Menstrual cycle disorders Flashcards
What is the definition of amenorrhea
No menstrual bleeding in a 90 day period
Risk factors for secondary amenorrhea (absence of period for 90 days in previously menstruating females)
- <25 yo with Hx of menstrual irregularities
- Competitive athletes
- Massive weight loss
Etiologies of amenorrhea
- Anatomical causes (eg. pregnancy, uterine structural abnormalities)
- Endocrine disturbances –> chronic anovulation
- Ovarian insufficiency/ failrue
Non-pharmacological treatment of amenorrhea
- Weight gain
- Reduction of exercise intensity
- Stress management
Pharmacological treatment for amenorrhea
- COC
- Estrogen only
- Progestin only
- Copper IUD
Definition of Menorrhagia
Heavy menstrual bleeding
- Menstrual blood loss >80mL per cycle or bleeding >7 days per cycle
Contraceptives for treatment of menorrhagia
- COC
- Progestin IUD
- Progestin-only pill
- Progestin injection
Non-contraceptive treatment for menorrhagia
- NSAIDs during menses
- Tranexamic acid during menses
- Cyclic progesterone (no contraceptive effect)
- Endometrial ablation or hysterectomy
Definition of dysmenorrhea
- Crampy pelvic pain with or just before menses
- Secondary is caused by endometriosis (endometrium grows outside of uterus)
Causative factor responsible for dysmenorrhea
Prostaglandins and leukotrienes –> vasoconstriction –> cramps
Non-pharmacological management of dysmenorrhea
- Topical heat therapy
- Exercise
- Acupuncture
- Low-fat vegetarian diet
Pharmacological treatment of dysmenorrhea
- NSAIDs (1st line)
- COC (2nd line)
- Progestin injection/ IUD (3rd line) –> to render patients amenorrhic
What does Premenstrual syndrome (PMS) means?
- Cyclic pattern of symptoms occurring 5 days before menses that resolve at the onset of menses
- Most patients do not report impairment of daily activities
What are the somatic symptoms of PMS (physical)?
- Bloating
- Headache
- Weight gain
- Fatigue
- Dizziness/ nausea
- Appetite changes
What are the Affective symptoms of PMS (mood)?
- Anxiety/ depression
- Angry outburst
- Social withdrawal
- Forgetfulness
- Tearful
- Restlessness
Pharmacological therapy for PMS
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- COC –> for physical symptoms not for Affective symptoms
What is Polycystic Ovary Syndrome (PCOS)?
Ovaries produce an abnormal amount of androgens –> small cysts form in ovaries
Clinical presentation of PCOS
- Menstrual irregularities
- Androgen excess (acne, oily skin, hirsutism, obesity)
- Metabolic disorder/ insulin resistance –> increase risk for DM and CVS disease
Treatment for PCOS
- COC (consider anti-androgenic progestin)
- Metformin
