58. Oligomenorrhea.Hypermenorrhea. Dysmenorrhea. Flashcards
what is dysmenorrhea and what are the different types of dysmenorrhea ?
painful menstrual cramps
essential and symptomatic
where is essential dysmenorrhea observed ?
women who have a low pain tolerance
or women having a hypoplastic uterus
what is the pathophysiology of dysmenorrhea ?
prostaglandins are released as the endometrium degrades causing uterine contractions (stop the blood flow to the endometrium to be sloughed and for expulsion of it) and they cause sharp pain
what is the treatment for essential dysmenorrhea?
we can give pain killers
antispasmolytics
combined hormonal birth control
physical activity
what is symptomatic dysmenorrhea ?
it is in the presence of a pelvic pathology :
such as uterine tumors
endometriosis
adenomyosis
ovarian cysts
parametritis - inflammation of the connective tissue adjacent to the uterus
uterine fibroids- leiyomyoma
Asherman’s syndrome - occurs when scar tissue forms (adhesions) inside the uterus or cervix - most often caused by curettage , removal of fibroids myomectomy ,inflammation
PID
IUD
how do we diagnose symptomatic dysmenorrhea ?
ultrasound
hysterosalpingography
hysteroscopy
laparoscopy
through exclusion
what is oligomenorrhoea ?
menstrual periods occurring in intervals greater than 35 days
what causes oligomenorrhoea ?
prolactinoma - benign adenoma of the pituitary
heavy exercise
hyperthyroidism / graves disease- disturb the hormonal balance of ovulation
polycystic ovarian syndrome - excessive androgens released by ovaries
cysts developed from primordial follicles, but the development has stopped (“arrested”) at an early antral stage
anorexia nervosa
hypopitutrism
ashman syndrome
premature aeging of ovaries
nearing climacteric
what is hypermenorhea ? and what causes it ?
excessive heavy blood flow - more than 80 ml
or prolonged blood flow for more than 5 days
unknown - HYPOTHYROIDISM, uterine fibroid uterine cancer endometrial polyp endometriosis and adenomyosis coagulopathy
what is the average blood flow in women ?
10-35 ml
known causes of abnormal uterine bleeding that need to be ruled out if there there is hypermenorrhea ?
painless : fibroids coagulation defect/ or anticogulants prescribed endometrial cancer /cervical cancer endometrial polyp
painful pelvic inflammatory disease endometriosis adenomyosis pregnancy related complication such as miscarriage or ectopic pregnancy
diagnosis of hypermenorrhea ?
pelvic and rectal examination
ensure bleeding not from lower genital tract or rectum
pap smear to rule out cervical cancer , biopsy
pelvic ultrasound - abnormalities
endometrial biopsy - to rule out endometrial cancer or hypoplasia
hysterectomy
TSH and T4 to rule out hyperthyroidism
what is the treatment of hypermenorrhea ?
first line
intrauterine device with progesterone
second line
antifibrinolytic agent , NSAIDs , combined oral contraceptive pills to stop the proliferation the endometrium
third line
oral progestogen - prevent endometrium from proliferating
gonadotropin relating hormone antagonist
definitive treatment is hysterectomy
endometrial ablation
complication of hypermenorrhea ?
anemia
amenorrhea is split into ?
primary and secondary
what is primary amenorrhea
patients who have no secondary sexual characteristics and no menarche by the age of 14 - delayed puberty
normal secondary sexual characteristics but no menarche by age of 16
what is secondary amenorrhea ?
absence of menstrual periods for more than 3 months who has previously been regular
what are the physiological etiology for amenorrhea ?
before puberty
after menopause
during pregnancy
during lactation
reason for secondary amenorrhea ?
anorexia nervosa
-Weight loss can cause elevations in the hormone ghrelin which inhibits the hypothalamic-pituitary-ovarial axis
hyperprolactinemia - chiari frommel syndrome - affects women who have recently given birth (postpartum) and is characterized by the over-production of breast milk/ excessive stress / pills
premature ovarian failure - genetic
Autoimmune diseases
smoking
pregnancy
sheehan’s syndrome - postpartum pituitary gland necrosis,
schemic necrosis due to blood loss and hypovolemic shock during and after childbirth
adrenal / ovarian tumors
PCOS
how do we diagnose secondary amenorrhea ?
pregnancy test
progesterone test performed - once you cease it bleeding occurs meaning normal endometrium
if bleeding does not occur oestrogen’s are applies followed by progesterone test - still no bleeding - asherman syndrome suspected
T3,T4,TSH measured
serum FSH- increased levels show ovarian insufficiency
if LH:FSH ratio over 3 = PCOS
prolactin tested
testosterone levels tested
increased testosterone but normal DHEAS = ovarian tumor
increase testosterone and DHEAS = PCOS , adrenal hyperplasia or neoplasia
abdominal US
CA125
dopamine agonists to treat prolactinom - bromocriptne and cabergoline
how do we diagnose premature ovarian failure ?
reports hot flashes and other symptoms of menopause.
Increased levels of LH & FSH, but other hormones are of normal levels.
