IC17 Menstrual Disorders + Menopause Flashcards
What is amenorrhea? What is primary and secondary amenorrhea? What are the possible causes?
Amenorrhea
Definition/Symptoms: No bleeding for 90 days (>= 3 months)
Primary/functional: No bleeding by age 15 for women who have never menstruated
Secondary: No bleeding for 3 cycles in women who have menstruated before
Common in:
- < 25y/o with menstrual irregularities
- Competitive athletes (lack of fats)
- Massive weight loss
Causes:
- Anatomical changes e.g. pregnancy, uterine structural abnormalities
- Endocrine disturbances chronic anovulation disrupts the cycle
- Ovarian insufficiency / failure can’t ovulate
a. E.g. GnRH/FSH/LH disrupted so E and P not produced, no menses
What are the non-pharm and pharm management of amenorrhea?
Treatment:
Non-pharmacological
- Weight gain
- Exercise less
- Stress management
Pharmacological
- COC
- Estrogen Only
- Progestin Only
- Copper IUD (intraurethral device)
What is menorrhea? What are the causes of menorrhagia?
Definition/Symptoms: bleeding >= 80mL per cycle OR >= 7 days per cycle + *affect QOL (comes with pain)
Causes:
- Uterine-related factors
a. Fibroids
b. Adenomyosis (tissue lining the uterus grows into the muscular wall of uterus)
c. Endometrial polyps
d. Gynecologic cancer
e. Alterations in HPO (hypothalamus-pituitary-ovarian) axis - Coagulopathy factors
a. Cirrhosis
b. Von Willebrand disease
c. Idiopathic thrombocytopenic purpura
What are the non-pharm and pharm management of Menorrhagia?
Treatment:
Pharmacological
Is contraception Desired:
- Yes
1. COC
2. Progestin IUD
3. Progestin only oral meds (Minipill)
4. Progestin injection - No
1. NSAIDs during menses
2. Tranexamic acid during menses e.g. slow break down clots
3. Cyclic Progesterone (not continuous so have no contraceptive effect)
Non-pharmacological
- Endometrial Ablation
- Hysterectomy
What is dysmenorrhea? What is the pathophysiology of dysmenorrhea?
Dysmenorrhea
Definition/Symptoms: crampy pelvic pain with or just before menses
Pathophysiology:
Primary: release more prostaglandins and leukotrienes –> vasoconstriction –> cramp
Secondary: endometriosis (endometrium grows outside of uterus)
What are the non-pharm and pharm management of dysmenorrhea?
Treatment:
Non-pharmacological
- Topical heat therapy
- Exercise
- Acupuncture
- Low-fat vegetarian diet (since prostaglandins and leukotrienes precursors are fats)
Pharmacological
- NSAIDs (pain management, 1st line)
- COC (2nd line)
- Progestin injections (3rd line, reduces menses and thins endometrium)
- Progestin IUD (3rd line)
What is PMS and the symptoms?
Premenstrual Syndrome (PMS)
Definition: cyclic pattern of symptoms occurring 5 days before menses, resolve on onset of menses (most do not report impairment of daily activities)
Symptoms:
Somatic (physical):
- Bloating
- Headache
- Weight gain
- Fatigue
- Dizziness / nausea
- Appetite changes
Affective (mental):
- Anxiety / Depression
- Angry outburst
- Social withdrawal
- Forgetfulness
- Tearful
- Restlessness
- Severe mood symptoms –> Premenstrual Dysphoric Disorder (PMDD)
What are the pharm and non-pharm ways to treat PMS?
Treatment:
Pharmacological
- Selective Serotonin Reuptake Inhibitors (SSRIs) –> for affective symptoms
- COC –> for somatic symptoms
Non-pharmacological
- Exercise more
- Eat more vitamins
- Less caffeine and sugar
What is PCOS? What are the symptoms? What are the possible treatment?
Polycystic Ovary Syndrome (PCOS)
Definition: ovaries produce abnormal amt of androgens + small cysts (fluid filled sacs) form in the ovaries
Symptoms:
- Menstrual irregularities
- Androgen effects
a. e.g. acne, hirsutism, obesity
b. Metabolic disorders / insulin resistance e.g increase risk for DM and CVD
Treatment:
Pharmacological
- COC (consider antiandrogenic progesterone e.g. drospirenone, cyproterone if acne/hirsutism)
- Metformin (not for everyone)
What is menopause?
Menopause
Definition: Permanent cessation of menses following loss of ovarian follicular activity
No menses for >= 12 months
What are the causes of menopause?
Causes:
- Natural –> perimenopause, menopause, post-menopause
- Induced –> any time before natural menopause e.g. ovaries removal, iatrogenic ablation e.g. chemotherapy or pelvic radiation
Describe the different stages of menopause.
Early perimenopause:
- Duration of each cycle is > 28 days
- FSH increase
- No symptoms
Late perimenopause:
- Duration of each cycle is >= 60 days (2 months or more)
- FSH increase
- Vasomotor symptoms
Menopause
- No bleeding for 12 months
- FSH increase
- Vasomotor symptoms
Post menopause
- No bleeding for >12 months
- FSH stabilizes
- Urogenital atrophy
What are the 4 symptoms?
- Vasomotor symptoms
- Genitourinary syndrome of menopause
- Psychiatric disorders
- Bone loss
What are vasomotor symptoms? What is the cause?
- Vasomotor symptoms
a. Hot flushes
b. Night sweating
c. Intense feeling of heat on face, rapid/irregular HR, flushing/reddened face, perspiration, cold sweats, sleep disturbances, anxiety
d. Occurs several times a day
Cause: estrogen withdrawal –>thermoregulatory dysfunction occurs at the hypothalamus
What are the genitourinary symptoms? What is the cause?
Genitourinary syndrome of menopause (GSM)
a. Genital dryness
b. Burning/irritation/pain
c. Lubrication difficulty
d. Libido/painful intercourse/impaired sexual function
e. Urinary urgency
f. Dysuria
g. Recurrent UTI
Cause: reduced estrogen –> vulvovaginal lose collagen and fat deposits, thus barrier protection lost and lose ability to retain water