IC17 Menstrual Cycle Disorders

Question 1

What is the clinical presentation of amenorrhea? In whom is it more frequent in?

Answer 1

No menstrual bleed in 90 day period
- Primary (Functional): Never experienced
- Secondary: Previously menstruating (<25 y.o. with hx of menstrual irregularities, competitive athlete, massive weight loss)

Question 2

What is the 3 etiologies of amenorrhea?

Answer 2

1. Anatomic - Uterine structural abnormalities, pregnancy
2. Endocrine disturbance - Chronic anovulation
3. Ovarian insufficiency

Question 3

What is the treatment of amenorrhea?

Answer 3

• Underlying cause to be identified
• Non-Pharm: Weight gain, exercise intensity reduced, manage stress
• Pharm: COC, Estrogen only, Progestin only, Copper IUD

Question 4

What is the clinical presentation of menorrhagia?

Answer 4

Heavy Menstrual Bleeding (80mL per cycle or 7 days per cycle) with poor QOL

Question 5

What is the pathophysiology of menorrhagia?

Answer 5

1. Uterine-related factors (Growth in uterine)
2. Coagulopathy factors

Question 6

How to treat menorrhagia?

Answer 6

Pharmacological
- If contraception is desired: COC, Progestin IUD, POP, Progestin IM injection
- If contraception not desired: NSAID, tranexamic acid during menses, cyclic progesterone

Non-pharmacological
- Endometrial ablation to hysterectomy

Question 7

What is the clinical presentation of dysmenorrhea?

Answer 7

Crampy pelvic pain with or just before menses
- Primary: Prostaglandin / leukotriene release causing vasoconstriction and cramps
- Secondary: Endometriosis (Growth outside uterus)

Question 8

How to treat dysmenorrhea?

Answer 8

Non-pharmacological
* Topical heat therapy
* Exercise
* Acupuncture
* Low-fat vegetarian diet

Pharmacological
1) NSAID (Firstline)
2) COC
3) Progestin injection / Progestin IUD

Question 9

What is the clinical presentation of PMS?

Answer 9

Cyclic patterns of symptoms occurring 5 days before menses that resolve at onset of menses

1) Somatic (Physical) - Bloating, headache, weight gain, fatigue, dizzy, nausea, appetite change

2) Affective (Mood) - Anxiety, depression, social withdrawal, restlessness

Severe mood symptoms = Premenstrual dysphoric disorder (Psychiatric)

Question 10

How to treat PMS?

Answer 10

Selective Serotonin Reuptake Inhibitors for PMDD

COC for physical symptoms

Question 11

What is the clinical presentation of PCOS?

Answer 11

Ovary production of abnormal amounts of androgens leading to small cysts (fluid filled sacs) formation in the ovaries

Present as:
1) Menstrual irregularities
2) Acne/Hirsutism/Obesity
3) Metabolic disorder, insulin resistance (DM, CV)

Question 12

How to treat PCOS?

Answer 12

COC (Antiandrogenic progestin), Metformin