Lecture 3 Flashcards
what are the disorders of the menstrual system (4)
Primary + Secondary amenorrhea
Dysfunctional uterine bleeding
Dusmenorrhea
Premestrual disorders
how does the hypothalamus influence the menstrual cycle
responsible fro producing GnRH
What role does the pituitary gland have in the menstrual cycle
GnRH acts on ant pituitary which releases FSH and LH
FSH and LH help release follicle from ovaries
what hormones does the ovaries influence
Influences estrogen and progesterone
what happens to estrogen/progesterone if the follicle is fertilized or not
fertilized- increase in estrogen and progesterone that will allow uterine lining to thicken and prepare for implantation
Non fertilized- Decrease in estrogen and progesterone to restart mentrual
what is primary amenorrhea
Absence of menarche in females of reproductive age
Evaluation for delayed puberty should be suggested if…
- no menarche by 15
- no menarche 3-5y post thelarche
- lack of pubertal development/secondary sex characteristics by 13
what genetic probs can primary amenorrhea be cause by
- Gonadal dysgenesis
- Androgen insensitivity syndrome
- Turners syndrom
- Mosaicism (mitosis doesnt work right)
What else can cause primary amenorrhea
hormone imbalances (elevated FSH, hyperprolactimia)
constitutional delay (late bloomer)
Inf
autoimmune disorder
Hypothalamic amenorrhea
What is secondary Amenorrhea
occurs when a women who has been having normal cycles stops getting her periods for greater than 3-6 months
-period of 6m w/o is concerning
What could secondary amenorrhea be caused by
- Physical damage to endometrium
- obstruction of mentrual flow
- Preg and lactation
- Menopause
- Birth control or Depoprovera
- exogenous androgens
- pituiatry conditions
- chemo
What is functional hypothalamic amenorrhea + what does it cause
-causes secondary amenorrhea
- obesity
- very low body fat
- stressors such as excessive ex/anxitey
- 35% of secondary amenorhhea
What is polycystic ovarian syndrome (PCOS) + what does it cause
- mc endocrine disorder (7-10% of W)
- characterized by ovulatory dysfunction w mentrual cycle being irregular + frequent
- presence of hyperandrogegism, often overweight w insulin resistance
how much more likely are girls in sports gunna develop amenorrhea
3x more likely
if weight is >15% below ideal weight or if BMI is >17.5kg/m what should be considered
eating disorder or malnutrition
what initially was needed to be dx with female athlete triad and now
Use to need: disordered eating/low energy, mentrual disturbance, bone loss
now don’t need pathology in all 3
What is energy availability and what does it cause when low
intake of cals- energy expenditure
-when body falls into negative balance the body reacts by reducing amount of energy needed for bodily functions
-many negatives such as low self esteem, depression, CV probs, GI probs
long term consequences for red s syndrome
- increased rate of MSK injuries
- Stress fx
- Abnormal lipid profiles
- endothelial dysfunction/ CVD probs
- irreversible boen loss
- Depression
- Anxiety
- Low self esteem
physical exam of somebody w red s
poor detention
- fine hair on body
- swollen parotid glands
- russel sign (callus on the knuckles)
- hoarsness
what is abnormal uterine bleeding and when is it mc
bleeding that diffes in quantity or timing from a women usual mentrual flow
-mc seen in women who are experiencing menarche for the first time
What is dysfunctional uterine bleeding and when does it mc happen
- in absence of any organic disease
- mc during reproductive years
- characterized by irregular and prolonged menstrual bleeding
- mc in <20 + >40
what is oligomenorrhea, po,ymenorrhea and menorrhagia
oligomenorrhea- bleeding that occurs in intervals of greater than 35 days
polymenorrhea- bleeding that occurs in intervals <21 days
Menorrhagia- Prolonged or excessive bleeding at reg intervals
what is mid cycle spotting + what is it due to
spotting that occurs before ovulation (day 13-14)
