Menstrual Disorders Flashcards
Define Amenorrhea
Absence of menstruation
What is the difference between primary and secondary amenorrhea?
Primary= no periods by age 16
Secondary= previously normal periods but now no periods for >6 months
What is the most common cause of primary amenorrhea?
Turner’s Syndrome
How does Turner’s syndrome cause primary amenorrhea?
Missing X chromosome: 45XO
- Ovary does not complete normal development
- Streak of ovary present at birth
- Therefore, low oestrogen produced
- lack of negative feedback causes High FSH and LH
- Lack of oestrogen means no puberty changes
What is an imperforate hymen and what problem does this cause?
A closed off hymen
Causes primary amenhorrea as blood can’t leave the vagina
What is a transverse vaginal septum and what problem does this cause?
A septum in the vagina caused by a failure of fusion of the urogenital sinus and mullerian duct
Causes primary Amenorrhea
Rare
What is Mullerian agenesis and what problem does this cause?
Congenital absence of the vagina with variable levels of uterine development in a syndrom called MRKH (Mayer Rokitansky Kuster Syndrome)
causes primary amenorrhea
How can primary amenorrhea arise from X- linked androgen insensitivy disorder?
Genotypically Male (XY) but restistant to testosterone due to a defect in the androgen receptor
Phenotypically Female
Therefore they won’t have periods as they have testes and not ovaries
Why should the testes of someone with androgen insensitivity syndrome be excised after puberty?
The testes are not descended and non functional
They give a higher risk of developing testicular cancer
How can an isolated GnRH deficiency lead to primary amenorrhea?
How may scarring cause secondary amenorrhea?
Either cervical or uterine scarring
Can cause cervical stenosis or asherman syndrome (intrauterine adhesions → occurs after repeated surgery or infection)
What triad of symptoms typically characterise PCOS
Menstrual irregularity, Obesity, Excessive Hair growth and acne
How does PCOS relate to GnRH?
- A lack of pulsatile GnRH means many follicles develop but a dominant follicle is not selected
- Follicles produce abnormal pattern of oestrogen
- Imbalance of hormones causes raised LH
Why are women with PCOS at risk of developing diabetes?
PCOS patients usually have raised insulin resistance
What treatments can be given for PCOS?
- Lifestyle changes- lose weight
- COCP
How can Hyperprolactinemia lead to amenorrhea?
- Excess prolactin inhibits hypothalamus release of GnRH
- Therfore… no FSH or LH release and no cycle
How can Hypothyroidism cause amenorrhea?
Mechanism not fully understood
Though that in Hypothyroidism, TRH levels increase which effectively increases prolactin levels
Increased prolactin inhibits hypothalamus release of GnRH
How can a prolactinoma cause amenorrhea and what can be give to treat this?
High prolactin levels due to a prolactin secreting tumour → High prolactin inhibits GnRH secretion
Treatment: Give Dopamine to inhibit prolactin
What is functional hypothalmic amenorrhea? What are these patients at risk of?
Stress induced by weight loss and exessive exercise causes abnormal GnRH secretion
Because of low oestrogen levels, they are at risk of bone loss
What are the 2 types of physiological amenorrhea?
Pregnancy and Menopause
What is oligomenorrhoea?
Menstruation of reduced frequency
leads to greater cycle legnth
What is menorrhagia?
Heavy menstrual bleeding
Either objectively to that patient or based on volume
What is Metrorrhagia?
Irregular periods
How do you distinguish between acute and chronic abnormal menstrual bleeding?
Acute= episode of heavy bleeding that requires immediate clinical intervention
Chronic= AUB for the past 6 months
What is dysmenorrhoea?
Painful periods - cyclical pain that interferes with QoL
What is the most common cause of abnormal uterine bleeding? Explain what this is
Fibroids (leiomyoma)
A benigns tumour ot uterine smooth muscle
Oestrogen dependent so gets worse with pregnancy/ shrink with menopause
What is dysfunctional uterine bleeding?
Bleeding of endometrial origin in the absence of any pathology- can’t find a cause
What are the 2 broad classifications of underlying causes of AUB?
Structural and Non Structural
Distinguish between primary and secondary dysmenorrhea?
Primary= painful since the 1st period (unlikely to have a cause)
Secondary= developed over time
What is endometriosis?
Condition of ectopic endometrial tissue i.e. endometrial glands and stroma outside uterine cavity
An Oestrogen dependent, benign, inflammatory disease
What are the most common sites of endometriosis?
- Ovaries (number 1 most common)
- Bladder
- Rectum
- Peitoneal lining
But can happen anywhere
