Disorders of the Menstrual Cycle

Question 1

Define amenorrhoea

Answer 1

Absence of periods for at least 6 months

Question 2

Define primary amenorrhoea

Answer 2

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

Question 3

Define secondary amenorrhoea

Answer 3

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

Question 4

Define oligomenorrhoea

Answer 4

Infrequent periods occurring at interval of 35 days to 6 months

Question 5

Define dysmennorhoea

Answer 5

Painful periods

Question 6

Define menorrhagia

Answer 6

Heavy periods in excess of 80 ml and prolonged bleeding for more than 7 days

Question 7

Define crytomennorrhoea

Answer 7

Periods occur but they are not visible due to an obstruction in the outflow tract

Question 8

Define dysfunctional uterine bleeding

Answer 8

Abnormal bleeding which has no obvious organic cause

Question 9

Define anovulatory cycles

Answer 9

Have no ovulation/luteal phase. Can present with oligomenorrhoea, amenorrhoea and with or without menorhagia.

Question 10

Define ovulatory cycles

Answer 10

Normal menstrual cycles with dysmenorrhoea or mastalgia

Question 11

Define mastalgia

Answer 11

Sore breasts

Question 12

What are the main causes for amenorrhoea?

Answer 12

• hypothalmic/pituitary- ovarian- outflow tract

Question 13

Describe hypothalmic/ pituitary amenorrhoea

Answer 13

Inadequate FSH levels lead to inadequately stimulated ovaries. These then cannot produce sufficient oestrogen to stimulate the endometrium of the uterus.

Question 14

Describe primary hypothalmic amenorhorroea

Answer 14

Kallman Syndrome- inability to produce GnRH

Question 15

Define secondary hypothalmic amenorrhoea

Answer 15

Exercise amenorrhoeaStress amenorrhoeaEating disorders and weight loss- falling below the critical weight of 47kg will halt menses

Question 16

Describe secondary pituitary amenorrhoea

Answer 16

Sheehan syndrome- hypopituitarism (no FSH produced)- Hyperprolactinaemia - Heamochromatosis (excess iron in the blood)Hypo and hyperthyroidism can be a cause of secondary amenorrhoea

Question 17

Describe gonadal or end-organ amenorrhoea

Answer 17

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.

Question 18

Describe primary gonadal/end-organ amenorrhoea

Answer 18

1. 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

Question 19

Describe secondary gonadal/end-organ amenorrhoea

Answer 19

PregnancyAnovulationMenopause or premature menopausePolycystic ovarian syndromeDrug-induced

Question 20

How do hormone levels differ in outflow tract amenorrhoea?

Answer 20

They don’t (FSH levels are normal)- have normal menstruation but there is an obstruction to the outflow tract

Question 21

Describe primary outflow tract obstruction

Answer 21

Uterine causes inclued mullerian agenessiVaginal causes include vagina atresia, cryptomenorrhoea and and imperforate hymen

Question 22

Describe secondary outflow tract obstruction

Answer 22

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)

Question 23

How can amenorrhoea be managed?

Answer 23

Depends on the cause - replacement for hormone- modifying lifestyle factors

Question 24

Describe dysfunctional uterine bleeding

Answer 24

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

Question 25

Give some causes that must be ruled out before you diagnose someone with dysfunctional uterine bleeding

Answer 25

PregnancyHypo or hyperthyroidismCoagulation dysfunctionsCancer

Question 26

What is the main cause of menorrhagia?

Answer 26

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.

Question 27

Give some other causes of menorrhagia

Answer 27

Organic (physiological disruptions)EndocrineHaemostatic (coagulation disorders) Iatrogenic

Question 28

How is menorrhagia managed?

Answer 28

Progesterone