menstrual disorders Flashcards
what is the most common cause of unexplained uterine bleeding?
What are other commonc uases?
the most common cause in a nonpregnant woman is dysfunctional menstrual cycles
• Unexplained uterine bleeding can occur for many reasons eg abortion, pregnancy, neoplasms, and bleeding disorders
when the basic pattern of bleeding is changed what is most likely the cause
• When the basic pattern of bleeding is changed its most often due to lack of ovulation & disturbances in pattern of hormone secretion.
if the basic pattern is the undisturbed but there is superimposed bleeding what is the etiology?
If the basic pattern is undisturbed and there are superimposed bleeding episodes or spotting, the etiology is more likely to be related to organic lesions or hematologic disorders
define amenorrhea and primary amenorrhea
- Amenorrhea is an absence of menstruation.
- Primary amenorrhea is failure to menstruate by 15yrs old or by 13yrs old if accompanied by absence of secondary sex characteristics.
what is secondary amenorrhea
• Secondary amenorrhea is the cessation of menses for at least 6 months in a woman with established normal menstrual cycles.
etiology of primary amenorrhea
brief exp of what each is will come later. might not be nec?
It is usually caused by gonadal dysgenesis
congenital mullerian agenesis,
testicular feminization,
or a hypothalamic-pituitary-axis disorder
etiology of 2ary amenorrhea
Causes include: ovarian, pituitary or hypothalamic dysfunction;
intrauterine adhesions;
infections (eg syphilis, TB)
pituitary tumor;
anorexia nervosa;
or strenuous physical exercise (that alters fat-muscle ratio which is necessary for menses to occur)
dx of amenorrhea
maybe doesnt need to be so detailed as he says briefly discuss
like that of dys fx uterine bleeding
history with emphasis on bleeding pattern and physical exam,
endocrine studies,
pregnancy test,
endometrium,
endometrial biopsy,
D;C with and without hysteroscopy, (Dilation and Curettage this means going in and getting sample)
progesterone withdrawal tests,
CT scan or MRI to exclude pituitary tumor
tx of amenorrhea
• Treatment: address underlying cause and induce menses with cyclic progesterone or combined estrogen progesterone
what is dysmenorrhea?
• Pain or discomfort with menstruation that is generally not serious but can cause some monthly disability for certain women
what is a possible cause of dysmenorrhea?
• Dysmennorrhea is thought to be the result of excess prostaglandin production that causes painful contraction of the uterus and arteriolar vasospasm
describe primary dysmenorhea
• Primary: menstrual pain that isn’t associated with a pathologic process or physical abnormality
describe Tx of primary dysmenorrhea
Treatment is directed at controlling symptoms. Aspirin and acetaminophen relieve minor cramps but prostaglandin synthetase inhibitors (eg ibuprofen, naproxen) are best if contraception isn’t desired. Ovulation suppression and symptomatic relief can be achieved with oral contraceptive.
describe secondary dysmenorrhea and summarize its Tx
• Secondary: menstrual pain caused by specific organc conditions eg endometriosis, uterine fibroids, adenomyosis, pelvic adhesions, IUDs or PID. Medical or surgical intervention may be necessary.
what is menorrhagia
• Prolonged or excessive bleeding during regular menstrual flow
etiology of menorrhagia
- In young women its usually related to endocrine disturbance
- Later in life it usually results from inflammatory disturbances, tumours of the uterus, or hormonal imbalance
which form of bleeding is most serious?
what is it?
metrorrhagia . • Vaginal bleeding between regular menstrual periods.
why is metrorrhagia significant
This is the most significant form of menstrual dysfunction as it may signal cancer, benign tumours of the uterus, or other gynaecologic problems and prompt evaluation is necessary
not under outcomes from here on
which hormones could cause irreg periods
estrogen and progesterone (id also say FSH, LH and GnRH or maybe even androgens)
how would estrogen deprivation affect a menstrual cycle?
estrogen deprivation causes retrogression of previously built-up endometrium and bleeding that often irreg in amount and duration
why would a woman not have progesterone
from failure of any of dev ovarian follicles to mature to point of ovulation, with subseq formation of corpus luteum and prod and sec of progesterone
how would a lack of progesterone affect a menstrual cycle
in its absence estrogen induces dec of much thicker endometrial layer with richer blood supply
if a womanwa having anovulatory bleeding what type of symptoms would be expected/not expected
becuse vasocnstriction and myometrial contractions that normally accompany menstruation are caused by progesterone, anovulatory bleeding is not often crampy, flow is freq heavy (d/t buildup of estrogen i guess?)
?? indicates not sure if nec.
et of primary amenorrhea what is gonadal dysgenesis
Gonadal dysgenesis is any congenital developmental disorder of the reproductive system characterized by a progressive loss of germ cells on the developing gonads of an embryo.
?? et of primary amenorrhea what is mullerian dysgenesis
most common presentation of müllerian agenesis is congenital absence of the vagina, uterus, or both, which also is referred to as müllerian aplasia,
??et of primary amenorrhea what is testicular feminization
Testicular feminization syndrome: Now more appropriately called the complete androgen insensitivity syndrome, this is a genetic disorder that makes XY fetuses insensitive (unresponsive) to androgens (male hormones). Instead, they are born looking externally like normal girls. Internally, there is a short blind-pouch vagina and no uterus, fallopian tubes or ovaries. There are testes in the abdomen or the inguinal canal.
??how is hormonal control involved in menstruation? hypothalamus and pituitary what secretes what? what is the hormones fx?
GnRH from hypothalamus stim rel of FSH and LH by ant pituitary (these stim growth and dev of cells in ovaries as a means of stim production of sex hormones). LH acts more on corpus luteum and progestins. FSH on estrogen. Levels of these hormones–> neg feedback
ant pituitary also sec prolactin (stims lactation and imp for pregnancy)
?? which hormones do ovaries produce? when do these peak? fx?
estrogens. peak before ovulation and in middle of luteal phase. fx=dev of 2ary sex char, dev of endometrial lining, promote growth of ovarian follicles, help w fertilization
progesterone=sec by corpus luteum after ovulation. Causes secretory phase of endometrium to prep for implantation. When this doesnt occur the sudden withdrawal of progesterone–>menstruation/shedding. the estrogen peaks then the progesterone peaks after
androgens…not r/t menstrual cycle r/t hair grownth and metb
??et of primary amenorrhea hypothalamic-pituitary-axis disorder
I guess that any problem of neg feedback, maybe not enough GnRH, imbalance of LH and FSH, no prod of estrogen and progesterone for neg feedback, etc
