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Repro > Lecture 8 - Menstrual disorders > Flashcards

Lecture 8 - Menstrual disorders Flashcards

1
Q

Primary amenorrhoea

A

Absence of menstruation

Never had a period by the age of 16

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2
Q

Secondary amenorrhoea

A

Started periods but the periods have stopped for more than 6 months

Causes:

  • pregnancy
  • weight loss
  • menopause
  • birth control
  • hypothyroidism
  • hyperprolactinaemia
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3
Q

Oligomenorrhoea

A

Reduced menstruation

Cycle length is more than 35 days

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4
Q

Menorrhagia

A

Heavy menstrual bleeding
More than 80ml

Causes:

  • benign or malignant growth in the endometrium
  • clotting disorders
  • anticoagulation therapy
  • look for anaemia
  • can be objective
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5
Q

How to measure menorrhagia

A

How many pads used
Changes in menstruation pattern
Cups

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6
Q

Dysmenorrhea

A

Painful periods

Causes:
- endometriosis

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7
Q

Turner’s syndrome

A

45XO - missing sex chromosome

Dysgenesis of ovary:

  • less oestrogen
  • high FSH and LH - lack of negative feedback
  • no oestrogen - no pubertal changes

Symptoms and signs

  • primary amenorrhoea
  • short
  • brown spots
  • widely displaced nipples
  • aortic constriction
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8
Q

Structural causes of primary amenorrhoea

A

Imperforate hymen - fusion of Müllerian duct and urogenital ridge so hymen closes off vagina

Transverse vaginal septum

Mullerian agenesis - no cervix therefore pouch of blood in uterus

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9
Q

Hormonal causes of primary amenorrhoea

A

Complete androgen insensitivity

Isolated GnRH deficiency

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10
Q

Complete androgen insensitivity pathophysiology

A
  1. XY
  2. Testes develop
  3. Testes produces mullerian inhibiting hormone supressing the Müllerian duct development (paramesonephric)and testosterone
  4. Due to androgen insensitivity, the mesonephric duct (wolffian) duct is not produced
  5. Testosterone is converted to oestrogen - female phenotype
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11
Q

Complete androgen insensitivity syndrome presentation

A
  • Male genotype with female phenotype
  • X linked recessive - 46 XY
  • Resistant to testosterone due to defect3 androgen receptor
  • testes palpable in the labia or inguinal area - surgically removed after puberty
  • abscence of the upper vagina, uterus and fallopian tubes
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12
Q

Isolated GnRH deficiency

A
  • idiopathic hypogonadotrophic hypogonadism
  • delayed puberty
  • autosomal dominant
  • X linked autosomal recessive - more common in males
  • poor development of secondary sexual characteristics
  • with anosmia (lack of smell) - Kallmann syndrome
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13
Q

Pathophysiology of isolated GnRH deficiency

A
  1. Lack of GnRH from hypothalamus
  2. No pituitary stimulation
  3. No release of FSH and LH
  4. No sex hormones released
  5. No secondary sexual characteristics
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14
Q

Anatomical causes of secondary amenorrhoea

A

Scarring

  • cervical stenosis
  • Asherman syndrome - intrauterine adhesions and uterine scarring due to surgery, infection or instrument

Primary ovarian insufficiency (POI) = premature menopause

  • depletion of all oocyte before 40 yrs old
  • no oestrogen or inhubin - high FSH as no negative feedback
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15
Q

Polycystic ovarian syndrome

A

Idiopathic

Elevated LH - hyperandrogenism 
Raised insulin resistance - Diabetes
Secondary amenorrhoea 
Infertility
Hirsutism 
Obesity

Investigation: USS and blood test

Risks: COCP and obesity

Treatment: remove uterus

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16
Q

Endocrine cause of secondary amenorrhoea

A

Hypothyroidism
Hyperthyroidism - also get oligomenorrhoea
Hyperprolactinaemia

17
Q

Hyperprolactinaemia

A
  1. Hypothyroidism can cause increased TSH and prolactin secretion from the anterior pituitary

Breastfeeding and drugs can also inhibit dopamine. Dopamine normally inhibits prolactin release therefore more prolactin is secreted.

Can get prolactin secreting tumours.

  1. This causes negative feedback on the hypothalamus which decreases the release of GnRH
  2. Amenorrhoea and nipple discharge
18
Q

Sheehan syndrome

A

Pituitary necrosis

19
Q

How long should menses last

A

7 - 9 days

20
Q

Structural causes of abnormal uterine bleeding

A

Polyps
Adenomyosis
Leimyoma (fibroid)
Malignancy /hyperplasia

21
Q

Non structural causes of abnormal uterine bleeding

A 
Coagulopathy
Ovulatory disorder
Endometrial 
Iatrogenic
Not classified
22
Q

Leiomyoma

A

Benign tumour of uterine smooth muscle in myometrium
Oestrogen dependent - regresses after menopause

  • menorrhagia and oligomenorrhoea
  • bulk pressure effects
  • recurrent pregnancy loss
  • pain
23
Q

Dysfunction uterine bleeding

A

Diagnosis of exclusion

24
Q

Primary dysmenorrhea

A

Since menarche

25
Q

Secondary dysmenorrhea

A

Developed over time

  • May have cause
    e. g. endometriosis, recurrent cysts or inflamed bowel disease
26
Q

Endometriosis

A

Endometrial tissue that occurs outside the uterine cavity

Can cause:

  • early menarche
  • menorrhagia
  • dysmenorrhea
  • AUB
  • infertility
  • dyspareunia

Oestrogen dependent

27
Q

Common sites of endometriosis

A

Most common place - ovary
Bladder
Rectum
Peritoneum

28
Q

Management of dysmenorrhea

A

NSAIDs
COCP
Intrauterine device
GnRH analogues

Surgery - hysterectomy

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