eL18 Menstrual Cycle Disorder

Question 1

problem of menstrual disorders

risks it increases

Answer 1

Negative impact on QOL, reproductive health

Increased risk of:
* osteoporosis with amenorrhea
* Diabetes with PCOS

Question 2

types of menstrual disorders

Answer 2

1. amenorrhea
2. heavy menstrual bleeding
3. dysmenorrhea
4. premenstrual syndrome
5. polycystic ovary syndrome

Question 3

(1) amenorrhea: definition

Answer 3

No menstrual bleeding in 90 days period (ie 3 cycles)

Question 4

(1) amenorrhea: classification

primary & secondary

Answer 4

Primary/ functional
Absence of menses by 15 years; never menstruated from the start

Secondary
Absence for 3 cycles in previously menstruating female (sudden stoppage)

Question 5

(1) amenorrhea: secondary classification
individuals at risk

Answer 5

• <25 years old with hx of menstrual irregularities
• Competitive athletics (low body fat)
  GnRH depletes rapidly
  Lower FSH & LH → lack of hormonal secretion
  Menstrual cycle stops
• Massive weight loss

Question 6

(1) amenorrhea: etiology

Answer 6

anatomical causes
* Pregnancy: no shedding of endometrium ⇒ no bleeding
* uterine structural abnormalities: prevents tissues (& blood) from exiting

Endocrine disturbances
* Leads to chronic anovulation (no ovulation)
* Affects GnRH, FSH, LH secretion
Prevents ovulation → no formation of corpus luteum → lack of oestrogen & progesterone production
* No menstrual cycle ⇒ no menses

Ovarian insufficiency/ failure

Question 7

(1) amenorrhea: treatment
non-pharmacological

Answer 7

• Weight gain, reduction of exercise intensity ⇒ secondary causes
• Stress management

Question 8

(1) amenorrhea: treatment
pharmacological

Answer 8

• Combined OC
• Oestrogen/ progesterone only ⇒ topical treatment, dont require large amounts
• Copper IUD ⇒ promotes heavy bleeding

Question 9

(2) heavy menstrual bleeding: definition

Answer 9

Menstrual blood loss > 80mL per cycle OR > 7 days per cycle
Problems of flow containment; unpredictable heavy menses

Question 10

(2) heavy menstrual bleeding: pathophysiology

Answer 10

1. Uterine-related factors
2. Coagulopathy factors (platelets affected; increased bleeding risk)

Question 11

(2) heavy menstrual bleeding: pharmacological methods

Answer 11

1. contraceptives
2. non contraceptives

Question 12

(2) heavy menstrual bleeding: contraceptive method (treatment)

Answer 12

COC, progestin IUD (causes amenorrhea), progestin only OC, progestin injection
NO OESTROGEN ONLY PRODUCT

Question 13

(2) heavy menstrual bleeding: contraceptive method (treatment)

importance of progestin

Answer 13

Stabilises & thin uterus lining
Induces amenorrhea & reduce blood loss

Question 14

(2) heavy menstrual bleeding: non-contraceptive method (treatment)

Answer 14

NSAIDs during menses
Tranexamic acid during menses
* slows breakdown of clots

Cyclic progesterone
* Only 14 or 21 days (non continuous)
* No contraceptive protection

Question 15

(2) heavy menstrual bleeding: non-pharmacological method

Answer 15

Endometrial ablation (removal) to hysterectomy

Question 16

(3) dysmenorrhea: definition

Answer 16

Crampy pelvic pain with/ just before menses

Question 17

(3) dysmenorrhea: types

Answer 17

Primary → functional
Release of prostaglandins & leukotrienes → vasoconstriction → cramp

Secondary → underlying anatomical/ physiological causes
Endometriosis: tissue growing outside of uterus (instead of inside)

Question 18

(3) dysmenorrhea: non-pharmacological treatment

Answer 18

Topical heat therapy (ie tiger balm), acupuncture, low-fat vegetable diet

Question 19

(3) dysmenorrhea: pharmacological treatment

Answer 19

NSAIDs
Due to increase in prostaglandins; for pain relief
COC
Progestin injections/ progestin IUD
* Have amenorrhea properties
* Prostaglandins (causes pain) → released during menstruation
Progestin reduces menses & thins endometrium ⇒ lesser prostaglandin production & hence pain

Question 20

(4) premenstrual syndrome: definition

Answer 20

Cyclic pattern of symptoms occurring 5 days before menses
Resolves at onset of menses
Mostly do not have impairment of daily activities

Question 21

(4) premenstrual syndrome: classificatios & symptoms

Answer 21

Somatic (physical)
Bloating, headache, weight gain, fatigue, dizziness/ nausea, appetite changes

Affective (mood)
Anxiety/ depression, angry outburst, social withdrawal, forgetfulness, teartful, restlessness

Question 22

(4) premenstrual syndrome: non-pharmacological management

Answer 22

Increase: exercise & vitamin intake
Decrease: caffeine, sugar, sodium

Question 23

(4) premenstrual syndrome: pharmacological management

Answer 23

Selective serotonin reuptake inhibitors (SSRIs) → for mood symptoms
COC → somatic symptoms

Question 24

(5) PCOS: definition

Answer 24

Ovaries producing abnormal amount of androgens
Small cysts (fluid-filled sacs) form in ovaries

Question 25

(5) PCOS: clinical presentation

Answer 25

Menstrual irregularities → amenorrhea, heavy bleeding during cycles
Excess androgens
* acne/ hirsutism/ obesity
* Metabolic disorder/ insulin resistance ⇒ increased risks for DM, CVD

Question 25

(5) PCOS: pharmacological treatment

Answer 25

COC → consider antiandrogenic prostin for acne/ hirsutism
Metformin → for insulin resistance & metabolic disorders