58. Oligomenorrhea.Hypermenorrhea. Dysmenorrhea.

Question 1

what is dysmenorrhea and what are the different types of dysmenorrhea ?

Answer 1

painful menstrual cramps

essential and symptomatic

Question 2

where is essential dysmenorrhea observed ?

Answer 2

women who have a low pain tolerance

or women having a hypoplastic uterus

Question 3

what is the pathophysiology of dysmenorrhea ?

Answer 3

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

Question 4

what is the treatment for essential dysmenorrhea?

Answer 4

we can give pain killers

antispasmolytics

combined hormonal birth control

physical activity

Question 5

what is symptomatic dysmenorrhea ?

Answer 5

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

Question 6

how do we diagnose symptomatic dysmenorrhea ?

Answer 6

ultrasound
hysterosalpingography
hysteroscopy
laparoscopy

through exclusion

Question 7

what is oligomenorrhoea ?

Answer 7

menstrual periods occurring in intervals greater than 35 days

Question 8

what causes oligomenorrhoea ?

Answer 8

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

Question 9

what is hypermenorhea ? and what causes it ?

Answer 9

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

Question 10

what is the average blood flow in women ?

Answer 10

10-35 ml

Question 11

known causes of abnormal uterine bleeding that need to be ruled out if there there is hypermenorrhea ?

Answer 11

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

Question 12

diagnosis of hypermenorrhea ?

Answer 12

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

Question 13

what is the treatment of hypermenorrhea ?

Answer 13

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

Question 14

complication of hypermenorrhea ?

Answer 14

anemia

Question 15

amenorrhea is split into ?

Answer 15

primary and secondary

Question 16

what is primary amenorrhea

Answer 16

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

Question 17

what is secondary amenorrhea ?

Answer 17

absence of menstrual periods for more than 3 months who has previously been regular

Question 18

what are the physiological etiology for amenorrhea ?

Answer 18

before puberty
after menopause
during pregnancy
during lactation

Question 19

reason for secondary amenorrhea ?

Answer 19

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

Question 20

how do we diagnose secondary amenorrhea ?

Answer 20

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

Question 21

how do we diagnose premature ovarian failure ?

Answer 21

reports hot flashes and other symptoms of menopause.

Increased levels of LH & FSH, but other hormones are of normal levels.