due to decreased estrogen lvls
What is menometrorrhagia
combo of menorrhagia and metrorrhagia
-Prolonged or excessive bleeding occurring irregular and more frequently than normal intervals
What are the main 2 causes of AUB/DUB
Anovulatory (90%)
Ovulatory (10%)
What is anovulatory AUB (AUB-o) and what is it caused by
menstrual cycle with ovulation or AUB with ovulatory dysfunction
systemic disorders which occur secondary to endocrine, neurochemical or pharm mechanisms
-dx of exclusion
What is the effect of no ovulation
no progesterone which leads to proliferative endometrium and non uniform bleeding
What is the ovulatory cause of AUB/DUB
occurs secondary to defects in the control mechanisms of menstruation
- -chromosomal abnormalities
- -congenital anatomic genital abnormalities that obstruct mentrual flow
tends to be more excessive bleeding during regular menstrual cycles compared to normal
What is dysmenorrhea (primary vs secondary)
Pain during menstraution that restricts daily activities
primary- lower abdominal pain during mentrual cycle
secondary - usually associated with other pathologies in or outside uterus
age for dysmenorrhea
usually effects nulliparous women between 16-25
often decreases after 25
risk factors of dysmenorrhea
- age younger than 30
- nulliparous
- BMI less than 20 and obesity
- Smoking and alcohol consumption
- high lvls of stress
- menarche younger than 12
- irregular flow etc
when does primary dysmenorrhea usually start
6 m to 2 y after menarche
classic symptoms of primary dysmenorrhea
- cramp like pain in lower abdomen and can radiate to back/inner thighs or both
- fluctuating intensity
- onset of pain shortly before or at the onset of bleeding and lasting up to 72hrs
- peak intensity 24-36hrs from onset
Causes of primary dysmenorhea
- usually have high lvls of prostaglandins, leukotriene, vasopressin, platelet activating factor
- cytooxygenase path increases prostanoids and prostaglandins result in uterine ishemia which leads to an increase in metabolites that stim pain
hormonal tx for dysmenorrhea
- combined hormonal contraceptoves (70-80% effective)
- combined oral contraceptive pill
- progestrone only method contraception
Known risk factors of hormonal tx for dysmenorrhea
Deep vein thrombosis
non hormonal tx for dsymenorrhea
- Acetaminophin
- NSAIDs (first line, 1-2days before menaces)
- Low fat veg diet
- essential fatty acids
- calc and magnesium (stabilize contractions)
- B1 (reduces pan)
Herbs used for dysmenorrhea
- black cohosh and cramp bark
- ginger root
- dong quai
other non pharm tx for dysmenorrhea
- TENS
- Heat
- Exercise and yoga
- Accupunctioure
- behabioural interventions
What is secondary dysmenorrhea
- caused by a disorder in the reproductive organs
- tends to get worse over tie and often lasts longer than normal mentrual cramps
causes for secondary dysmenorrhea
- Endometriosis (endometrium grows outside uterus, younger)
- Adenomyosis (Endrometrial tissue that grows into mm layer of uterus, 40-50y)
- pelvic inflammatory disease
- Cerve stenosis
- IUD
- Leomyomas/fibroids
- polyps
How many women does PMS occur in and what part of menstrual cycle does it happen
75-80% of women
- hormone disorder that occurs in luteal phase
- mc in 20-30s
what do u need to dx PMS
- at least one affective symptom and one somatic that causes dysfunction in social, academic, work performance
- cyclical
- begin after olulativ and resolving shortly after onset of menes
What is premenstrual dysphoric disorder and how many women does it occur in
occurs in 5-8%
-experienc symptoms a few days to two weeks (intensify 6 days before and most severe 2 days before0
How to dx premenstrual dysphoric disorder
five symptoms in the week before menses and these symptoms must improve within a few days after the onset of menaces
Pot causes of premenstrual dysphoric disorder
- not really known
- Increased estrogen (had an effect on prolactin, suppress dopamine action, suppress serotonin)
- B6 def
