Amenorrhea and Dysmenorrhea

Question 1

What is the definition of Primary Amenorrhoea?

Answer 1

The absence of the onset of menses by age 13 in the absence of the development of secondary sexual characteristics, or by age 15 in the presence of normal growth and secondary sexual characteristics.

Question 2

What is the definition of Secondary Amenorrhea?

Answer 2

The cessation of previously regular menstruation for 3 months or more, or the cessation of previously irregular menstruation for 6 months or more.

Question 3

What are the causes of amenorrhea ?

Answer 3

1. Drugs- Antipsychotics, chemo-/radiotherapy, illicit drugs
   Disrupt normal hormonal function
2. Pregnancy
3. Chronic renal failure and cystic fibrosis

4.Hypogonadotrophic Hypogonadism due to
Anorexia nervosa, excessive exercise, athletic women.

5. Kallmann’s syndrome due to
   Abnormal GnRH neurons,
   Dysgenesis of olfactory bulbs
   Mutation on short arm of X chromosome.

6.Central Nervous System (CNS) Disorders- Hydrocephalus, CNS tumors (e.g., craniopharyngioma)

7. Ideopathic and ideopathic delayed puberty.

Question 4

What are the most common causes of Primary Amenorrhoea?

Answer 4

*Gonadal dysgenesis (43%)
*Mullerian agenesis (15%)
*Constitutional (14%)
*PCOS (7%)

Question 5

what are the gonadal diseases associated to Primary Amenorrhoea ?

Answer 5

Gonadal dysgenesis: Ovarian dysgenesis (mosaic X abnormalities), Turner’s syndrome (46X0) or Swyer Syndrome (46XY; testicular dysgenesis)
-Complete androgen insensitivity syndrome (46XY)

Question 6

What is the most common cause of cyclical pelvic pain in woman of reproductive age ?

Answer 6

Dysmenorrhoea

Question 7

What is the first step of choice for any patient presenting with dysmenorrhoea ?

Answer 7

urine pregnancy test to rule out ectopic pregnancy and to avoid NSAID’s if pregnant.

Question 8

When should post pill amenorrhea needs to be investigated?

Answer 8

6 months since discontinuing OCP or 12 months since last injection of Depo-provera

Question 9

What is the minimum number of menstrual periods required for protecting the endometrium ?

Answer 9

4/12 months.

Question 10

what is the key differentiator of dysmenorrhoea from other causes of pelvic pain ?

Answer 10

Predictable cyclical pattern.

Question 11

What are the gyencological causes of pelvic pain ?

Answer 11

• Dysmenorrhoea
• Endometriosis and adenomiosis
• Leiomyoma, adenxal mass and reproductive tract cancer.
• Pelvic organ prolapse and Endocervical polyps.
• Chronic PID

Question 12

What are the risk factors for primary dysmenorrhoea ?

Answer 12

• Early menarchy
• Longer menstrual periods.
• High BMI and smoking.

Question 13

what is associated to decreased incidents of dysmenorrhoea ?

Answer 13

Parity

Question 14

What is the pathophysiology of dysmenorrhoea ?

Answer 14

In primary dysmenorrhoea the pathophysiology is basically a higher secretion of endometrial prostaglandine.

Question 15

What are the difference b/w primary and secondary dysmenorrhoea ?

Answer 15

• The age of onset of primary dysmenorrhoea is 16-25 years. Whereas the age of onset of secondary dysmenorrhoea is 30 to 45 years.
• The onset of pain is just prior to menstrual period in primary dysmenorrhoea. whereas it progresses through the late luteal phase in secondary dysmenorrhoea.
• In primary dysmenorrhoea there is only pain as opposed other symptoms in secondary dysmenorrhoea.
• Primary dysmenorrhoea responds to NSAIDs and combined oral contraceptives. Where as secondary dysmenorrhoea is resistant.
• The physical examination is unremarkable in primary dysmenorrhoea. Whereas in secondary dysmenorrhoea , it depends on the cause.

Question 16

The number one cause of secondary dysmenorrhoea ?

Answer 16

endometriosis.

Question 17

What are the indications of secondary dysmenorrhoea ?

Answer 17

• Onset after 25 years of age
• Abnormal pelvic exam
• Infertility and or abnormal menstruation.
• Have dysperiunia
• lack of response to conventional medical therapy for primary dysmenorrhoea

Question 18

What is the presentation of dysmenorrhoea in PMS ?

Answer 18

In premenstrual syndrome the dysmenorrhoea and symptoms such as mood swings, breast tenderness, depression, food cravings etc. All these symptoms along with dysmenorrhoea occurs in the luteal phase.

Question 19

What is the Tx of PMS ?

Answer 19

SSRIs.

Question 20

What are the drugs for primary dysmenorrhoea ?

Answer 20

• First line NSAIDs, Melanamic acid or progestin only contraceptives , if contraception is also a requirement.
• Seocondline is progestin only contraceptive orally.

Question 21

What is Mettelshmerz or middle pain ?

Answer 21

It is a one sides lower abdominal pain that coincide with ovulation. It is thought to occur due to blood from the folecules irritating the lines of the abdoman. It can last for min to upto 48 hrs. and the Tx of OTC analgecis.

Question 22

What is the evaluation of secondary amnorrrheoea ?

Answer 22

https://www.aafp.org/pubs/afp/issues/2006/0415/p1374/jcr:content/root/aafp-article-primary-content-container/aafp_article_main_par/aafp_figure0.enlarge.html

Question 23

What is the evaluation of primary amnorrrheoea ?

Answer 23

https://www.aafp.org/pubs/afp/issues/2013/0601/p781/jcr:content/root/aafp-article-primary-content-container/aafp_article_main_par/aafp_figure.enlarge.html

Question 24

InPCOS the FSH LH ratio is ?

Answer 24

> 2

Question 25

Ovulation can best be confirmed by measuring serum ________ levels in the mid-luteal phase

Answer 25

progesterone

Question 26

What is the presentation of placenta previa ?

Answer 26

Placenta previa presents with sudden, painless, profuse bleeding in the third trimester.

Question 27

____s the first drug of choice in patients with infertility due to anovulation with normal hormone levels

Answer 27

Clomiphene citrate