Menstrual Disorders Flashcards
What is amenorrhoea?
Absence or cessation of menstruation
What is primary amenorrhoea?
Failure to establish menstruation by:
- 15 years old in girls with normal secondary sexual characteristics
- 13 years old in girls with no secondary sexual characteristics
What is secondary amenorrhoea
Cessation of menstruation
- for 3-6 months in women with previously normal + regular periods
- for 6-12 months in women with pervious oligomenorrhoea
What is oligomenorrhoea?
Irregular periods defined by cycle length between 6 weeks + 6 months
What is menorrhagia?
Heavy periods
>80ml and/or duration of >7 days
What is dysmenorrhoea?
Painful periods
What is mullerian agenesis?
Atresia of vagina or uterus due to embryological underdevelopment of paramesonephric/Müllerian duct
What is the Karyotype in Turner’s syndrome?
45, XO
What is SWYER syndrome?
Individuals has female phenotype with female external genital organs but have 46 XY karyotype + underdeveloped gonads
What are the most common causes of primary amenorrhoea with normal secondary sexual characteristics?
Anatomical causes:
- imperforate hymen
- vaginal septum
- absent vagina
- absent uterus
What is an imperforate hymen?
Congenital disorder where a hymen without an opening completely obstructs the vagina
What does primary amenorrhoea without secondary sexual characteristics suggest?
Underlying chromosomal or hormonal cause
e..g Turner’s syndrome, hypothalamic-pituitary dysfunction
How can you differentiate between primary amenorrhoea without secondary sexual characteristics being due to problem with the hypothalamus/pituitary or the gonads?
- Hypothalamus/pituitary: low FSH/LH
- Gonads: high FSH/LH
What are causes of primary amenorrhoea without secondary sexual characteristics due to issues with the hypothalamus/pituitary?
- genetic: kallmann syndrome, isolated gonadotrophin deficiency
- acquired: CNS tumour, brain injury/injection
- functional: stress, weight loss, hypothyroidism
Physiological causes of amenorrhoea
Pregnancy
Breastfeeding
Menopause
Causes of secondary amenorrhea
- pregnancy, breastfeeding, menopause
- hormonal contraception
- PCOS
- stress
- low weight/eating disorders
- cervical stenosis
- primary ovarian insufficiency
- hyper/hypothyroidism
- hyperprolactinaemia
What is PCOS?
What issues does it cause?
Polycystic ovary syndrome
- triad of issues: menstrual irregularity, androgen excess + obesity
- raised insulin resistance
PCOS symptoms
- hair loss
- oligomenorrhoea
- acne
- obesity
- pelvic pain
- infertility
- high testosterone levels
- Hirsutism
Diagnosis of PCOS
- oligomenorrhoea or amenorrhoea
- polycystic ovaries on ultrasound
- clinical signs of hyperandrogenism e.g. Hirsutism, acne, elevated levels of testosterone
What is Hirsutism?
Masculine hair growth on women
Causes of oligomenorrhoea
- PCOS
- ovarian insufficient
- perimenopause
- thyroid dysfunction
- excessive exercise
- eating disorders
- hormonal contraception
What is dysfunctional uterine bleeding?
Menorrhagia with no underlying cause
What is the most common cause of Menorrhagia?
Dynfunctial uterine bleeding (no underlying cause)
Causes of menorrhagia - uterine + ovarian pathologies
- uterine fibroids
- pelvic inflammatory disease
- endometrial polyps
- endometrial hyperplasia
- endometrial cancerr
- adenomyosis
- PCOS
Causes of menorrhagia - systemic diseases
- coagulation disorders e.g. von Willebrand disease
- hypothyroidism
- diabetes mellitus
- hyperprolactinaemia
- liver or renal disease
Iatrogenic causes of menorrhagia
- anticoagulant treatment
- IUD
What are uterine fibroids?
Benign tumours which are caused by proliferation of smooth muscle cells + fibroblasts > form hard, round tumours in myometrium
Risk factors of uterine fibroids
- increasing age (until menopause)
- early menarche
- older age at first pregnancy
- black + Asian ethnicity
- family history
Examples of abnormal uterine bleeding?
- intermenstrual bleeding
- postcoital bleeding
- post menopausal bleeding
What is intermenstrual bleeding?
Bleeding in between periods
What is postcoital bleeding?
Bleeding after sex
Management of dysfunction uterine bleeding
- IUS: Ievonorgestral intrauterine system (IUD with hormones)
- tranexamic acid or NSAID
- combined pill or progesterone only
What are the red flags in menorrhagia which need a referral?
- post menopausal bleeding
- persistent intermenstrual bleeeding
- postcoital bleeding
- pelvic mass
- bloating
- ascites
What is primary dysmenorrhea
Painful periods with an absence of any indentifiable underlying pelvic pathology
What is secondary dysmenorrhoea?
Painful periods caused by underlying pelvic pathology
+ often starts after several years of painless periods
Causes of secondary dysmenorrhoea
underlying pelvic pathology:
- endometriosis/adenomyosis
- fibroids
- endometrial polyps
- pelvic inflammatory disease
- IUD insertion
What is endometriosis?
- Presence of endometrial glands + stroma outside of endometrial cavity
- Ectopic tissue induce an oestrogen dependent chronic inflammatory process > fibrosis + scaring
Risk factors for endometriosis
- early menarche
- late menopause
- delayed childbearing
- nulliparity
- family history
- vaginal outflow obstruction e.g. imperforate hymen
- white ethnicity
- low BMI
- autoimmune disease
- late first sexual encounter
- smoking
What is nulliparity?
Women has never been pregnant or given birth
What is adenomyosis?
Endometrial tissue found deep within myometrium
What is an endometrioma?
Ovarian cyst containing blood + endometriosis like tissue
Complications of endometriosis
- infertility due to scarring in fallopian tubes
- chronic pain
- reduced quality of life
- adhesions
- bowel obstruction
- endometriomas
Management of primary dysmenorrhoea
- NSAID or paracetamol
- oral contraceptive
- conservative advise
Management of secondary dysmenorrhoea
- referral if any red flag symptoms
- NSAID
- hormonal contraceptive
- surgical management if fertility is a priority
Diagnosis of endometriosis
Only by laparoscopic visualisation of pelvic
What is dyspareunia?
Painful intercourse
What test must be done on all women who hae menorrhagia?
Full blood count
(Possible anaemia)
Two most common causes of secondary amenorrhoea
Decreased in body weight
Pregnancy
Managment of PCOS
- Lifestyle advice
- Screening for type 2 diabetes mellitus
- Combined oral contraceptive pill
