5. Menstrual Disorders

Question 1

What is amenorrhoea?

Answer 1

Absence of menstruation, can be physiological (occurring in childhood, pregnancy, lactation and menopause), can be pathological

Question 2

What is primary amenorrhoea?

Answer 2

Whenmenstruation has not started yet by the ae if 16 yers in presence of normal secondary sexual characteristics, or 14 years in absence of other evidence of puberty

Question 3

What is secondary amenorrhoea?

Answer 3

Absent periods for at least 6 months in a woman who has previously had regular periods, or 12 months if she has had oligomenorrhoea

Question 4

What are possible causes of primary amenorrhoea?

Answer 4

Genitourinary malformations e.g. imperforate hymen, vaginal septum, absent vagina or absent uterus
Turner’s syndrome
Complete androgen insensitivity syndrome
Diseases in hypothalamus and pituitary - GnRH deficiency, constitutional delay of puberty[

Question 5

What are the anatomical causes of secondary amenorrhoea?

Answer 5

Scarring - cervical stenosis, Asherman syndrome

Ovarian disorders - primary ovarian insufficiency (premature menopause)

Question 6

What is a key clinical manifestation of secondary amenorrhoea?

Answer 6

PCOS

Question 7

What is the triad of PCOS?

Answer 7

Menstrual irregularity
Androgen excess
Obesity

Question 8

What are some pathological causes of secondary amenorrhoea?

Answer 8

PCOS
Thyroid disease - complex interplay between thyroid hormone and HPG axis
Hyperprolactinemia - high prolactin levels interfere with normal production of other hormones

Question 9

What are some causes of hyperprolactemia?

Answer 9

Pituitary tumour
Hypothyroidism
Medicines given for depression, psychosis and high BP

Question 10

What are some causes of physiological secondary amenorrhoea?

Answer 10

Pregnancy

Menopause

Question 11

What is abnormal uterine bleeding?

Answer 11

Uterine bleeding outside of the parameters:

• ration greater than 8 days
• flow greater than 80ml/cycle or subjective impression of heavier than normal flow
• occur more frequently than every 24 days or less frequently than every 38 days
• intermenstrual bleeding or postcoital spotting
• absence of menses

Question 12

What can the underlying causes of abnormal uterine bleeding be?

Answer 12

PALM-COEIN
Structural - Polyps, Adenomyosis, Leiomyoma (fibroid), Malignancy
Non-structural - Coagulopathy, Ovulsatory dysfunction, Endometrial, Latrogenic, Not yet classified

Question 13

What is the most common cause of abnormal uterine bleeding?

Answer 13

Fibroids - leiomyoma

Question 14

What is dysfunctional uterine bleeding (DUB)?

Answer 14

Bleeding of endometrial origin

Common at extremes of reproductive life

Question 15

What are the 4 divisions of DUB?

Answer 15

Anovulatory
Inadequate signal
Impaired positive feedback
Ovulatory - idiopathic

Question 16

What is dysmenorrhea?

Answer 16

Painful menstruation - crampy and intermittently intense, or continuous dull ache
1-2 days before or with onset on menses

Question 17

What is primary dysmenorrhoea?

Answer 17

Pain since menarche

Question 18

What is secondary dysmenorrhoea?

Answer 18

Pain developed over time

Question 19

What is a common cause of dysmenorrhoea?

Answer 19

Endometriosis

Question 20

What is endometriosis?

Answer 20

Endometrial glands and stroma that occur outside the uterine cavity

Question 21

What are the risk factors for endometriosis?

Answer 21

Nulliparity
Early menarche
Short cycles
Heavy bleeding
Low BMI

Question 22

What are the most common sites for endometriosis?

Answer 22

Ovaries
Endometrioma
Bladder
Rectum
Peritoneal lining and pelvic side walls

Question 23

What is adenomyosis?

Answer 23

Endometrial tissue found deep within myometrium

Question 24

What is the management for dysmenorrhoea?

Answer 24

NSAIDs
Hormonal contraceptives - COCP, intrauterine device
GnRH analogues
Surgery