78. Menstrual disturbance Flashcards
DDX dysmennorhoea
primary dysmenorrhoea
endometriosis
adenomyosis
fibroids
PID
IUD
DDX menorrhagia
benign
anovulatory cycles (extremes of reproductive age)
dysfunctional uterine bleeding
gynae
fibroids
adenomyosis
PID
iatrogenic
IUD
systemic
hypothyroidism
bleeding disorders eg von willebrans
DDX secondary amenorrhoea
pregnancy
hypothalamic amenorrhoea
pituitary pathoogy
sheehans syndrome
PCOS
premature ovarian insufficiency
menopause
ashermans
What gynaecological conditions can cause sub fertility
annovulation
- priamary amenorrhoea eg hypothalamic
- secondary eg pcos
tubal
- endometriosis
uterine
- fibroids
- polyps
History taking menstrual disturbance
Examination menstrual disturbance
Examination findings menstrual disturbance
What is primary dysmenorrhoea
Primary dysmenorrhoea occurs in young females in the absence of any identifiable underlying pelvic pathology. It is thought to be caused by the production of uterine prostaglandins during menstruation, which causes uterine contractions and pain.
It affects up to 50% of menstruating women and usually appears within 1-2 years of the menarche. Excessive endometrial prostaglandin production is thought to be partially responsible.
pain typically starts just before or within a few hours of the period starting
suprapubic cramping pains which may radiate to the back or down the thigh
The pain starts shortly before the onset of menstruation and may last for up to 72 hours, improving as the menses progresses.
primary dysmenorrhoea
management primary dysmenorrhoea
- NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
- combined oral contraceptive pill
how is the pain in secondary dysmenorrhoea different to priamry
In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period.
what is dysfunctional uterine bleeding
this describes menorrhagia in the absence of underlying pathology. This accounts for approximately half of patients
what is primary amenorrhoea vs secondary?
primary -the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics
secondary - pt previously had periods, subsequently stopped, cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhea
what is oligomenorrhoea
irregular and inconsistent menstrual blood flow
PC: menorrhagia, prolonged menstruation (>7days), abdominal pain worse during menstruation, bloating or feeling full in the abdomen, urinary or bowel symptoms due to pelvic pressure, deep dyspareunia, reduced fertility
o/e: abdominal and bimanual exam may reveal palpable pelvic mass or an enlarged non-tender uterus
fibroids
PC: cyclical abdominal or pelvic pain, deep dysparenunia, dysmenorrhoea, infertility, cyclical bleeding from other sites eg haematuria, urinary symptoms, bowel symptoms
o/e: endometrial tissue visible in vagina, particularly in posterior fornix, fixed cervix on bimanual examination, tenderness in the vagina, cervix and adenexa
endometriosis
Usually presents in later reproductive years
PC: dysmenorrhoea, menorrhagia, dysparenunia, infertility
o/e: enlarged and tender uterus. More soft than a uterus containing fibroids
adenomyosis
PC: Cessation of menstruation for 3-6 months in women with previously normal and regular menses
- ?pregnancy
PC: secondary amenorrhoea
HoPC: excessive exercise, low body weight/eating disorders, chronic disease, psychological stress
hypothalamic amenorrhoea
PC: weight gain, hair loss, constipation, cold, amenorrhoea, struggled to breastfeed after birth
HoPC: recent post partum haemorrhage
sheehans syndrome
PC: oligomenorrhoea, secondary amenorrhoea, subfertility and infertility
HoPC: hirsutism, acne, obesity, acanthosis nigricans
PCOS
PC: oligomenorrhea, secondary amenorrhoea in patients <40, hot flushes, night sweats, vaginal dryness
premature ovrian insufficiency
PC: no periods for 12 months, hot flushes, night sweats, vaginal dryness, mood disturbance
menopause
PC: secondary amenorrhoea, lighter periods, dysmenorrhoea
HoPC: recent dilatation and courgette, uterine surgery or endometritis
ashermans syndrome