Menstrual Cycle Disorder

Question 1

Define amenorrhea

Answer 1

No menses bleeding in 90 day period

Question 2

What is primary and secondary amenorrhea?

Answer 2

Primary: Absence of menses by age 15 in females who never menstruated

Secondary: Absence of 3 cycles in previously menstruating females

Question 3

Which subpopulation group does secondary amenorrhea happen to?

Answer 3

< 25 year olds with history of menstrual irregularities
Increased weight loss
Competitive athletics

Question 4

What are some possible etiology of amenorrhea?

Answer 4

Anatomical causes such as pregnancy and uterine structural abnormalities

Endocrine disturbances causing chronic anovulation

Ovarian insufficiency or failure

Question 5

What is the pharmacological treatment for amenorrhea?

Answer 5

COC/ Estrogen only/ Progestin only/ Copper IUD

Question 6

What advice can I give patients with amenorrhea?

Answer 6

Weight gain
Decrease exercise intensity
Stress management

Question 7

Define heavy menstrual bleeding (menorrhagia)

Answer 7

Menstrual blood loss > 80mL per cycle

Bleeding more than 7 days in a cycle

Question 8

What are the pathophysiology behind menorrhagia?

Answer 8

Uterine related factors such as fibroids, adenomyosis, endometrial polyps and alteration of HPO axis

Coagulopathy such as cirrhosis, von willebrand disease and idiopathic thrombocytopenia purpura

Question 9

What should I consider before patients are to start therapy for menorrhagia?

Answer 9

If they consent to be on contraception

Question 10

What contraceptive methods can I provide to help with menorrhagia?

Answer 10

COC
Progestin IUD
Progestin only oral contraceptives
Progestin injections

Question 11

What non-contraceptive methods to consider for menorrhagia?

Answer 11

NSAIDS
Tranexamic acid
Cyclic progesterone

Question 12

Define dysmenorrhea

Answer 12

Crampy pelvic pain with/ before menses

Question 13

What is the possible primary and secondary mechanism of actions of dysmenorrhea?

Answer 13

Primary: Release of prostaglandin and leukotrienes lead to vasoconstriction thus causing cramps

Secondary causes could be due to endometriosis

Question 14

What are some nonpharmacological and pharmacological intervention to help with severe dysmenorrhea?

Answer 14

Non Pharmacological: Topical heat therapy, exercise, acupuncture, low fat vegetable diet

Pharmacological: NSAID, COC, Progestin only injections

Question 15

Define premenstrual symptoms

Answer 15

Cyclic pattern of symptoms occurring 5 days before menses and is resolved at onset of menses

Question 16

PMS symptoms are classified as somatic and affective. List a few of these symptoms in the broad categories.

Answer 16

Somatic: Bloating, headache, weight gain, fatigue, nausea, appetite change

Affective: anxiety, depression, angry outburst, social withdrawal, forgetful, tearful, restlessness

Question 17

What is a severe case of PMS?

Answer 17

Premenstrual dysphoric disorder

Question 18

What options can I consider for somatic and affective symptoms respectively

Answer 18

Somatic: COC
Affective: Selective serotonin reuptake inhibitors

Question 19

Define polycystic ovary syndrome

Answer 19

Ovaries producing abnormal amount of androgen causing small cysts to form in the ovaries

Question 20

What are the clinical presentations of PCOS?

Answer 20

Menstrual irregularities
Androgen excess symptoms including acne, hirsutism and obesity

Question 21

What potential treatments are considered for PCOS?

Answer 21

COC that are antiandrogenic
Metformin