L8: menstrual disorders

Question 1

Define amenorrhoea

Answer 1

Absence of menstruation

Question 2

What is primary amenorrhoea? What are common causes?

Answer 2

Failure of menstruation by the age of 16 years in the presence of normal secondary sexual characteristics
OR 14 years in the absence of other evidence of puberty
Causes: congenital disorders, hormonal disorders or structural disorders (such as imperforate hymen)

Question 3

Describe Turner’s syndrome

Answer 3

45XO
Ovary does not complete its normal development
No oestrogen = no pubertal changes
No secondary sexual characteristics with primary amenorrhoea

Question 4

Describe complete androgen insensitivity syndrome

Answer 4

X-linked recessive disorder
Resistant to testosterone due to defect in the androgen receptor
46XY but normal female phenotype (external)
Testes should be surgically excised after puberty

Question 5

What is secondary amenorrhoea? What are common causes?

Answer 5

Absent periods for at least six months in a woman who has previously has regular periods, or 12 months if she has previously had oligomenorrhoea
Causes: pregnancy, menopause or weight loss

Question 6

Describe polycystic ovarian syndrome

Answer 6

Syndrome of hyperandrogenism and chronic anovulation (egg doesn’t release from ovary during menstrual cycle) in which other causes have been ruled out
Presentation: secondary amenorrhea, infertility, hirsutism & obesity
Related to a lack of GnRH release – many follicles begin to develop but a dominant follicle is not selected to mature
Abnormal oestrogen secretion = increased risk of endometrial malignancy
Insulin resistance = risk of diabetes and cardiovascular disease
Prevention of these long term risks must be a goal for therapy as well as management of the presenting problems

Question 7

Define oligomenorrhoea

Answer 7

Classed as menstruation that has reduced in frequency

Cycle length greater than 35 days, resulting to 4-9 periods a year

Question 8

Define menorrhagia

Answer 8

Defined as heavy menstrual bleeding, either by objective volume/subjective opinion of the patient or that she is passing clots
Important to consider structural problems (benign/malignant growths in the endometrium), clotting disorders or anticoagulation therapy
Look for anaemia in these patients

Question 9

What are fibroids?

Answer 9

Benign tumours of smooth muscle occurring in the myometrium
Can be large and numerous
Tumours are hormone dependent & so regress after the menopause but prior to that they can lead to very heavy menstrual bleeding & other problems

Question 10

Describe irregular periods

Answer 10

Change in the usual pattern of a woman’s menstrual cycle
Important considerations are hormonal contraception, menopause & hormone-secreting ovarian cysts
Important to consider infective causes

Question 11

Define dysmenorrhoea

Answer 11

Defined as painful periods to the point where it is interfering with quality of life
Often leads to chronic pelvic pain & can be a result of obstructive structural causes
Common cause = endometriosis

Question 12

Describe abnormal uterine bleeding

Answer 12

Acute: episode of heavy bleeding that is of sufficient quantity to require immediate clinical intervention to stop further blood loss
Chronic: bleeding of abnormal volume, duration, regularity or frequency that has been present for most of the previous 6 months
Causes: polyps, adenomyosis, iatrogenic, DUB, leiomyoma (fibroid)

Question 13

List potential causes of abnormal uterine bleeding in premenopausal women

Answer 13

P - polyps 
A - adenomyosis 
L - leiomyoma
M - malignancy
C - coagulation problems 
O - ovulatory disorders 
E - endometrial dysfunction 
I - iatrogenic 
N - not classified

Question 14

Define metrorrhagia

Answer 14

Irregular periods