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Reproductive system > Lecture 9– Menstrual disorders > Flashcards

Lecture 9– Menstrual disorders Flashcards

1
Q

Amenorrhoea-

A

absence of periods

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2
Q

Oligomenorrhoea-

A

infrequent periods

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3
Q

Menorrhagia-

A

heavy/ prolonged menstrual bleeding

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4
Q

Dysmenorrhea-

A

painful menstruation

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5
Q

amenorrhea can be

A

primary or secondary

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6
Q

primary amenorrhea is defined as

A

no periods by age 16 and normal secondary characteristics

  • or 14 years in abscence of other evidence of puberty
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7
Q

secondary amenorrhea is defined as

A

as the cessation of regular menses for three months or the cessation of irregular menses for six months.

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8
Q

causes of amenorrhea overview

A
  • Overlap of presentation of primary and secondary is because secondary causes may present as primary if they happen early enough
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9
Q

causes of primary amenorrhea in those with normal secondary characteristics

A
  • Anatomical cause- Genitourinary malformations
    • Imperforate hymen
    • A vaginal septum
    • Absent vagina
    • Absent uterus
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10
Q
  • Imperforate hymen
    *
A
  • Congenital disorder where a hymen without an opening completely obstruct the vagina
  • Caused by failure of the hymen to perforate during fetal development
  • Most often diagnosed in adolescent girls when menstrual blood accumulates in vagina or uterus
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11
Q
  • A vaginal septum
A
  • Can be longitudinal or transverse
  • Loss of outflow tract
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12
Q

causes of primary amenorrhea in those without normal secondary characteristics

A
  • Underling chromosomal or hormonal cause
    • E.g. Turners syndrome
    • Hypothalamic-pituitary dysfunction
    • Complete androgen insensitivity disorder
    • Disease in the hypothalamus
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13
Q

turners syndrome

A
  • 45XO (female missing a whole/partial X chromosome)
  • 1:2500
  • Cause incomplete development of the ovary
    • Only stroma present at birth= streak ovaries/gonads
  • Lab values
    • Low oestrogen
    • High FSH and LH
    • No oestrogen= no pubertal changes
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14
Q
A
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15
Q
  • Complete androgen insensitivity disorder
    *
A
  • X linked recessive
  • Resistant to testosterone due to a defect in androgen receptor
  • 46XY but normal female phenotype (external)
    • actually a boy in a females body
  • Testes may be palpable in the labia or inguinal area
  • Absence of the upper vagina, uterus and fallopian tubes
  • Testes should be surgically excised after puberty
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16
Q
  • Disease in the hypothalamus
    • Isolated GnRH deficiency
      *
A
  • Idiopathic hyopgonadotrophic hypogonadism
  • Autosomal dominant or X-linked autosomal recessive
  • Poor development of secondary sexual characteristic
  • With anosmia (smell blindness)= kallman syndrome
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17
Q

clinical checklisrt for primary amenorrhea

A
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18
Q

causes of secondary emnorrhea

A
  • anatomical causes
    • scarring
    • ovarian disorders
  • PCOS
  • thyroid disease
  • hyperprolactinemia
  • pituitary necrosis
  • functional hypothalamic amenorrhea
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19
Q
  • Scarring
    *
A
  • Cervical stenosis
  • Asherman syndrome (intrauterine adhesions)
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20
Q
  • Ovarian disorders
A

Primary ovarian insufficiency (POI)- “premature menopause”

  • Depletion of oocytes before age of 40

No oestrogen, no inhibin= high FSH (loss of negative feedback)

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21
Q
  • Polycystic ovarian syndrome (PCOS)
    *
A
  • 20% of amenorrhea (up to 50% of oligomenorrhea)
  • Elevated LH
  • Raised insulin resistance
  • May be asymptomatic
  • Polycystic ovaries on ultrasound
    • Multiple small follicles
  • Treatment (Rx)
    • Lifestyle changes
    • COCP- change in contraceptive pill
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22
Q

PCOS Triad=

A

menstrual irregularity + androgen excess + obesity

23
Q
  • Thyroid disease
A
  • Menstrual abnormalities common in both hyper and hypothyroidism
  • Severe hyperthyroidism classically associated
  • May be proceeded by oligomenorrhea
  • Complex interplay between thyroid hormones and HPG axis
24
Q
  • Hyperprolactinemia
    *
A
  • Raised prolactin levels (>800)
  • Anterior pituitary hormone has its principles physiological action in initiation and maintenance of lactation
  • High prolactin levels interfere with normal production of other hormones , such as oestrogen and progesterone
  • Can cause change or stop ovulation and also lead to irregular or missed periods
25
Q

causes of hyperprlactinemia

A
  • Pituitary tumours (prolactinomas)
  • CT head- enhancing pituitary macroadenoma
  • Hypothyroidisms
  • Medicines given for depression, psychosis and high blood pressure
26
Q

pituitary necrosis

A

Sheehan syndrome

Sheehan’s syndrome is a condition that affects women who lose a life-threatening amount of blood in childbirth or who have severe low blood pressure during or after childbirth, which can deprive the body of oxygen. This lack of oxygen that causes damage to the pituitary gland is known as Sheehan’s syndrom

