Menstrual Disorders

Question 1

Define Amenorrhea

Answer 1

Absence of menstruation

Question 2

What is the difference between primary and secondary amenorrhea?

Answer 2

Primary= no periods by age 16

Secondary= previously normal periods but now no periods for >6 months

Question 3

What is the most common cause of primary amenorrhea?

Answer 3

Turner’s Syndrome

Question 4

How does Turner’s syndrome cause primary amenorrhea?

Answer 4

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

Question 5

What is an imperforate hymen and what problem does this cause?

Answer 5

A closed off hymen

Causes primary amenhorrea as blood can’t leave the vagina

Question 6

What is a transverse vaginal septum and what problem does this cause?

Answer 6

A septum in the vagina caused by a failure of fusion of the urogenital sinus and mullerian duct

Causes primary Amenorrhea

Rare

Question 7

What is Mullerian agenesis and what problem does this cause?

Answer 7

Congenital absence of the vagina with variable levels of uterine development in a syndrom called MRKH (Mayer Rokitansky Kuster Syndrome)

causes primary amenorrhea

Question 8

How can primary amenorrhea arise from X- linked androgen insensitivy disorder?

Answer 8

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

Question 9

Why should the testes of someone with androgen insensitivity syndrome be excised after puberty?

Answer 9

The testes are not descended and non functional

They give a higher risk of developing testicular cancer

Question 10

How can an isolated GnRH deficiency lead to primary amenorrhea?

Answer 10

Question 11

How may scarring cause secondary amenorrhea?

Answer 11

Either cervical or uterine scarring

Can cause cervical stenosis or asherman syndrome (intrauterine adhesions → occurs after repeated surgery or infection)

Question 12

What triad of symptoms typically characterise PCOS

Answer 12

Menstrual irregularity, Obesity, Excessive Hair growth and acne

Question 13

How does PCOS relate to GnRH?

Answer 13

• 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

Question 14

Why are women with PCOS at risk of developing diabetes?

Answer 14

PCOS patients usually have raised insulin resistance

Question 15

What treatments can be given for PCOS?

Answer 15

• Lifestyle changes- lose weight
• COCP

Question 16

How can Hyperprolactinemia lead to amenorrhea?

Answer 16

• Excess prolactin inhibits hypothalamus release of GnRH
• Therfore… no FSH or LH release and no cycle

Question 17

How can Hypothyroidism cause amenorrhea?

Answer 17

Mechanism not fully understood

Though that in Hypothyroidism, TRH levels increase which effectively increases prolactin levels

Increased prolactin inhibits hypothalamus release of GnRH

Question 18

How can a prolactinoma cause amenorrhea and what can be give to treat this?

Answer 18

High prolactin levels due to a prolactin secreting tumour → High prolactin inhibits GnRH secretion

Treatment: Give Dopamine to inhibit prolactin

Question 19

What is functional hypothalmic amenorrhea? What are these patients at risk of?

Answer 19

Stress induced by weight loss and exessive exercise causes abnormal GnRH secretion

Because of low oestrogen levels, they are at risk of bone loss

Question 20

What are the 2 types of physiological amenorrhea?

Answer 20

Pregnancy and Menopause

Question 21

What is oligomenorrhoea?

Answer 21

Menstruation of reduced frequency

leads to greater cycle legnth

Question 22

What is menorrhagia?

Answer 22

Heavy menstrual bleeding

Either objectively to that patient or based on volume

Question 23

What is Metrorrhagia?

Answer 23

Irregular periods

Question 24

How do you distinguish between acute and chronic abnormal menstrual bleeding?

Answer 24

Acute= episode of heavy bleeding that requires immediate clinical intervention

Chronic= AUB for the past 6 months

Question 25

What is dysmenorrhoea?

Answer 25

Painful periods - cyclical pain that interferes with QoL

Question 26

What is the most common cause of abnormal uterine bleeding? Explain what this is

Answer 26

Fibroids (leiomyoma)

A benigns tumour ot uterine smooth muscle

Oestrogen dependent so gets worse with pregnancy/ shrink with menopause

Question 27

What is dysfunctional uterine bleeding?

Answer 27

Bleeding of endometrial origin in the absence of any pathology- can’t find a cause

Question 28

What are the 2 broad classifications of underlying causes of AUB?

Answer 28

Structural and Non Structural

Question 29

Distinguish between primary and secondary dysmenorrhea?

Answer 29

Primary= painful since the 1st period (unlikely to have a cause)

Secondary= developed over time

Question 30

What is endometriosis?

Answer 30

Condition of ectopic endometrial tissue i.e. endometrial glands and stroma outside uterine cavity

An Oestrogen dependent, benign, inflammatory disease

Question 31

What are the most common sites of endometriosis?

Answer 31

• Ovaries (number 1 most common)
• Bladder
• Rectum
• Peitoneal lining

But can happen anywhere