eL18 Menstrual Cycle Disorder Flashcards
problem of menstrual disorders
risks it increases
Negative impact on QOL, reproductive health
Increased risk of:
* osteoporosis with amenorrhea
* Diabetes with PCOS
types of menstrual disorders
- amenorrhea
- heavy menstrual bleeding
- dysmenorrhea
- premenstrual syndrome
- polycystic ovary syndrome
(1) amenorrhea: definition
No menstrual bleeding in 90 days period (ie 3 cycles)
(1) amenorrhea: classification
primary & secondary
Primary/ functional
Absence of menses by 15 years; never menstruated from the start
Secondary
Absence for 3 cycles in previously menstruating female (sudden stoppage)
(1) amenorrhea: secondary classification
individuals at risk
- <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
(1) amenorrhea: etiology
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
(1) amenorrhea: treatment
non-pharmacological
- Weight gain, reduction of exercise intensity ⇒ secondary causes
- Stress management
(1) amenorrhea: treatment
pharmacological
- Combined OC
- Oestrogen/ progesterone only ⇒ topical treatment, dont require large amounts
- Copper IUD ⇒ promotes heavy bleeding
(2) heavy menstrual bleeding: definition
Menstrual blood loss > 80mL per cycle OR > 7 days per cycle
Problems of flow containment; unpredictable heavy menses
(2) heavy menstrual bleeding: pathophysiology
- Uterine-related factors
- Coagulopathy factors (platelets affected; increased bleeding risk)
(2) heavy menstrual bleeding: pharmacological methods
- contraceptives
- non contraceptives
(2) heavy menstrual bleeding: contraceptive method (treatment)
COC, progestin IUD (causes amenorrhea), progestin only OC, progestin injection
NO OESTROGEN ONLY PRODUCT
(2) heavy menstrual bleeding: contraceptive method (treatment)
importance of progestin
Stabilises & thin uterus lining
Induces amenorrhea & reduce blood loss
(2) heavy menstrual bleeding: non-contraceptive method (treatment)
NSAIDs during menses
Tranexamic acid during menses
* slows breakdown of clots
Cyclic progesterone
* Only 14 or 21 days (non continuous)
* No contraceptive protection
(2) heavy menstrual bleeding: non-pharmacological method
Endometrial ablation (removal) to hysterectomy
(3) dysmenorrhea: definition
Crampy pelvic pain with/ just before menses
(3) dysmenorrhea: types
Primary → functional
Release of prostaglandins & leukotrienes → vasoconstriction → cramp
Secondary → underlying anatomical/ physiological causes
Endometriosis: tissue growing outside of uterus (instead of inside)
(3) dysmenorrhea: non-pharmacological treatment
Topical heat therapy (ie tiger balm), acupuncture, low-fat vegetable diet
(3) dysmenorrhea: pharmacological treatment
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
(4) premenstrual syndrome: definition
Cyclic pattern of symptoms occurring 5 days before menses
Resolves at onset of menses
Mostly do not have impairment of daily activities
(4) premenstrual syndrome: classificatios & symptoms
Somatic (physical)
Bloating, headache, weight gain, fatigue, dizziness/ nausea, appetite changes
Affective (mood)
Anxiety/ depression, angry outburst, social withdrawal, forgetfulness, teartful, restlessness
(4) premenstrual syndrome: non-pharmacological management
Increase: exercise & vitamin intake
Decrease: caffeine, sugar, sodium
(4) premenstrual syndrome: pharmacological management
Selective serotonin reuptake inhibitors (SSRIs) → for mood symptoms
COC → somatic symptoms
(5) PCOS: definition
Ovaries producing abnormal amount of androgens
Small cysts (fluid-filled sacs) form in ovaries
(5) PCOS: clinical presentation
Menstrual irregularities → amenorrhea, heavy bleeding during cycles
Excess androgens
* acne/ hirsutism/ obesity
* Metabolic disorder/ insulin resistance ⇒ increased risks for DM, CVD
(5) PCOS: pharmacological treatment
COC → consider antiandrogenic prostin for acne/ hirsutism
Metformin → for insulin resistance & metabolic disorders
