Menstrual Disorders Flashcards

1
Q

Definitions of :

Amenorrhea

Oligomenorrhoea

Menorrhagia

Dysmenorrhagia

A

Amenorrhea: absence of menstruation

Oligomenorrhoea: infrequent periods

Menorrhagia: Heavy menstrual bleeding

Dysmenorrhagia: painful menstrual bleeding

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2
Q

Difference between primary and secondary amenorrhoea?

A

Primary: When a women over the age of 16 has never had a period

Secondary: absence of periods for >6months in a woman that previously had them

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3
Q

Common causes of Amenorrhoea

A
  • Physiological: lactation, menopause, pregnancy
  • Hypothalamic/pituitary disorders:
    • stress, weight change, excessive exercise and various drugs
    • Prolactinomas or damage; eg Sheehans Syndrome
  • Ovarian Anomalies
    • Turners (XO)
    • Gonadal agenesis (XX or XY )
    • PCOS
  • Uterine and Outflow Tract Disorders
    • TB
    • Asherman’s syndrome: damage to the endometrium with adhesions secondary to curettage
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4
Q

What is Sheehan’s syndrome

A

postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth

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5
Q

What is the commonest endocrine disorder in the world and how does it cause amenorrhoea and oligomenorrhoea?

A

PCOS

  • Complex condition of ovarian dysfunction thought to affect between 5-20% of women of reproductive age.
  • Both hyperinsulinaemia and high levels of luteinizing hormone are seen in PCOS and there appears to be some overlap with the metabolic syndrome.

However the actual underlying aetiology is not understood

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6
Q

Features of PCOS

A
  • Subfertility and infertility
  • menstrual disturbances: oligomenorrhea and amenorrhoea
  • hirsutism, acne (due to hyperandrogenism)
  • obesity
  • Acanthosis nigricans (due to insulin resistance)
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7
Q

Can I have PCOS and not know it?

A

Yes, although ~20-30% of women are thought to have the appearance on USS, only ~5-10% have the syndrome.

This is an important distinction as the syndrome is associated with T2DM, obesity and endometrial hyperplasia and carcinoma.

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8
Q

What is required to make a definative diagnosis for PCOS

A

​2 of the 3 criteria

  1. Oligo and / or anovulation which commonly manifest as oligomenorrhea or irregular and unpredictable bleeding pattern.
  2. Clinical (hirsuitism,acne) and /or biochemical (raised free testosterone) evidence of androgen excess (hyperandogenisation)
  3. Polycystic ovary/ies on transvaginal USS- 12 or more follicles in either ovary measuring 2-9mm in diameter and/or increased ovarian volume >10ml
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9
Q

Investigations for menorrhagia

A
  • FBC
  • Transvaginal ultrasound if symptoms suggest a structural abnormality
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10
Q

Treatment for a patient with menorrhagia if they do not require contraception

A
  • mefenamic acid 500mg tds or tranexamic acid 1 g tds
  • Start on the first day of period
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11
Q

Treatment for a patient with menorrhagia who does require contraception

A
  • Mirena IUD : first line treatment
  • COCP
  • Long acting progesterones eg; depo provera
  • Surgical treatments include hysterectomy (a major operation, achieved by either the abdominal or vaginal route) or endometrial ablation
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12
Q

Common causes for intermenstrual and post-coital bleeding?

A
  • Cervical ectropian
  • Cervical polyps
  • Cervicitis (Chlamydia a common cause)
  • Cervical cancer
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13
Q

What is a cervical ectropian?

A
  • it’s a normal occurrence with the transformation zone being visualised on the surface of the cervix and this may sometimes cause bleeding after sex.
  • More common in women using the COCP
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14
Q

Definition of ‘postmenopausal bleeding’

A

Any bleeding following one year of no periods

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15
Q

Causes of post menopausal bleeding?

A
  • atrophic vaginitis (thinning of the vaginal mucosa due to estrogen withdrawal)
  • Endometrial or cervical polyps
  • Hormone Replacement Therapy
  • ALWAYS important to rule out carcinoma
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16
Q

If you have post menopausal in a woman over 45years, what investigations should you do?

A

Vaginal USS to check endometrial thickness (<5mm normal)

If the endometrium is thick then a pipelle biopsy should be done

**A pipelle is a thin flexible tube that is passed through the cervix to take a small sample of the endometrium, via vacuum aspiration. It can produce a slightly crampy sensation as it is passed through the cervix but is generally well tolerated by patients and easy to perform in the clinic setting.**

17
Q

What is the actual cause of pain during periods?

A

excess prostaglandins stimulating uterine contractions

18
Q

When does secondary dysmenorrhagia occur?

A

In the 3rd to 4th decade, due to an underlying pelvic pathology.

eg; PID, Endometriosis, fibroids