Menstrual cycle and disorders Flashcards
what are the stages of female sexual development in order?
Thelarche = occurs at 9-11 years Adrenarche = occurs at 11-12 years Menarche = 13 years and is the final stage
define adrenarche
Adrenarche = growth of pubic hair, occurs at 11-12 years
define menarche
Menarche = 13 years and is the final stage
Define Therlache
Thelarche = breast development, occurs at 9-11 years
what day is the start of the menstraul cycle?
first day of your period/mentraution
what are the phases of the menstraul cycle and when?
Days 1–4: menstruation
-shedding endometrium
Days 5–13: proliferative phase
- proliferative endometrium
Days 14–28: luteal/secretory phase
- basal endometrium - secretory endometrium
what are the landmarks of normal menstraution? eg normal start time, normal stop, length etc?
Menarche <16 years Menopause >45 years Menstruation 3–8 days in length Blood loss <80 mL Cycle length 24–38 days No intermenstrual bleeding (IMB)
define AUB - abnromal uterine bleeding?
any variation from the normal menstrual cycle,
this includes changes in regularity and frequency of menses,
in duration of flow, or in amount of blood loss
why is fsh much lower than lh around the day 14 mark?
there had been a negative feeedback on fsh prodcution from ostradiol and inhibin produced by the follicles.
spike in oestradiol levels causes positive feedback on LH hence LH surge
which hormones cause follicular growth and lead to the maturation and therefore survival of 1 follicle over the remaining antral follicles?
LH and FSH (mainly)
what are the causes of abnormal uterine bleeding?
PALM-COEIN (‘palm-coin’)
PALM - structural:
Polyps
Adenomyosis
Leiomyomas (fibroids) –Submucosal –Other
Malignancy and hyperplasia
COEIN - medical:
Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet specified
what 6 charactersitics are used to assess abnormal utreine bleeding - FIGO?
Volume
Regularity (cycle-to cycle variation)
Frequency (normal every 24–38 days)
Duration (normal3–8 days)
Irregular, non-menstrual bleeding
eg Premenstrual and postmenstrual spotting
Bleeding outside reproductive age:
eg Postmenopausal bleeding,Precocious menstruation
what are the limits for Prolonged menstrual bleeding
and Shortened menstrual bleeding?
Bleeding >8 days duration
Bleeding <3 days duration
what are the limits for frequent and Infrequent menstrual bleeding?
Bleeding at intervals >38 days apart (5 wks+) - so menstraul cycle occurs between 38 days - 6 months.
Bleeding at intervals <24 days apart (>3 wks)
what is the new term for oligomennorhea?
most common cause?
Infrequent menstrual bleeding
most common: PCOS
how are the following defined:
Irregular menstrual bleeding
Absent menstrual bleeding (amenorrhoea)
irreg: Cycle-to-cycle variation >20 days
absent: No bleeding in a 6-month interval
define heavy menstraul bleeding clinically and objectively?
what was the previous term for this?
clinical:
Excessive menstrual blood loss which interferes with
the woman’s physical, emotional, social and material
quality of life, and which can occur alone or in
combination with other symptoms
objective:
This is blood loss of >80 mL in
an otherwise normal menstrual cycle. This value corresponds to the maximum amount that a woman on
a normal diet can lose per cycle without becoming
iron deficient. In practice, actual blood loss is rarely
measured.
The cycle is REGULAR!
previously - mennorhagia
define Postmenopausal bleeding
Bleeding occurring more than 1 year after the acknowledged menopause
define Precocious menstruation
Bleeding before the age of 9 years
define primary amennorhea?
Absence of menstruation despite signs of puberty
before age 16 usually
define secondary amennorhea?
most common cause? other causes?
Absence of menstruation for 3-6 months in a woman who has previously menstruated.
Most common = pregnancy. Other causes include high/low BMI, stress, exercise, prolactinoma
define Dysfunctional Uterine Bleeding?
Irregular bleeding due to anovulation or an anovulatory cycle (may be anatomical e.g. uterine fibroids)
what are the 2 forms of heavy menstraul bleeding?
mennorhagia - regualr cycle
metrorraghia - irregular cycle
what are the cause and characteristics of Anovulation/Anovulatory Menses?
Menstrual cycle without ovulation (often very light due to absence of progesterone)
define Dysmenorrhoea?
name some causes
Menstrual pain
associated with high prostaglandin levels in the endometrium
is due to contraction and uterine ischaemia.
what is the most common form of Abnormal uterine bleeding?
HMB - heavy menstraul bleeding / mennorghia
what is the aetiology and most common causes of HMB/menorragia?
Uterine fibroids - 30%
polyps - 10%
uterine prostaglandin levels pevic infection gynae malignancy thyroid disease anticoagulant therapy coagulopahties eg vWD
women has HMB, she has personal and fhx of excessive bleeding after surgery/trauma or easy bruising.
what is possible aetiology?
coagulopathy may be suggested
by a family or personal history of excessive bleeding after surgery/trauma or easy bruising
what are the hallmarks of excessive blood loss?
History:
- flooding - sheets become soaked with blood while sitting or lying down
- passage of clots
examination:
- anaemia
- Irregular enlargement of uterus = fibroids
- Tenderness with/without enlargement = adenomyosis
