Credits
- Section Writer: Dr. Om J Lakhani
- Section Editor: Dr. Om J Lakhani

Q. What are the points in Menstrual history?

• Age of menarche
• Last menstrual period (LMP)
• Cycle length
• Cycle regularity
• Duration of blood flow
• Amount of blood flow
• Associated pain
• Moliminal symptoms
• Intermenstrual bleeding

Q. What is the last menstrual period- LMP?

• First day of the last menstrual cycle

Q. What is the definition of 1 cycle length?

• First day of one menstrual period to 1st day of the next menstrual period

Q. What are Molimina symptoms?

• They are symptoms that occur during the premenstrual period. Symptoms include
• Irritation
• Breast tenderness
• Increase food craving
• Abdominal distention
• Labile mood
• Weight gain

Q. What is the significance of the history of molimina symptoms?

• Presence of moliminal symptoms suggest that you are dealing with an ovulatory cycle.
• However it's accuracy in predicting ovulation is limited. ^[1]

Q. What is Mittelschmerz ?

• It is a midcycle pain, spotting, and/or clear vaginal discharge
• It is associated with ovulation

Q. What is abnormal uterine bleeding (AUB)?

• Bleeding of abnormal:
• Quantity
• Duration
• Or schedule

Q. Name some important causes of AUB in non-pregnant women?

• it is given by acronym- PALM- COEIN
  • Polyp
  • Adenomyosis
  • Leiomyoma (fibroid)
  • Malignancy
  • Coagulation disorder
  • Ovulatory dysfunction
  • Endometrial hyperplasia
  • Iatrogenic
  • Not yet classified

Q. What are the characteristics of a normal menstrual bleed?

• Occurs every 21-35 days
• Amount is <80 ml
• Duration is 5 days
• Occurs at fairly regular interval

Q. Why 80 ml ?

• Because blood loss >80 ml regularly during the menstrual cycles makes you anemic

Q. How is heavy menses judged clinically?

• Soaking of a tampoon every 2 hours
• Interfering with daily activities

Q. What are the characteristics of normal menstrual bleed quantity?

• Changes pads >/= every 3 hours
• No need to change pads at night
• Clots <1 inch in size
• <21 pads in  cycle
• Not anemic

Q. Which terminologies are discarded according to FIGO?

• Menorrhagia (all usages, including "essential menorrhagia)
  • "idiopathic menorrhagia,' 'primary menorrhagia,"
  • "functional menorrhagia," "ovulatory or anovulatory menorrhagia"')
• Metrorrhagia
• Hypermenorhea
• Hypomenorrhea
• Menometrorrhagia
• Polymenorrhea
• Polymenorrhagia
• Epimenorrhea
• Epimenorrhagia
• Metropathica hernorrhagica
• Uterine hemorrhage
• Dysfunctional uterine bleeding
• Functional uterine bleeding

Q. What are terminologies to be used now?

• Disturbances in regularity
  • Irregular menstrual bleed
  • Absent menstrual bleed- amenorrhea word is retained
• Disturbances in frequency
  • Infrequent menstrual bleed- <2 cycles in 90 days (previously called oligomenorrhea)
  • Frequent menstrual bleed- > 4 cycles in 90 days
• Disturbances in quantity
  • Heavy menstrual bleed - >80 ml
  • Heavy and prolonged menstrual bleed
  • Light menstrual bleed - <5 ml
• Disturbances in duration
  • Prolonged menstrual bleed-  > 8 days
  • Shortened menstrual bleed - <2 days
• Other terms
  • Intermenstrual bleeding
  • Postmenopausal bleeding

Q. What is bleeding, and what is spotting?

• Bleeding – requiring a tampoon for protections
• Spotting – bleed small enough and not requiring a tampoon

Q. Amongst the older terms, what do oligomenorrhea and polymenorrhea mean?

• Oligomenorrhea is defined as intervals between episodes of uterine bleeding longer than 35 days
• Polymenorrhea is used to describe intervals shorter than 24 days.

Q. What do hypomenorrhea and hypermenorrhea mean?

• Hypermenorrhea refers to regular intervals (24 to 35 days) but excessive flow or duration of bleeding, or both.
• Hypomenorrhea refers to the diminution of the flow or shortening of the duration of regular menses or both

Q. What is metrorraghia ?

• Intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected periods

Q. What is Menometrorrhagia?

• Menometrorrhagia is a condition marked by abnormally heavy, prolonged, and irregular uterine bleeding. It is characterized by more than 80 ml during a menstrual cycle. The bleeding is also unexpected and frequent.