PBL MODULE 13, MBBS YEAR 2, FPSK.

Menorrhagia

TRIGGER 1

Mrs. Raihan, 28-year-old, lady came to outpatient department, Hospital Sultanah

Nur Zahirah, with complaint of fever for 2 days and passing heavy and irregular
menses for the past three months. She had to use about 8 pads per day. On further
questioning, patient also complains right abdominal pain, palpitation & lethargy.
She is married for 4 years, but still did not conceive.

On examination, patient was obese, pale with blood pressure: 110/70mmHg, pulse
rate 100/min, temperature: 37oC. She has hersutism and multiple acne on her face.
Abdominal examination revealed a non tender mass at right iliac fossa. On
speculum examination, whitish vaginal discharge mixed with blood was seen.

She was admitted to Obstetric & Gynaecology (O&G) ward for further investigations
& management.

TRIGGER 2

In the ward, Mrs. Raihan told that her elder sister also had similar problem &
currently on hormonal therapy. Relevant investigations were carried out and the
results were as follows:

1. Full blood count ( FBC)

TWC : 10 x 103/mm3

Hb: 8.0 g/dL

Plt : 150 x 103 /L

2. Vaginal Swab : C&S – presence of fungi

3. Serum FSH/LH : FSH: 7.5 IU/L

LH: 15.2 IU/L

4. Ultrasound of the abdomen, revealed multiple cystic lesions at right iliac

fossa measuring around ~0.5 – 2.0 cm.
ISSUES OF THISS PBL: PCOS presenting with pallor, hirsutism, acne, irregular
menses, menorrhagia and infertility. Pt also has concomitant candida infection.

LEARNING OUTCOME:

1. Anatomy :

a. Reproductive system of female.

b. Microstructure of the blood supply to the uterus.

2. Physiology :

a. Normal menstrual cycle & its hormonal regulation. Hypothalamo-

hypophysial gonada axis.

3. Biochemistry :

Hormonal metabolism (Biosynthesis and catabolism)

: FSH in normal range (female: 6.63 – 8.82 IU/L), normal in PCOS

LH in normal range (female : 5.76-9.22 IU/L), high in PCOS

4. Pathology :

a. Pathophysiology of menorrhagia

b. Etiology of menorrhagia

c. Outline of causes of infertility (both in male and female)

5. Microbiology :

a. Caandida infection of the vagina

6. Interpretation of all investigation result.

7. Principles of management of menorrhagia, infertility & Polycystic ovariaan

cyst (PCOS).