27
Q
  • Functional hypothalamic amenorrhea
    *
A
  • Weight loss and excessive exercise
  • Emotional stress and induced by illness
  • E.g. gymnasts and atheletes
  • Risk of bone loss due to hypoestogenmia
28
Q

dont forget phsyiological amenorrhea

A
  • Pregnancy
  • Menopause
    • Towards end of women’s repro timespan periods may become irregular before stopping completely
    • Still possible to get pregnant in transition
29
Q

menorrhoea

A
  • Refers to abnormal uterine bleeding outside of parameters noted below
    • duration greater than 8 days
    • glow greater than 80mL/cycle or subjective impression of heavier-than-normal flow
    • occurs more frequently than every 24 days or less frequently than 38 days
    • intermenstrual bleeding or postcoital spotting
    • absences of menses
30
Q

acute abnormal uterine bleeding

A

episodes of heavy bleeding that is of sufficient quantity to require clinical intervention to stop further blood loss

31
Q

chronic abnormal uterine bleeding

A

bleeding of abnormal volume, duration, regularity, or frequency that has been present or most of the previous 6 months

32
Q

symptoms of abnormal uterine bleeding

A

Types of symptoms

  • Heavy
  • Irregular
  • Infrequently
  • Frequent
  • Shortened
  • Postcoital
  • Intermenstrual
33
Q

underlying causes of abnormal uterine bleeding (menorrhoea)

A

Underlying causes (PALM- COEIN (FIGO)

  • Structural
    • Polyp
    • Adenomyosis
    • Leiomyoma (fibroid)
    • Malignancy/hyperplasia
  • Non-structural
    • Coagulopathy
    • Ovulatory dysfunction (includes thyroid)
    • Endometrial
    • Iatrogenic
    • Not yet classified (DUB)
34
Q

Abnormal uterine bleeding: Fibroids

  • Most common cause
  • Benign tumour of uterine smooth muscle= leiomyoma
  • Oestrogen dependent
  • 40% prevalence
A
35
Q
  • Complications of fibroids
A
    • Heavy Menstrual Bleeding (HMB) and Intermenstrual bleeding (IMB)
      • Subfertility and recurrent pregnancy loss
      • Bulk pressure effects
36
Q

rare complication of fibroids

A

Rare malignant change to leiomyosarcoma 1 in 350

Mostly asymptomatic

37
Q

Dysfunctional uterine bleeding (DUB) is a type of

A

Abnormal uterine bleeding

38
Q

Dysfunctional uterine bleeding (DUB) is the

A

most common cause of menorrhagia

39
Q

causes of Dysfunctional uterine bleeding (DUB)

A
  • No apparent local or systemic causes of menorrhagia
  • Altered endometrial prostaglandin metabolism seems to play important role in aetiology of DUB
    • Prostaglandin inhibitors decrease menstrual blood loss in women with DUB
  • Bleeding of endometrial origin
40
Q

DUB diagnosis is a

A

diagnosis of exclusion

  • PALM-COEIN – “N”- not yet classified
  • common at the extremes of repro life
41
Q

DUB can be subdivided

A
  • Anovulatory
  • Inadequate signal
  • Impaired positive feedback i.e. adolescence
42
Q
  • Ovulatory DUB- idiopathic
A
  • Secondary to increased prostaglandins and reduced endothelin (vasoconstrictors)
  • Genetic?
43
Q

dysmenorrhoea

A
  • Painful menstruation: crampy and intermittently intense, or continuous dull ache
  • 45-95% of women of repro age
44
Q
  • Presentation of dysmenorrhoea
A
  • 1-2 days before or with onset of menses
  • Improves 12-72 h
  • Lower abdomen and suprapubic area
45
Q

types of dysmenorrhoea

A
46
Q

Dysmenorrhea management

A
  • NSAIDS
  • Hormonal contraceptives
    • COCP
    • Intrauterine device
  • GnRH analogues- drives down process
  • Surgery
    • Adhesiolysis
    • Treatment to endometriosis
    • Hysterectomy (final option)
  • Heat, ginger, acupuncture, TENS
47
Q

Dysmenorrhea- Endometriosis

A
  • Endometrial glands and stroma that occur outside uterine cavity
  • 5-10% prevalence
48
Q
  • Risk factors of endometriosis
A
  • Nulliparity (a woman has never given birth to a child, or has never carried a pregnancy)
  • Early menarche
  • Short cycles
  • Heavy bleeding
  • Low BMI
49
Q

cause of endometriosis

A
  • Cause
    • Not really sure
    • Oestrogen dependent, benign inflammatory disease
50
Q

endometriosis repsonds to

A
  • Responds to cyclical hormonal changes
51
Q

symptoms and signs of endometriosis

A
  • Can cause dysmenorrhea, dyspareunia (recurring pain in genital area), chronic pain and infertility
52
Q

endometriosis has a multifactorial pathogenis- could be

A

retrograde menstruation

53
Q

Most common sites of endometriosis

A

Adenomyosis: endometrial tissue found deep within myometrium

  • Ovaries
    • Endometrioma= chocolate cycst
  • Bladder
  • Rectum
  • Peritoneal lining and pelvic side walls
54
Q

ALWAYS

A

RULE OUT PREGNANCY

Reproductive system (28 decks)

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