8 Menstrual Disorders Flashcards
What does amenorhoea mean and what does primary and secondary amennorhoea mean?
Why might a secondary cause of amenorhea be mistaken for a primary cause?
If secondary cause happens early enough in life
Identify some causes of amenorhea. Use the diagram to help:
Kallman’s syndrome: absence or failure to respond to GnRH–> characteristically lack sense of smell (anosmia)
What is Polycystic Ovarian syndrome? (PCOS)
Minimum 12 cysts
- Syndrome of
- hyperandrogenism
- chronic anovulation
- ONCE OTHER CAUSES RULED OUT
How do patients with PCOS present clinically?
- Obesity
- Amenorhoea
- Infertility
- Hirsutism (unwanted, male-pattern hair growth in women)
*
How might PCOS be caused?
- Lack of pulsatile GnRH release
- Many follicles develop BUT dominant follicle not selected to mature
- Abnormal pattern of oestrogen secretion
- Many follicles develop BUT dominant follicle not selected to mature
- LH dependent excess androgen production from ovaries and adrenal glands
Why are patients with PCOS at an increased risk of endometrial malignancy, diabetes and CVS disease?
Endometrial malignancy: Abnormal oestrogen secretion
Diabetes and CVS disease: increased insulin resistance
What is oligomenorrhoea?
Menstruation with reduced frequency
Cycle length >35 days
(4-9 periods per year)
What is menorrhagia?
Heavy menstrual bleeding:
- >80ml per day?
- Subjective opinion of patient (periods heavier/passing clots)
What pathologies should we consider for a patient presenting with menorrhagia?
- Benign/malignant growths in endometrium
- Clotting disorders
- Anticoagulation therapy
- Anaemia
Fibroids are relatively common (women). What are fibroids and how do they cause heavy menstrual bleeding?
Fibroid: benign tumour of smooth muscle in myometrium (rarely become malignant)
Heavy bleeding due to increased surface area
Why do fibroids regress after menopause?
Tumours are oestrogen dependent
Give examples of what may cause irregular periods.
Hormonal contraception
Infection
Hormone-secreting ovarian cysts
Menopause
What is dysmenorrhoea?
Dysmenorrhoea= painful periods (cyclical pain) interfering with quality of life
Identify a cause of dysmenorrhea?
- Obstructive structural cause
- Endometriosis
What is endometriosis and what complications does it have?
Ectopic endometrial tissue (inc endometrial glands and stroma)
Responds to estrogen like endometrial lining of uterus
Complications:
- Pain
- Intrabdominal adhesions
- Infertility
- Dyspareunia
When taking the history of a patient with amenorrhoea, what should be considered?
When taking the history of a patient with menorrhagia, what should be considered?
When taking the history of a patient with dysmenorrhea, what should be considered?
Talk through making differential diagnosis with menstrual disorders
See image:
Describe the following parameters for the menstrual cycle and there limits/ranges:
Frequency
Regularity
Duration of Flow
Volume (objective and subjective)
Differentiate between Acute and Chronic abnormal uterine bleeding (AUB):
Use the acronym PALM-COEIN to list possible cause of AUB (structural and non-structural).
Polyps: Overgrowth of cells in the lining of the uterus (endometrium)
Adenomyosis: inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium)
Iatrogenic: relating to illness caused by medical examination or treatment
Where is pain from dysmenorrhea usually located?
Suprapubic area
Lower abdomen
Can radiate to back and thighs
What is the difference between primary and secondary dysmenorrhoea?
Primary= since first period
Secondary= developed over time- more likely to have cause
What are some risk factors for endometriosis?
Nulliparity (never having given birth)
Early menarche
Short cycles
Heavy bleeding
Low BMI
Name some common sites for endometriosis to occur.
- Ovaries
- Bladder
- Rectum
- Peritoneal lining
What are some treatment options for dysmenorrhea?
Explain why Turner’s syndrome causes primary amenorrhea? (leading cause of primary amenorrhea)
Absent sex chromosome (45XO)
Ovary undergoes accelerated apoptosis- no oestrogen
Ovary does not complete normal development- seen as streak on scan
Will require HRT
What are some of the anatomical (structural) causes of primary amenorrhea?
- Imperforate hymen
- Transverse vaginal septum
- Failure of fusion between parts of vagina- upper developed from mullerian duct and lower developed from urogenital sinus
- Mullerian agenesis (Mayer Rokitansky Kuster Hauser Syndrome)
- Congenital absence of vagina with variable uterine development
- CYCLICAL PAIN
- Congenital absence of vagina with variable uterine development
Give some anatomical causes for secondary amenorrhea:
Secondary amenorrhea can be caused by hypothalamic or pituitary disease. Identify these specific causes (3)
Sheehan syndrome: catastrophic interuption of blood supply to pituitary on delivery of baby
Outline how you would investigate primary ammenorhoea.
What effects does rising oestrogen have
in the proliferative phase of the uterine
cycle?
- Myometrium
- ◦Increase growth and motility
- Fallopian tube
- ◦Growth and motility of cilia
- ◦Secretion and muscular contraction
- ◦Growth and motility of cilia
- Endometrium
- ◦Thickening
- ‣ Increase number and size of glands - secrete watery fluid- conductive to sperm
- ◦Thickening
- Cervix
- ◦Thin, alkaline mucus
What effects does the progesterone acting on oestrogen primed cells have during the secretory phase of the uterine cycle?
Myometrium Further thickening but reduces motility- don’t want to expel morula if implanted •
Fallopian tubes Reduce motility, cilia activity and secretions
Endometrium Slightly more thickening Secretions increase and development of spiral arteries •
Cervix Thick, acidic mucus-prevent further sperm entry
