4.2 Disorders of Menstruation

Question 1

Define amenorrhea

Answer 1

Absence of menstruation

Primary = Failure to establish menstruation by 16 
Secondary = Stopped previously normal periods for 6 months

Question 2

Define oligomenorrhoea

Answer 2

Infrequent menstruation

More than 35 days long
4-9 times a year

Question 3

Define menorrhagia

Answer 3

Excessive menstrual blood loss

Heavy menstrual bleeding (HMB)

Question 4

Define dysmenorrhea

Answer 4

Pain during menses

Associated with ovulatory cycles

Question 5

Define dysfunctional uterine bleeding

Answer 5

Heavy and irregular menstrual bleeding secondary to anovulation

Question 6

Define premenstrual syndrome (PMS)

Answer 6

Cyclical disorder in latter half of cycle
Physical or psychological effects
Resolves with onset of menstruation

Question 7

What condition describes severe PMS with extreme mood swings?

Answer 7

Premenstrual dysphoric disorder

Question 8

Describe the HPO axis

Answer 8

Hypothalamus releases GnRH 
Acts on the anterior pituitary 
Which produces FSH and LH 
Which act on the ovary
To produce oestrogen and progesterone 
Which act on the uterus and are involved in negative feedback

Question 9

Name some common causes of disorders of menstruation

Answer 9

Hormonal
Chromosome abnormalities eg turners
Structural
Other: bleeding diathesis, drugs, thyroid disease, chronic illness

Question 10

What are physiological causes of amenorrhoea?

Answer 10

Prepubertal
Pregnancy
Menopause

Question 11

What are some structural causes of menstrual disorders?

Answer 11

Agenesis of genital tract
Uterine fibroids - leiomyoma
Imperforate hymen, vaginal septae 
Ashermans syndrome
Cervical stenosis

Question 12

What is ashermans syndrome?

Answer 12

Structural cause of menstrual disorder

Get adhesions in endometrial cavity which provides an obstruction

Question 13

What are some common causes of menorrhagia?

Answer 13

Uterine fibroids - leiomyoma 
Uterine polyps 
Endometrial cancer 
Bleeding diathesis
Copper IUCD 
Drugs - warfarin

Question 14

Causes of irregular bleeding

Answer 14

Hormonal contraception - particularly progesterone only
Infection - STI
Cervical or endometrial pathologies
Ovarian cyst
- Hormone secreting type effects the endometrium

Question 15

Cause of primary dysmenorrhea

Answer 15

Idiopathic
Due to response of uterus to local secretion of prostaglandins
Leads to painful contractions

Question 16

Cause of secondary dysmenorrhea

Answer 16

Due to endometriosis or obstructed menses

Question 17

What would you ask about in a history for menstrual disorders?

Answer 17

Age 
Onset of puberty
Pain - is it cyclical?
Menstrual history incl cycle, volume and any changes 
Sexual history
Medical history

Question 18

Describe examinations for menstrual disorders

Answer 18

General, abdominal, speculum, bimanual
Presence of secondary sexual characteristics
Appearance of known chromosomal abnormalities
Swellings or lumps
Discharge

Question 19

What investigations would you undertake for menstrual disorders?

Answer 19

Bloods
Hormone profile - FSH, LH 
Karyotype 
Thyroid function
FBC 

Imaging: USS, MRI

Hysteroscopy, laparoscopy

Question 20

Disadvantage of hysteroscopy

Answer 20

Cant tell anything about uterine tubes

As looks inside uterus itself

Question 21

Disadvantage of laparoscopy

Answer 21

Invasive