3.2 Flashcards
Define amenorrhoea
Absence of periods for at least 6 months.
What is primary amenorrhoea?
Never had a period
Absence of menses by age 14 with absence of secondary sexual characteristics.
OR
Absence of menses by 16 with normal secondary sexual characteristic development.
What is secondary amenorrhoea?
Established menstruation has ceased for three months in a woman with a history of regular cyclic bleeding or nine months in a woman with a history of irregular periods.
Normally in women aged 40-55.
Define menorrhagia.
Heavy periods
Excessive (>80ml), prolonged (>7 days) regular uterine bleeding.
Define Dysmenorrhoea
Painful periods
Define oligomenorrhoea
Infrequent periods occurring at intervals of 35 days - 6 months.
Define cryptomenorrhoea
Periods occur but not visible due to obstruction in outflow tract.
Define Dysfunctional Uterine Bleeding
Abnormal bleeding
Excessively heavy, prolonged or frequent
Origin that is not due to pregnancy, pelvic or systemic disease.
What are anovulatory cycles?
No ovulation/luteal phase
Olio/amenorrhoea +/- menorrhagia
What are ovulatory cycles?
Normal menstrual cycles + Dysmenorrhoea and mastalgia (sore breasts)
What are the origins of amenorrhoea?
Hypothalamic/pituitary Ovarian/gonadal Outflow tract (uterus, cervix, vagina)
How can primary/secondary outflow tract amenorrhoea be caused? What is the FSH level?
Outflow tract origin
HPO axis is functional so FSH is normal?
Primary:
Uterine - Mullerian agenesis
Vaginal - vaginal atresia, cryptomenorrhoa, imperforacte hymen
Stenosed cervix
Secondary: Intrauterine adhesions (Asherman's syndrome)
Describe gonadal/end organ amenorrhoea. Primary and secondary causes? FSH levels?
Ovary does not respond to pituitary stimulation.
Low oestrogen levels.
Lack of negative feedback –> High FSH (hypergonadotrophic amenorrhoea).
Primary: Gonadal dysgenesis (Turner's) Androgen insensitivity syndrome Receptor abnormality for FSH/LH Congenital adrenal hyperplasia
Secondary: Pregnancy Anovulation MEnopause Polcystic ovarian syndrome Drug induced
What is hypothalamic/pituitary amenorrhoea? FSH levels?
Inadequate FSH levels lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate the endometrium of the uterus –> amenorrhoea.
(Hypogonadotrophic)
Describe causes of primary and secondary hypothalamic amenorrhoea.
Primary hypothalamic:
Kallmann Sydrome - inability to produce GnRH (therefore FSH)
Secondary hypothalamic:
Exercise amenorrhoea
Stress
Eating disorder and weight loss (below 47kg menses cease).
Secondary pituitary
Sheehan syndrome - hypopituitarism
Hyperprolactinaemia
Hypo/hyperthyroidism
How to evaluate secondary amenorrhoea?
Menstrual history - regularity? Contraception Pregnancy Surgery Medication Weight change Chronic disease Stress Diet Family history - Thyroid, age at menopause, diabetes Physical exam - BMI, hair (PCOS), thyroid, breast discharge (hyperprolactinaemia)
How is amenorrhoea managed?
Hormone replacement if due to hormonal insuffieciey
Lifestyle changes
Laser ablation of endometrium - destroy endometrial basalis layer - renders woman incapable of producing endometrium.
Describe dysfunctional uterine bleeding
Excessive heavy, prolonged or frequent bleeding of uterine origin, not due to pregnancy, pelvic or systemic disease.
When does DUB occur?
Usually Anovulatory
90% when ovulation is not occurring.
Corpus luteum des not form to release progesterone
Oestrogen is produced continuously causing uterine overgrowth.
10% occurs when ovulation is occurring
Progesterone secretion is prolonged because oestrogen is low.
Irregular shedding and erratic bleeding
how DUB diagnosed?
Exclusion
hCG, TSH - Exclude pregnancy and thyroid
Smear to exclude cancer
Sample endometrium
Management of DUB?
Oestrogen therapy followed by progesterone.
What is menorrhagia? When does it occur? Causes?
Heavy vaginal bleeding that is not DUB.
Secondary to distortion of the uterine cavity, leaving the uterus unable to contract down on open venous sinuses in the zone basal is.
Usually ovulatory
Causes:
Organic, endocrine, haemostatic, iatrogenic
What are fibroids and how are they diagnosed?
Benign tumours of myometrium Increased blood supply and neovascularisation Diagnosed: Bimanual examination Ulatrsound Hysteroscopy - into womb via vagina Laparoscopy - into womb via abdominal incision Bopsy
How is menorrhagia assessed?
FBC - Hb
Pictoral blood loss assessment - pad/tampon counts
>80ml for >7days excessive and prolonged
