All of the following are the causes of menorrhagia EXCEPT

ESIC Nursing Officer-7July 2024

Obstetrics & Gynaecology

Medium

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

Androgen-producing tumours secrete high levels of male hormones (androgens).
Excess androgens disrupt the normal female hormonal cycle, specifically the hypothalamic-pituitary-ovarian axis.
This disruption leads to the suppression of ovulation (anovulation) and prevents the normal cyclical growth of the uterine lining (endometrium).
Consequently, patients typically experience infrequent periods (oligomenorrhea) or a complete absence of periods (amenorrhea), not heavy bleeding (menorrhagia).

Option B: Pelvic endometriosis is a recognized cause of menorrhagia. The presence of endometrial tissue outside the uterus leads to inflammation, which can result in heavy and painful menstrual bleeding.
Option C: Adenomyosis is a classic cause of menorrhagia. The growth of endometrial glands and stroma into the uterine muscle (myometrium) leads to an enlarged, boggy uterus that bleeds heavily during menstruation.
Option D: Granulosa cell tumours of the ovary are functional tumours that often secrete estrogen. The excess estrogen causes endometrial hyperplasia (overgrowth of the uterine lining), which leads to abnormal and heavy uterine bleeding.

Visual 1: Diagram - A flowchart illustrating the effects of estrogen vs. androgen excess on the hypothalamic-pituitary-ovarian (HPO) axis and the endometrium. This would visually demonstrate why estrogen leads to bleeding and androgen leads to suppression.
Visual 2: Illustration - A comparison of a normal uterus, a uterus with adenomyosis (showing thickened, boggy walls), and pelvic endometriosis (showing ectopic implants). This helps visualize the structural causes of heavy bleeding.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Menorrhagia (Heavy Menstrual Bleeding) as background academic context rather than a clinical decision trigger.
A key nursing responsibility is to take a thorough menstrual history, including frequency, duration, and volume of bleeding, to help differentiate between potential causes of abnormal uterine bleeding.
Understanding the underlying cause of menorrhagia is crucial for patient education. For example, a nurse would explain the need for endometrial biopsy in a patient with suspected granulosa cell tumour due to the risk of malignancy, whereas management for endometriosis might focus on pain and inflammation control.
What if? If a patient presented with irregular, light periods and signs of virilization (e.g., hirsutism, acne, deepening voice), the nurse should suspect an androgen-producing tumour, and the priority would be to facilitate prompt endocrine and gynecological evaluation, not to manage heavy bleeding.

How to Approach the Question

First, identify the core concept: 'menorrhagia', which means heavy menstrual bleeding.
Next, recognize the negative framing of the question due to the word 'EXCEPT'. This means you are looking for the option that does NOT cause heavy bleeding.
Evaluate each option based on its known hormonal or structural effect on the uterus and menstrual cycle.
Analyze Option A: Androgen-producing tumours. Recall that androgens are male hormones and their excess in females suppresses the menstrual cycle, causing little to no bleeding.
Analyze Options B, C, and D: Pelvic endometriosis, adenomyosis, and granulosa cell tumours. Recall that these conditions are all associated with inflammation, structural changes, or estrogen excess, which are known to cause heavy bleeding.
Conclude that the condition which does not fit the pattern of causing heavy bleeding is the correct answer to the 'EXCEPT' question.

Concept Tested & Keywords

Concept Tested: Etiology of Menorrhagia (Heavy Menstrual Bleeding)
Stem keywords: causes, menorrhagia
Lead-in keywords: EXCEPT
Negative lead-in flag: The question uses the word 'EXCEPT', requiring identification of the option that is NOT a cause of menorrhagia.

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