristine, Psychotropics. iii) Metabolic/endocrine: Cystic fibrosis, hypothyroidism, Panhypopituitrism iv) Neuromuscular: Cerebral palsy, Psychomotor retardation, spinal cord lesions, Myotonic dystophy, Neuropathy or myopathy of GIT v) Other causes: Low fibre diet, Milk protein allergy.

Secretion of the cervical glands is alkaline and thick, rich in mucoprotein, fructose and sodium chloride. The vaginal pH , from puberty to menopause, is acidic because of the presence of Döderlein’s bacilli which produce lactic acid from the glycogen present in the exfoliated cells. The pH varies with the estrogenic activity and ranges between 4 and 5. Reference : DC Dutta textbook of obstetrics, 8th edition; chapter 1

Metropathia hemorrhagica is a type of anovulatory DUB, hence logically speaking it should be best treated by progesterone therapy. It is mostly seen in premenopausal women. Patients complain of a variable period of amenorrhea followed by excessive painless bleeding. On HPE-cystic glandular hyperplasia, Swiss cheese pattern is seen, and secretory changes are absent Treatment: In DUB due to anovular causes: Progesterones are the mainstay of therapy. They diminish the effects of estrogen on target cells by inhibiting oestrogen receptors. Reference: Dutta Gynae 5 th /ed pp 184,187.

Remember: Warfarin is contraindicated in the first trimester of pregnancy as it can lead to contradi syndrome comprising of microcephaly, optic atrophy, nasal hypolplasia and chondrodysplasia punctate.It can also lead to IUGR, abortions and IUD. But warfarin is absolutely safe during lactation as an extremely minute quantity of it is excreted in breast milk. Reference : Dutta Obs 7/e, pg 146

LOCHIA: It is the vaginal discharge for the first fortnight during puerperium The discharge originates from the uterine body, cervix and vagina. Its reaction is alkaline tending to become acid towards the end. Depending upon the variation of the color of the discharge, it is named as: Lochia rubra (red) 1-4 days. Lochia serosa (5-9 days) - the color is yellowish or pink or pale brownish. Lochia alba — (pale white) - 10-15 days Reference : Dutta Obs. 7/e, pg 146

Prevention of CHD. But recent trials have shown an increase in the Hormone Replacement Therapy (HRT) is generally indicated for conditions such as osteoporosis, hot At flushes, and atrophic vaginitis. However, it is not recommended for the prevention of cardiovascular disease. 49 In fact, studies have shown potential risks associated with HRT, particularly in relation to cardiovascular events, which has led to a more cautious approach in prescribing HRT for this purpose. Reference: Novak 15th/ed p 1242

Since she is perimenopausal and her childbearing is complete we can go for hysterectomy. Indications for Operating an Asymptomatic Fibroid: Fibroids larger than 12-14 weeks pregnancy. Rapidly growing fibroids. Subserous and pedunculated fibroid prone to torsion. If it is likely to complicate a future pregnancy. If there is doubt about its nature Unexplained infertility and unexplained recurrent abortion. Uncertain diagnosis: If patient is symptomatic decide whether you give medical. Treatment or surgical treatment. Indications of Medical Management To treat anemia and recover hemoglobin levels before To reduce the size of large fibroid and facilitate Treatment of women approaching menopause to avoid In women with medical contraindication to surgery or those who are postponing surgery. For preservation of fertility in women with large myomas before conservative surgery like myomectomy.

GnRH is the controlling factor for gonadotropin release (LH and FSH). Indications for using Synthetic GnRH In females: (In all those conditions where there is increased estrogen, GnRH analogues are useful). In males: Cryptorchidism: short-term intranasal nafarelin is used. Carcinoma prostate: GnRH agonists are as effective as orchidectomy in Ca prostate but if there are neurological symptoms or life-threatening metastatic disease - androgens should first be started followed by GnRH agonist. BPH: Daily administration of leuprorelin or nafarelin decreases obstructive urinary symptoms in 1-6 months time. Adverse Effects of GnRH Local allergic reactions may occur at injection sites. They cause menopause like symptoms-hot flushes, vaginal dryness, headache, joint and muscle stiffness, depression, osteoporosis, and irregular vaginal bleeding. Reference: Jeffcoate 7 th /ed p 652