6. Disorders Of Mestruation

Question 1

What is primary amenorrhea?

Answer 1

Failure to establish menstruation by 16 years.

Question 2

What is secondary amenorrhoea?

Answer 2

Cessation of previously normal menstruation for 6 months or more.

Question 3

What is oligomenorrhoea?

Answer 3

Infrequent menstruation, with each cycle lasting more than 35 days and so there being only 4-9 menstruations in a year.

Question 4

What is menorrhagia/heavy menstrual bleeding?

Answer 4

A complaint of excessive menstrual blood loss over consecutive cycles or more than 80ml per menstruation.

Question 5

What is primary dysmenorrhea? What can it be secondary to?

Answer 5

Idiopathic pain during menses, associated with ovulatory cycles, due to the response of the uterus to local prostaglandins, hence painful contractions. Can also be secondary to menorrhagia.

Question 6

What is dysfunctional uterine bleeding?

Answer 6

Heavy and irregular menstrual bleeding that occurs secondary to an ovulation.

Question 7

What is premenstrual syndrome?

Answer 7

A cyclical disorder, occurring in the latter half of the menstrual cycle. Symptoms could be physical or psychological and resolve with the onset of menstruation.

Question 8

What is premenstrual dysphoric disorder?

Answer 8

The severe end of the spectrum of premenstrual syndrome with extreme mood symptoms.

Question 9

Give 2 common causes of amenorrhoea

Answer 9

Physiological eg prepubertal, pregnancy, menopause.
Endocrine eg hypothalamic, pituitary, ovarian, uterine/endometrial pathology.
Structural causes eg agenesis/hypoplasia at any level of the genital tract, leiomyoma (uterine fibroids), imperforate hymen, vaginal septae, Asherman’s syndrome, cervical stenosis.

Question 10

In amenorrhoea, what can be used to find the level of pathology causing the amenorrhoea?

Answer 10

Gonadotrophin levels (FSH and LH).

Question 11

Give 3 common causes of menorrhagia

Answer 11

Leiomyoma (uterine fibroids).
Uterine polyps.
Endometrial cancer.
Bleeding diathesis.
Copper IUCD.
Drugs eg warfarin.

Question 12

Give 3 causes of irregular bleeding

Answer 12

Hormonal contraception, especially progesterone-only.
STI’s/PID infection.
Cervical ectopy or pathology (usually as postcoital bleed).
Endometrial pathology (polyp or cancer).
Ovarian cyst (hormone secreting type).

Question 13

What is secondary dysmenorrhoea?

Answer 13

Pain during menses, associated with ovulatory cycles, du to endometriosis or obstructed menses.