Menstrual Disorders

Question 1

What is amenorrhoea?

Answer 1

Absence of menstruation (not pregnancy)

Question 2

What is Oligomenorrhoea?

Answer 2

Infrequent menstruation (over 35 days) - If over 6 months then secondary amenorrhoea.

Question 3

What is Menorrhagia?

Answer 3

A complaint of excessive menstrual blood loss over consecutive cycles or over 80ml per menstruation

Question 4

What is Dysmenorrhoea?

Answer 4

Pain during menses associated with ovulatory cycle. -If pain makes you unable to work / school and very severe.

Question 5

What is IMB?

Answer 5

Erratic bleeding that doesn’t fit into a pattern (Could be due to infection or contraception -progesterone- or meds).

Question 6

What is Dysfunctional uterine bleeding (DUB)?

Answer 6

Heavy and irregular menstrual bleeding that occurs secondary to an ovulation

Question 7

What is premenstrual syndrome (PMS)?

Answer 7

A cyclical disorder, occurring in latter half of the menstrual cycle. Symptoms could be physical or psycological and resolve with onset of menstruation.

Question 8

What is primary amenorrhoea?

Answer 8

Failure to establish menstruation by 16 years old. (ask about family history).

Question 9

What is secondary amenorrhoea?

Answer 9

Cessation of previous menstruation for over 6 months.

Question 10

What is premenstrual dysphoric disorder?

Answer 10

Is the severe end of the spectrum of PMS with extreme mood symptoms.

Question 11

What are come common causes of disorders of menstruation?

Answer 11

-Hormonal (HPO Axis)
-Chromosomal abnormalities
Structural / Anatomical - uterine or vaginal e.g. fibroids, polyps
-Bleeding diathesis,
-Drugs (contraception),
-Thyroid disease,
-Chronic illness

Question 12

What chromosomal abnormalities can cause menstrual disorders?

Answer 12

Turner's syndrome 
Androgen insensitivity syndrome 
Swyer syndrome 
Mayer-Rokintansku-kustner-Hayer (MRHK) syndrome
Congenital renal hyperplasia

Question 13

What could cause amenorrhoea?

Answer 13

Physiological: Prepubertal, pregnancy, menopause

Pathology at various levels of endocrine control: Hypothalamic, Pituitary, Ovarian, Uterine / endometrial,

Ganadotropin levels indicate the level of pathology

Question 14

What are some structural causes of menstrual disorders?

Answer 14

Agenesis / hypoplasia at any level of the genital tract
Leiomyoma 
Imperforate hymen, vaginal septa
Ashermans syndrome
Cervical stenosis

Question 15

Common causes of menorrhagia / heavy menstrual bleeding?

Answer 15

Uterine fibroids (Submucus fibroids are most common) - Leiomyoma
Uterine polyps
Endometrial cancer (if bleeding suddenly heavy)
Bleeding diathesis
Copper IUCD
Drugs - e.g. warfarin

Question 16

What could cause irregular bleeding?

Answer 16

Hormonal contraception - especially progesterone only. 
STI's / PID - infection
Cervical ectopy or pathology 
Endometrial pathology -polyp/cancer
Ovarian cyst - hormone secreting type

Question 17

What could cause dysmenorrhoea?

Answer 17

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

Question 18

What is endometriosis?

Answer 18

When there is normal endometrial tissue in other places.

Can lead to fibrosis (frozen pelvis)

Question 19

What particular things would you look for in the history?

Answer 19

Emphasis on age, 
menarche / onset of puberty, 
pain -cyclical or not, 
menstrual history - cycle, volume, change ect,
sexual history, 
medical history, 
symptoms of effect

Question 20

What particular things would you look for in the examination?

Answer 20

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

Question 21

What particular investigations would you do?

Answer 21

Bloods, hormone profile (FSH, LH), karyotype, thyroid function test, FBC

Hysteroscopy

Laparoscopy

Question 22

What could be the impact of menstrual disorders?

Answer 22

Physical
Psychological
Social
-All need to be taken into account during management