General Menstrual Disordes

Question 1

What is amenorrhea?

Answer 1

absence of periods >90 days

Primary or secondary

Question 2

What is oligomenorrhea

Answer 2

• Oligomenorrhoea – infrequent period >35 days

Question 3

What is polymenorrhea

Answer 3

• Polymenorrhoea – frequent periods >21 days

Question 4

what is menorrhagia?

Answer 4

Heavy bleeding
Regular bleeding – excessive in amount/duration or both
o Clarify – how long does the bleeding go for

Question 5

What is hypomenorrhea

Answer 5

diminished menstrual flow (PV spotting only)

Question 6

• Metorrhagia –

Answer 6

heavy & prolonged menstrual bleeding

Question 7

Dysmenorrhea

• primary
• secondary

Answer 7

– painful periods
o	Primary (have always been painful)
o	Secondary (they have become painful)

Question 8

What is amenorrhea

Answer 8

Absence of periods for >90 days

Question 9

What are the causes of primary amenorrhea?

Answer 9

Primary (no menarche by age 16)
• Exclude thyroid disease (hyper/hypothyroidism)
• Anatomical
• Hypothalamic/pituitary ovarian axis disorder
• Stress, exercise, eating disorder
• Pregnant

Question 10

What are the causes of secondary amenorrhea?

Answer 10

• Pregnancy or COCP
• Menopause
• Ovarian failure (if it occurs ~40 years old)
• Chronic disease
• Hypothalamic/pituitary dysfunction (ie tumour)
• PCOS
• Weight loss/gain, eating disorder
• Anxiety/stress
• Ashermann’s disease

Question 11

What would you be thinking if someone came in with post coital bleeding?

Answer 11

CERVICAL CANCER

Question 12

What is primary dysmenorrhea?
What are the causes?
What is the management?

Answer 12

Primary
6-12 months after menarche
Pain commences before bleeding, lasts ~48-72 hours (first few days of menstruation) & improves, not associated with pathology
Higher levels of uterine prostaglandins caused prolonged uterine contractions & spasm of BVs leading to reduced blood flow to muscles in uterine wall → pain
May also have fatigue, nausea & vomiting, change in bowel habits, headache etc
More common in younger women with earlier menarche, primiparous, smokers, hx prolonged/heavy periods, fhx painful periods

Management = heat packs, rest, relaxation, diet & exercise modification + paracetamol +/- codeine, NSAIDs & COCP

Question 13

What is the definition of secondary dysmenorrhea?

what are the causes?

Answer 13

• 20 years onwards, pain not limited to menses; dull, continuous pain that commences with menses & increases

Associated with pathology:
o	Endometritis,
 endometriosis, 
PID, 
adhesions,
 Ovarian cyst/tumour
, uterine disorders (fibroids, polyps, adenomyosis, endometrial carcinoma)

Question 14

What are the gynecological causes of menorrhagia

Answer 14

Gynecological causes
•	Adenomyosis
•	Uterine fibroids
•	Endometritis
•	Endometriosis
•	Cervical polyps
•	PID
•	IUCD
•	Endometrial carcinoma

Question 15

What are the medical causes of menorrhagia?

Answer 15

Medical Causes
•	Clotting disorders
•	Hypothyroidism
•	PCOS
•	SLE
•	Some liver or kidney conditions