This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Disorders of menstruation, Subject name: Gynaecology & Obstetrics
The following are the features of anovulatory menstruation except : 
Select and explain. 
A. The only symptom may be failure of conception, B. It is usually associated with painless periods, C. May be associated with premenstrual syndrome, D. May be associated with DUB
C: May be associated with premenstrual syndrome
Answer: C: May be associated with premenstrual syndrome 
Explanation: Anovulatory DUB is characterised by irregular cycles,sho cycles with scanty flow or periods of amenorrhoea followed by prolonged and irregular bleeding Usually due to alteration in the hypothalamic-pituitary axis.More common in extremes of reproductive life and in PCOS. There is unopposed oestrogen stimulation of the endometrium and this Oestrogen withdrawal bleeding is characteristically painless irregular and prolonged,lacking the synchronous nature of normal menstruation. Reference :textbook of gynaecology, Sheila balakrishnan, 2nd edition,page 50