Abnormalities Of The Menstrual Cycle Flashcards
Define menorrhagia
Heavy periods
Define amenorrhea
Absence of periods for a least six months
Define dysmenorrhea
Painful periods
Define oligomenorrhea
Delays between periods of more than 35 days up to 6 months
What is pre-menstrual syndrome?
A group of symptoms experienced in the week before menstruation
What is primary amenorrhea?
Absence of menses by age 14 with absence of secondary sexual characteristics or
Absence of menses by age 16 with normal secondary sexual characteristics
What is secondary amenorrhea?
Where an established menstruation has ceased for three months in a woman with a history of regular cyclic bleeding
Or
Ceased for 9 months in a woman with a history of irregular periods
Causes of secondary amenorrhea?
Pregnancy
Menopause
Weightloss
What are some outflow tract problems that can cause primary amenorrhea?
Müllerian agenesis - 15% of primary amenorrhea
Vaginal atresia - so you have crytomenorrhea
Imperforate hymen
What are some outflow tract problems that can cause secondary amenorrhea?
Intrauterine adhesions (Asheman's syndrome) -front and back walls of the uterus stick together due to fibrosis
What are some gonadal or end-organ disorders which can cause amenorrhea?
When the ovary fails to respond to pituitary stimulation
-caused by gonadal dysgenesis or premature menopause
What indicates hypergonadotrophic amenorrhea?
Chromosome testing in younger people
Low oestrogen
What do gonadal abnormalities tend to be linked to when thinking about where the problem for amenorrhea lies?
Linked to high FSH
Typically in the menopausal range
What are some primary causes of gonadal disorders?
Gonadal dysgenesis
-Turner’s syndrome (XO)
Androgen insensitivity syndrome (testicular feminisation syndrome)
Receptor abnormalities for hormones FSH and LH
Specific forms of congenital adrenal hyperplasia
What are some secondary causes of gonadal disorders?
Pregnancy Anovulation Menopause Premature menopause Polycystic ovarian syndrome Drug-induced
Explain how central regulatory disorders can lead to amenorrhea
Problem at the pituitary or hypothalamus
Inadequate levels of FSH lead to inadequately stimulated ovaries
Fail to produce enough oestrogen to stimulate the endometrium causing amenorrhea
Linked to low FSH leading to hypogonadotrophic amenorrhea
Potentially still fertile
What are some primary causes of hypogonadotrophic amenorrhea?
Hypothalamic
-Kallman syndrome, where hypothalamic neurones for GnRH release fail to migrate into the hypothalamus during development. Either fail to start or complete at puberty
What are some secondary causes of hypogonadotrophic amenorrhea?
Hypothalamic
- exercise amenorrhea
- stress amenorrhea
- eating disorders
- weight loss
Pituitary
- Sheehan syndrome
- hyperprolactinaemia
- haemochromatosis
- hypo/hyperthyroidism
What do you need to consider when evaluating secondary amenorrhea?
Menstrual history Contraception Pregnancy Surgery Medication Weight change Chronic diseases Stress Diet Family history -age at menopause -thyroid dysfunction -diabetes -cancer
What physical examination should be done with secondary amenorrhea?
BMI Hair distribution Thyroid Visual fields Breasts - any discharge Abdomen - mass or tenderness
How should amenorrhea be managed?
Rule out pregnancy
If history suggests
-ovarian - axis problem: TSH, prolactin, FSH, LH
-chronic disease - ESR, LFTs
-CNS - MRI
-Hirsuitism (lots of hair): high testosterone, check 17-OH progesterone
Define menorrhagia
Excessive (>80ml) uterine bleeding or prolonged (>7days)
Define dysfunctional uterine bleeding
Abnormal bleeding but no obvious cause
Could be excessively heavy, prolonged or frequent bleeding
Not due to pregnancy, pelvic or systemic disease
Anovulatory
When does dysfunctional uterine bleeding commonly occur?
In extremes of reproductive life and in patients with polycystic ovary syndrome
Pathogenesis of ovulatory dysfunctional uterine bleeding?
Progesterone secretion is prolonged because oestrogen levels are low.
Causes irregular shedding of the uterine lining
Pathogenesis of anovulatory dysfunction uterine bleeding?
Corpus luteum which produces progesterone does not form because there is no ovulation
Therefore oestrogen is produced continuously, causing an overgrowth of the endometrium
Period is delayed and when it happens, can be very heavy
Management of DUB?
Progesterone or OCP
How can distortion of the uterine cavity lead to menorrhagia?
Uterus unable to contract down on open venous sinuses in zona basalis
