8 - Menstrual Disorders Flashcards
What is amennorhea?
Can be primary or secondary
What are some causes of primary and secondary amennorhea?
Primary: congenital disorders, imperforate hymen, hormonal disorders, constitutional delay of puberty
Secondary: pregnancy, weight loss, menopause, endocrine issues
What is the most common cause of primary amennorhea and what are some characteristics of this disease?
- Turners Syndrome, 45 X
- Streak gonads
- Low estradiol and high FSH/LH as no negative feedback
What are some anatomical causes of primary amennorhea?
- Imperforate hymen
- Transverse vaginal septum due to failure of UGS and mullerian duct to fuse
- MRKH syndrome
Why does AIS lead to primary amennorhea?
- 46 XY but female phenotype
- Need to excise testes after puberty due to risk of testicular cancer
- May feel testes in labia or inguinal area
- Absence of upper vagina, uterus and fallopian tubes
What is Kallman syndrome?
- Delayed or absent puberty alongside anosmia
- Form of idiopathic hypogonatrophic hypogonadism
- Autosomal dominant or X Linked Recessive
What is the most common cause of secondary amenorrhea and what are the symptoms associated with this?
- PCOS
- Hyperandrogenism and chronic anovulation
- Secondary amennorhea, infetility, hirsutism, obesity
- May be asymptomatic
- Elevated LH
What is the pathogenesis of PCOS?
- Lack of pulsatile GnRH release due to androgens
- Many follicles develop but dominant one not selected
- Follicles produce abnormal oestrogen secretion
What are women with PCOS at increased risk of and how is this risk reduced?
- Endometrial malignancy due to abnormal oestrogen secretion
- Diabetes and CVS disease due to insulin resistance
- Lifestyle advice and OC pill
How can hypothyroidism lead to secondary amenorrhea?
- Usually hyperthyroidism
How can hyperthyroidism lead to secondary amennorhea?
What are some causes of hyperprolactinaemia and how can it lead to amennorhea?
Prolactin inhibits GnRH release
What are some hypothalamus and pituitary disorders that lead to amenorrhea?
- Prolactinoma (give dopamine agonist)
- Sheehan syndrome (ischaemic necrosis during birth)
- Functional hypothalamic amenorrhea (weight loss, excessive exercise, emotional stress, gymnasts, anorexia)
When diagnosing the cause of amennorhea what can you first rule out?
Physiological causes:
- Pregnancy
- Menopause
What is oligomenorrhoea?
What is menorrhagia and what pathologies should you consider if you are presented with this?
- Heavy menstrual bleeding
- >80ml (pad is 10ml)
- Opinion that periods heavier or passing clots
- Think about endometrial growths, clotting disorders, anaemia
How can we split uterine bleeding into different parameters to describe it?
Also if having abnormal uterine bleeding can be acute or chronic (6 months)
What are some causes of abnormal uterine bleeding and what are some accompanying symptoms?
- Can be structural or non-structural
- Heavy, irregular, infrequent, frequent, prolonged, shortened
- Postcoital, intermenstrual
What is the most common cause of AUB?
- Fibroids: benign tumour of uterine smooth muscle (myometrium)
- Oestrogen dependent so will clear when menopause and worse in pregnancy
- Can cause heavy menstrual bleeding, recurrent pregnancy loss but dont tend to cause pain unless degenerating or torsion
What is dysfunctional uterine bleeding?
- When can find no structual or systemic cause for abnormal bleeding
- Common at extremes of reproductive life and is diagnosis of exclusion
- Subdivided into anovulatory and ovulatory
What is dysmenorrhea?
- Painful menstruation to the point where it is interfering with quality of life. Often leads to chronic pelvic pain and result of obstructive causes
- Associate with malaise, diarrhoea, nausea
- Primary since menarche or secondary
What is the most common cause of dysmennorhea?
Endometriosis
- Ectopic endometrial tissue that responds to hormonal stimulation the same way as the uterus does
- Can irritate the peritoneum leading to pain, intraabdominal adhesions and infertility
How can we manage the symptoms of dysmenorrhea?
- NSAIDs
- Hormonal contraceptions, IUD and COCP
- GnRH analogues
- Surgery e.g hysterectomy and break adhesions
- Heat, ginger, TENS, acupuncture
How do you gather a differential diagnosis for
- Amenorrhoea?
- Menorrhoagia?
- Dysmenorrhoea?
- Look at HPG values to see if hormonal
- If no issue then look at structural problems, e.g MRI, USS, laparoscopy
3. System review, e.g thyroid disorders
