Menstrual Disorders Flashcards
What is amenorrhoea?
Absence of menstruation (not pregnancy)
What is Oligomenorrhoea?
Infrequent menstruation (over 35 days) - If over 6 months then secondary amenorrhoea.
What is Menorrhagia?
A complaint of excessive menstrual blood loss over consecutive cycles or over 80ml per menstruation
What is Dysmenorrhoea?
Pain during menses associated with ovulatory cycle. -If pain makes you unable to work / school and very severe.
What is IMB?
Erratic bleeding that doesn’t fit into a pattern (Could be due to infection or contraception -progesterone- or meds).
What is Dysfunctional uterine bleeding (DUB)?
Heavy and irregular menstrual bleeding that occurs secondary to an ovulation
What is premenstrual syndrome (PMS)?
A cyclical disorder, occurring in latter half of the menstrual cycle. Symptoms could be physical or psycological and resolve with onset of menstruation.
What is primary amenorrhoea?
Failure to establish menstruation by 16 years old. (ask about family history).
What is secondary amenorrhoea?
Cessation of previous menstruation for over 6 months.
What is premenstrual dysphoric disorder?
Is the severe end of the spectrum of PMS with extreme mood symptoms.
What are come common causes of disorders of menstruation?
-Hormonal (HPO Axis)
-Chromosomal abnormalities
Structural / Anatomical - uterine or vaginal e.g. fibroids, polyps
-Bleeding diathesis,
-Drugs (contraception),
-Thyroid disease,
-Chronic illness
What chromosomal abnormalities can cause menstrual disorders?
Turner's syndrome Androgen insensitivity syndrome Swyer syndrome Mayer-Rokintansku-kustner-Hayer (MRHK) syndrome Congenital renal hyperplasia
What could cause amenorrhoea?
Physiological: Prepubertal, pregnancy, menopause
Pathology at various levels of endocrine control: Hypothalamic, Pituitary, Ovarian, Uterine / endometrial,
Ganadotropin levels indicate the level of pathology
What are some structural causes of menstrual disorders?
Agenesis / hypoplasia at any level of the genital tract Leiomyoma Imperforate hymen, vaginal septa Ashermans syndrome Cervical stenosis
Common causes of menorrhagia / heavy menstrual bleeding?
Uterine fibroids (Submucus fibroids are most common) - Leiomyoma
Uterine polyps
Endometrial cancer (if bleeding suddenly heavy)
Bleeding diathesis
Copper IUCD
Drugs - e.g. warfarin
What could cause irregular bleeding?
Hormonal contraception - especially progesterone only. STI's / PID - infection Cervical ectopy or pathology Endometrial pathology -polyp/cancer Ovarian cyst - hormone secreting type
What could cause dysmenorrhoea?
Associated with ovulatory cycles can be primary or secondary.
Primary: idiopathic due to response of the uterus to local prostaglandins, hence painful contractions.
Secondary: Endometriosis or obstructed menses
What is endometriosis?
When there is normal endometrial tissue in other places.
Can lead to fibrosis (frozen pelvis)
What particular things would you look for in the history?
Emphasis on age, menarche / onset of puberty, pain -cyclical or not, menstrual history - cycle, volume, change ect, sexual history, medical history, symptoms of effect
What particular things would you look for in the examination?
General, abdominal, speculum, bimanual
Presence or absence of secondary sexual characteristics - appearance of known chromosomal abnormalities or abnormal facies
Swelling / lumps / masses, discharge pattern of hair growth
What particular investigations would you do?
Bloods, hormone profile (FSH, LH), karyotype, thyroid function test, FBC
Hysteroscopy
Laparoscopy
What could be the impact of menstrual disorders?
Physical
Psychological
Social
-All need to be taken into account during management
