Menstrual Disorders

Question 1

Define amenorrhoea and distinguish primary and secondary

Answer 1

Absence or cessation of menstruation

Primary is where menstruation never starts by 15 years old

Secondary is where menstruation started but then stops for 3-6 months

Question 2

Causes of primary ammenorhea with normal secondary sexual characteristics - 7

Answer 2

Constitutional delay - puberty is delayed
Imperforate hymen
Vaginal septum
Absent vagina or uterus
PCOS
Cushings
Androgen insensitivity syndrome

Question 3

Causes of primary amenorrhoea with no secondary sexual characteristics - 4

Answer 3

Turners syndrome (missing an X chromosome so no internal genitalia)
Hypothalamus/pitutary disorders e.g. GNRH def
Excessive exercise/weight loss
Chronic illness e.g. diabetes

Question 4

Causes of secondary amenorrhoea - 6

Answer 4

Pregnancy
Menopause
Hormonal drugs
Over excersising / weight loss
PCOS
Pituitary issues

Question 4

how to assess for primary ammenohorea cause - history (4) and exam (4)

Answer 4

HISTORY
- ask about sex to exclude pregnancy
- ask about excercise, stress, depression, eating
- ask about visual disturbance, galactorrhoea, headache (prolactinoma)
- ask about FH of menstruation

EXAMINATION
- take BMI (high may mean PCOS or low may be under eating)
- Features of turners syndrome, cushings, PCOS, thyroid disease
- clitoromegaly (excess androgen)
- galactorhea

Question 5

Define oligomenorrhoea

Answer 5

Infrequent menstruation of a cycle between 6 weeks and 6 months

Question 6

Causes of oligomenorrhoea - 6

Answer 6

PCOS
Ovarian insufficiency
Perimenopause
thyroid dysfunction
Excessive exercise or malnutrition
Hormonal contraception

Question 7

Define menorrhagia

Answer 7

excessive menstrual blood loss which interferes with a woman’s physical, social, emotional, and/or material quality of life

Question 8

Causes of menorrhagia - 5

Answer 8

uterine fibroids
uterine cancer
endometriosis
coagulation disorders
medications (anti-coags)

Question 9

assessment of menorrhagia - 2

Answer 9

• if they have associated symptoms (pelvic pain ect) then perform pelvic exam. If no symptoms give meds straight. away
• FBC is always indicated to rule out iron deficiency anaemia

Question 10

Management of mennorhagia

Answer 10

1st line - IUS (hormonal coil) should be offered

2nd line - if refused, tranexamic acid, methanamic acid (an NSAID) other NSAIDs or hormonal trx and offer iron tablets

Question 11

Define dysmenorrhoea

Answer 11

pain that occurs in conjunction with menstruation, pain becomes severe and debilitating

Question 12

Causes of dysmenorrhoea primary and secondary

Answer 12

Primary - idiopathic
Secondary - endometriosis, PID, uterine fibroids