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Reproductive System > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is amenorrhoea?

A

Absence or cessation of menstruation

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2
Q

What is primary amenorrhoea?

A

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

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3
Q

What is secondary amenorrhoea

A

Cessation of menstruation
- for 3-6 months in women with previously normal + regular periods
- for 6-12 months in women with pervious oligomenorrhoea

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4
Q

What is oligomenorrhoea?

A

Irregular periods defined by cycle length between 6 weeks + 6 months

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5
Q

What is menorrhagia?

A

Heavy periods
>80ml and/or duration of >7 days

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6
Q

What is dysmenorrhoea?

A

Painful periods

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7
Q

What is mullerian agenesis?

A

Atresia of vagina or uterus due to embryological underdevelopment of paramesonephric/Müllerian duct

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8
Q

What is the Karyotype in Turner’s syndrome?

A

45, XO

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9
Q

What is SWYER syndrome?

A

Individuals has female phenotype with female external genital organs but have 46 XY karyotype + underdeveloped gonads

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10
Q

What are the most common causes of primary amenorrhoea with normal secondary sexual characteristics?

A

Anatomical causes:
- imperforate hymen
- vaginal septum
- absent vagina
- absent uterus

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11
Q

What is an imperforate hymen?

A

Congenital disorder where a hymen without an opening completely obstructs the vagina

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12
Q

What does primary amenorrhoea without secondary sexual characteristics suggest?

A

Underlying chromosomal or hormonal cause
e..g Turner’s syndrome, hypothalamic-pituitary dysfunction

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13
Q

How can you differentiate between primary amenorrhoea without secondary sexual characteristics being due to problem with the hypothalamus/pituitary or the gonads?

A
  • Hypothalamus/pituitary: low FSH/LH
  • Gonads: high FSH/LH
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14
Q

What are causes of primary amenorrhoea without secondary sexual characteristics due to issues with the hypothalamus/pituitary?

A
  • genetic: kallmann syndrome, isolated gonadotrophin deficiency
  • acquired: CNS tumour, brain injury/injection
  • functional: stress, weight loss, hypothyroidism
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15
Q

Physiological causes of amenorrhoea

A

Pregnancy
Breastfeeding
Menopause

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16
Q

Causes of secondary amenorrhea

A
  • pregnancy, breastfeeding, menopause
  • hormonal contraception
  • PCOS
  • stress
  • low weight/eating disorders
  • cervical stenosis
  • primary ovarian insufficiency
  • hyper/hypothyroidism
  • hyperprolactinaemia
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17
Q

What is PCOS?
What issues does it cause?

A

Polycystic ovary syndrome
- triad of issues: menstrual irregularity, androgen excess + obesity
- raised insulin resistance

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18
Q

PCOS symptoms

A
  • hair loss
  • oligomenorrhoea
  • acne
  • obesity
  • pelvic pain
  • infertility
  • high testosterone levels
  • Hirsutism
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19
Q

Diagnosis of PCOS

A
  • oligomenorrhoea or amenorrhoea
  • polycystic ovaries on ultrasound
  • clinical signs of hyperandrogenism e.g. Hirsutism, acne, elevated levels of testosterone
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20
Q

What is Hirsutism?

A

Masculine hair growth on women

21
Q

Causes of oligomenorrhoea

A
  • PCOS
  • ovarian insufficient
  • perimenopause
  • thyroid dysfunction
  • excessive exercise
  • eating disorders
  • hormonal contraception
22
Q

What is dysfunctional uterine bleeding?

A

Menorrhagia with no underlying cause

23
Q

What is the most common cause of Menorrhagia?

A

Dynfunctial uterine bleeding (no underlying cause)

24
Q

Causes of menorrhagia - uterine + ovarian pathologies

A
  • uterine fibroids
  • pelvic inflammatory disease
  • endometrial polyps
  • endometrial hyperplasia
  • endometrial cancerr
  • adenomyosis
  • PCOS
25
Q

Causes of menorrhagia - systemic diseases

A
  • coagulation disorders e.g. von Willebrand disease
  • hypothyroidism
  • diabetes mellitus
  • hyperprolactinaemia
  • liver or renal disease
26
Q

Iatrogenic causes of menorrhagia

A
  • anticoagulant treatment
  • IUD
27
Q

What are uterine fibroids?

A

Benign tumours which are caused by proliferation of smooth muscle cells + fibroblasts > form hard, round tumours in myometrium

28
Q

Risk factors of uterine fibroids

A
  • increasing age (until menopause)
  • early menarche
  • older age at first pregnancy
  • black + Asian ethnicity
  • family history
29
Q

Examples of abnormal uterine bleeding?

A
  • intermenstrual bleeding
  • postcoital bleeding
  • post menopausal bleeding
30
Q

What is intermenstrual bleeding?

A

Bleeding in between periods

31
Q

What is postcoital bleeding?

A

Bleeding after sex

32
Q

Management of dysfunction uterine bleeding

A
  • IUS: Ievonorgestral intrauterine system (IUD with hormones)
  • tranexamic acid or NSAID
  • combined pill or progesterone only
33
Q

What are the red flags in menorrhagia which need a referral?

A
  • post menopausal bleeding
  • persistent intermenstrual bleeeding
  • postcoital bleeding
  • pelvic mass
  • bloating
  • ascites
34
Q

What is primary dysmenorrhea

A

Painful periods with an absence of any indentifiable underlying pelvic pathology

35
Q

What is secondary dysmenorrhoea?

A

Painful periods caused by underlying pelvic pathology
+ often starts after several years of painless periods

36
Q

Causes of secondary dysmenorrhoea

A

underlying pelvic pathology:
- endometriosis/adenomyosis
- fibroids
- endometrial polyps
- pelvic inflammatory disease
- IUD insertion

37
Q

What is endometriosis?

A
  • Presence of endometrial glands + stroma outside of endometrial cavity
  • Ectopic tissue induce an oestrogen dependent chronic inflammatory process > fibrosis + scaring
38
Q

Risk factors for endometriosis

A
  • 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
39
Q

What is nulliparity?

A

Women has never been pregnant or given birth

40
Q

What is adenomyosis?

A

Endometrial tissue found deep within myometrium

41
Q

What is an endometrioma?

A

Ovarian cyst containing blood + endometriosis like tissue

42
Q

Complications of endometriosis

A
  • infertility due to scarring in fallopian tubes
  • chronic pain
  • reduced quality of life
  • adhesions
  • bowel obstruction
  • endometriomas
43
Q

Management of primary dysmenorrhoea

A
  • NSAID or paracetamol
  • oral contraceptive
  • conservative advise
44
Q

Management of secondary dysmenorrhoea

A
  • referral if any red flag symptoms
  • NSAID
  • hormonal contraceptive
  • surgical management if fertility is a priority
45
Q

Diagnosis of endometriosis

A

Only by laparoscopic visualisation of pelvic

46
Q

What is dyspareunia?

A

Painful intercourse

47
Q

What test must be done on all women who hae menorrhagia?

A

Full blood count
(Possible anaemia)

48
Q

Two most common causes of secondary amenorrhoea

A

Decreased in body weight
Pregnancy

49
Q

Managment of PCOS

A
  • Lifestyle advice
  • Screening for type 2 diabetes mellitus
  • Combined oral contraceptive pill

Reproductive System (20 decks)

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