Disorders of the Menstrual Cycle Flashcards
Define amenorrhoea
Absence of periods for at least 6 months
Define primary amenorrhoea
Never had a period- absence of menses by 14 with absence of secondary sexual characteristics-absence of menses by 16 with normal secondary sexual characteristics
Define secondary amenorrhoea
Established menstruation has ceased for three months in a woman with a history of regular cyclic bleeding OR has ceased for nine months in a woman with a history of irregular bleeding. Normally in women aged 40-55
Define oligomenorrhoea
Infrequent periods occurring at interval of 35 days to 6 months
Define dysmennorhoea
Painful periods
Define menorrhagia
Heavy periods in excess of 80 ml and prolonged bleeding for more than 7 days
Define crytomennorrhoea
Periods occur but they are not visible due to an obstruction in the outflow tract
Define dysfunctional uterine bleeding
Abnormal bleeding which has no obvious organic cause
Define anovulatory cycles
Have no ovulation/luteal phase. Can present with oligomenorrhoea, amenorrhoea and with or without menorhagia.
Define ovulatory cycles
Normal menstrual cycles with dysmenorrhoea or mastalgia
Define mastalgia
Sore breasts
What are the main causes for amenorrhoea?
- hypothalmic/pituitary- ovarian- outflow tract
Describe hypothalmic/ pituitary amenorrhoea
Inadequate FSH levels lead to inadequately stimulated ovaries. These then cannot produce sufficient oestrogen to stimulate the endometrium of the uterus.
Describe primary hypothalmic amenorhorroea
Kallman Syndrome- inability to produce GnRH
Define secondary hypothalmic amenorrhoea
Exercise amenorrhoeaStress amenorrhoeaEating disorders and weight loss- falling below the critical weight of 47kg will halt menses
Describe secondary pituitary amenorrhoea
Sheehan syndrome- hypopituitarism (no FSH produced)- Hyperprolactinaemia - Heamochromatosis (excess iron in the blood)Hypo and hyperthyroidism can be a cause of secondary amenorrhoea
Describe gonadal or end-organ amenorrhoea
The ovary does not respond to pituitary stimulation which leads to low oestrogen levels. Low oeastrogen negatively feedsback and increases FSH levels into the menopausal range. This is known as hypergonadotrophic amenorrhoea.
Describe primary gonadal/end-organ amenorrhoea
- Patient has gonadal dysgenesis, e.g. Turner Syndrome (45, X)2. Androgen Insensitivity Syndrome3. Receptor Abnormalities for FSH and LH4. Specific forms of congenital adrenal hyperplasia
Describe secondary gonadal/end-organ amenorrhoea
PregnancyAnovulationMenopause or premature menopausePolycystic ovarian syndromeDrug-induced
How do hormone levels differ in outflow tract amenorrhoea?
They don’t (FSH levels are normal)- have normal menstruation but there is an obstruction to the outflow tract
Describe primary outflow tract obstruction
Uterine causes inclued mullerian agenessiVaginal causes include vagina atresia, cryptomenorrhoea and and imperforate hymen
Describe secondary outflow tract obstruction
Intrauterine adhesions- Asherman’s Syndrome(damage to the wall of the uterus leads to scar tissue or adhesions forming. This can mean that the uterus will not respond to oestrogen)
How can amenorrhoea be managed?
Depends on the cause - replacement for hormone- modifying lifestyle factors
Describe dysfunctional uterine bleeding
90% = when ovulation is not occurring. Corpus luteum cannot form so progesterone cannot be released. This leads to continuous oestrogen production, causing overgrowth of functional layer leading to an increase in uterine bleeding. 1%= occurs when ovulation is occurring however progesterone levels are prolonged because of low oestrogen levels. This leads to irregular shedding of the uterine lining and erratic bleeding
Give some causes that must be ruled out before you diagnose someone with dysfunctional uterine bleeding
PregnancyHypo or hyperthyroidismCoagulation dysfunctionsCancer
What is the main cause of menorrhagia?
Usually is secondary to distortion of the uterine cavity so the uterus is unable to contract down on the venous sinuses in the zona basalis.
Give some other causes of menorrhagia
Organic (physiological disruptions)EndocrineHaemostatic (coagulation disorders) Iatrogenic
How is menorrhagia managed?
Progesterone
