Disorders Of Menstrual Cycle

Question 1

What is Dysmenorrhoea?

Answer 1

Painful menstruation
45-95% of women in reproductive age.
Declines with incrasing age, and may improve after childbirth.

Question 2

Aetiology of Dysmenorrhoea?

Answer 2

Endometriosis 
Adenomyosis
Pelvic inflammatory disease (PID) 
Cervical stenosis
Haematometra (rare)

Question 3

What is endometriosis?

Answer 3

Reproductive age
Endometrial tissue outside uterine cavity.
Patches of ectopic tissue, are influenced by hormones ; exacerbation of sx dusring menstruation

Question 4

What is the gold standard for endometriosis diagnosis?

Answer 4

Laparoscopy

Question 5

Whatbare the treatment options for endometriosois?

Answer 5

Combined pill- taken continuously,
Mirena IUS- (intrauterine system) 
Or surgical- laser,
Diathermy, 
Excision of endometriotic tissue

Question 6

What are some complications of endometriosis?

Answer 6

Adhesions, endometriomas( chocolate ovarian cysts)

Infertility

Question 7

What is adenomuosis?

Answer 7

Prescence of ectopic endometrial tissue in the myometrium.
Assc w/ previous procedures that may have broken the barrier between the 2 layers e.g
Suction termination of prvs pregnancy or Caesarean section.

Question 8

How do you asses the severity of pain,?

Answer 8

Do u take painkillers? Which tablets help?

Did u need to take time off?

Question 9

What are some sx of endometriosis?

Answer 9

Pelvic mass if endometrioma pressent
Fixed uterus if adhesions
Endometriotic nodules palpable in pouch of douglas or on uterosacral ligaments.

Question 10

How would you investigate Dysmenorrhoea?

Answer 10

High vaginal and endocervical swabs- exclude infx - chlamydia trachomatis, neisseria gonorrhoea

Pelvic USS- detect endometriomas
Or apprearences- adenomyosis- enlarged uterus, heterogenous texture.

Question 11

When is diagnostic laparoscopy perforemd?

Answer 11

Hx suggestive
When swans and USS normal, but still sx
When pt wants it:
Risks- anaesthetic complications, damage ro blood vessels, bladder, bowel, infx

Fact that this procedure might show nothing.

Question 12

How do you manage Dysmenorrhoea?

Answer 12

🔸NSAIDS- naproxen, iburofen, mefenemic acid
🔹Oral contraceptive: RCT- so and so effective
🔸LNG-IUS- effective + adenomyosis, endometriosis.
🔷Lifestyle: low fat veggie + exercise that improves blood flow to pelvis.
🔸GnRH analogues : not 1st line, before hysterectomy.
🔹Heat- benefit ! As effective as NSAIDS.
If pain does bot resolve w/ them, then removal of ovaries unlikely to resolve problem.

Question 13

Whats Dyspareunia?

Answer 13

Pain during sexual intercourse.
Superficial or deep
Assc w/ endometriosis or PID

Question 14

Amenorrhea and oligomenorrhoea- what are they?

Answer 14

Amennorrhoea- defined as the abscence of menstruation.
1o amenorrhoea- girls fail to menstruate by 16Y
2oabsence of menstruatiom for >6M in a normal female, in a reproductive age that is bot due to pregnancy, lactation or ,menopause.

Question 15

What ovarian disorders might cause probs?

Answer 15

Anovulation: polycystic ovarian syndrome
Premature ovarian failure: POF- cessation of periods before 40Y
May be due to chemo, radiotherapy, autoimmune disease, chromosomal disorders - turners- 45XO, 46XX

Question 16

Any pituitary disorders?

Answer 16

Prolactinoma- adenoma

Pituitary necrosis- sheehan syndrome- prolonged hypotension + major obstetric haemmorhage

Question 17

What hypothalamic disorders can cause such problems?

Answer 17

Xs exercise, wt loss + stress- can switch off hypothalamic stimulation of pituitary.
Hypothalamic lesions
Head injuries
Kallman’s syndrome- X-linked recessive condition- GnRH deficiency- underdeveloped genitalia.
Systemic disorders- sarcoidosis, TB.
Drugss: progesterone, HRT, dopamine antagonists.

Question 18

Anatomical disorders?

Answer 18

Genital tract abnormalities
Asherman’s syndrome- intrauterine adhesions preventing menstruation
Mullerian agenesis- congenital malformation- abscence of uterus & malformation of vagina.
Transverse vaginal septum
Imperforate hymen

Question 19

Investigations of Amennorrhoea/ oligomenorrhoea?

Answer 19

Hx & examination
Swxually active?- pregnancy test
Blood- FSH, LH, & testosterone= polycustic ovarian syndrome (PCOS) 
⬆️FSH suggestive of POF.
⬆️ prolactin- prolactinoma if- TSH

USS- polycystic ovaries
MRI if sx consistent w/ pituitary adenoma
Hysteroscopy not routine- inx Ashermans or cervical stenosis.
Karyotyping- Turners.

Question 20

How would you manage amenorrhoea and oligomenorrhoea?

Answer 20

Low BMI- dietary advice & support
Hypothalamic lesions; glioma- surgery
Hyperprolactinaemia/ prolactinoma- dopamine agonist or surgery if fails.
POF- HRT or COCP
Ashermans- adhesiolysis and IUD insertion at time of hysteriacopy- to prevent recurrent ones.
Cervical stenosis- hysteroecopy and cervical dilatation.