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Repro > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What does amenorrhea mean?

A

Absence of menstruation

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2
Q

What is primary amenorrhea?

A

When a patient has never had a period by the age of 16 years

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3
Q

What are some causes of primary ammenorrhea?

A

Turner’s syndrome - most common
Anatomical causes
Complete androgen insensitivity syndrome
Hypothalamic and pituitary disease

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4
Q

What is turner’s syndrome?

A

Female-only genetic condition where there is a missing X chromosome

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5
Q

What is the karyotype for turner’s syndrome?

A

45XO

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6
Q

What happens in turner’s syndrome?

A

The ovary doesn’t complete its normal development (dysgenesis) so you will have low estrogen

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7
Q

What would the lab results show with turners syndrome (oestrogen and FSH/LH)

A

Low oestrogen and high FSH/LH

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8
Q

Why would FSH and LH be high in turners syndrome?

A

ovarian failure and reduced ovarian feedback causes the AP gland to release FSH and LH as nothing is telling it not to

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9
Q

What happens if there is no oestrogen?

A

You get no pubertal changes

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10
Q

What would someone with turners present with?

A
  • short stature
  • short neck
  • lack of secondary sexual characteristics
  • horseshoe kidney on scan
  • brown spots
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11
Q

What will girls with turners syndrome need?

A

HRT when older to get breasts, female characteristics and periods

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12
Q

What are some of the health problems associated with turners syndrome?

A
  • coarctation of the aorta
  • horseshoe kidney
  • streak ovaries
  • infertility
  • osteoporosis
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13
Q

What anatomical causes can cause primary amenorrhea?

A

imperforate hymen - problem with the outflow tract (the hymen completely blocks the vagina as failed to perforate in fetal development)

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14
Q

What is mullerian agenesis?

A

Failure of the mullerian duct to formed resulting in a missing uterus - also called MRKH syndrome

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15
Q

What is complete androgen insensitivity syndrome?

A

It is an x-linked recessive disorder where you become resistant to testosterone due to a defect in the androgen receptor

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16
Q

What affects happen in CAIS?

A

A child born with this is genetically male but will have female phenotypes
-testes may be palpable in the labia or inguinal area

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17
Q

What is the treatment for CAIS?

A

Testes should be surgically excised after puberty

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18
Q

How is primary amenorrhea caused by hypothalamic and pituitary disease?

A
  • Isolated GnRH deficiency
  • no GnRH produced so no pituitary stimulation so no FSH/LH so no ovarian or uterine function so no oestrogen so no secondary sexual development
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19
Q

Why do CAIS have female phenotype?

A

XY chromosome so have testes developed

  • Anti-mullerian hormone and testosterone produced causing regression of mullerian structures
  • failure of androgen receptors so absence of male physical characteristics
  • Testosterone converts to oestrogen causing female phenotype
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20
Q

What is secondary amenorrhea?

A

no periods for more than 6 months after previously having them

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21
Q

What are physiological causes of secondary amenorrhea?

A
  • pregnancy (always rule out pregnancy)
  • contraception
  • menopause (periods may become irregular before stopping completely but it is still possible to get pregnant)
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22
Q

What are some physiologically causes of secondary amenorrhea?

A

Anatomical causes, PCOS, Endocrine

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23
Q

What are some anatomical causes of secondary amenorrhea?

A
  • Scarring

- Ovarian disorders

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24
Q

How does scarring cause secondary amenorrhea?

A

Cervical stenosis can cause scarring

  • also asherman syndrome
  • scarring can be caused by repeated infections or operations
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25
Q

What is asherman syndrome?

A

scarring of the uterus (not the cervix)

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26
Q

What ovarian disorders cause secondary amenorrhea?

A

Primary ovarian insufficiency

-premature menopause - depletion of oocytes before 40

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27
Q

What does a depletion of oocytes cause (hormones)?

A

no oestrogen so no inhibin so high FSH

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28
Q

What is PCOS?

A

Polycystic ovary syndrome - it is a group of symptoms e.g. hyperandrogegism and chronic anovulation

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29
Q

What would a patient with PCOS present with?

A

secondary amenorrhea, infertility, hirsutism (hair growth on face), obesity

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30
Q

Why does PCOS occur?

A

lack of pulsatile GnRH - many follicles begin to develop but a dominant follicle is not selected to mature - these follicules respond to pituitary hormones by secreting abnormal oestrogen pattern

31
Q

Why are PCOS women at risk of endometrial malignancy?

A

Abnormal oestrogen can cause over proliferation of the endometrium

32
Q

What do tests show with PCOS?

A
  • raised insulin resistance
  • elevated LH
  • need to do USS
33
Q

What does raised insulin resistance cause?

A

diabetes risk

34
Q

What is the treatment for PCOS?

A
  • COCP

- lifestyle advice

35
Q

Why does thyroid disease cause secondary amenorrhea?

A

Thyroid imbalances causes hyperthyroidism - don’t know why though

36
Q

How does hyperprolactinemia cause amenorrhea?

A

too much prolactin supresses GnRH so don’t get FSH or LH so no oestrogen so amenorrhea

37
Q

Why would someone get hyperprolactinemia?

A
  • physiological (breastfeeding raises prolactin and so does pregnancy)
  • Dopamine inhibits anterior pituitary to inhibit secretion of prolactin but if you have drugs which target dopamine receptors, the effect will increase prolactin release
  • side effect of hypothyroidism (will increase TRH and stimulate AP to release TSH but also prolactin)
  • Tumours on the AP causing prolactin to be realeased
38
Q

What is a prolactinoma?

A

adenoma in the pituitary causing release of prolactin

39
Q

How is prolactinoma treated?

A

instead of surgery, give a drug that acts like dopamine to inhibit prolactin release from the AP

40
Q

What is sheehan syndrome and when would it develop?

A

Necrosis of pituitary secretory cells - it would develop if a women suffers a sever haemorrhage during childbirth resulting in a blood pressure drop due to volume loss - due to the increased size of the pituitary gland in pregnancy it is much more sensitive to hypotension and hypoxia

41
Q

When would functional hypothalamic amenorrhea?

A

Occurs if there is weight loss, excessive exercise, emotional stress - gymnasts, anorexics

42
Q

How does functional hypothalamic amenorrhea occur?

A

abnormal GnRH causes absence of the LH surge so you get annovulation and therefore decreased oestrogen

43
Q

What can the decreased oestrogen cause?

A

osteoporosis and risk of bone loss

44
Q

What is AUB?

A

abnormal uterine bleeding

45
Q

What is frequency?

A

how often a women is having her period - 24-38 days
if reduced - too frequent
if prolonged - infrequent

46
Q

What is regularity?

A

Calculating the difference between longest and shortest cycle in 6 months
regular - less than 7-9 days
irregular - more than 7-9 days

47
Q

What is Duration of flow?

A

How many days is the woman bleeding for?
normal - less than 8 days
prolonged - more than 8 days

48
Q

What is volume?

A

how much is the woman bleeding?
it can be subjective
5-80ml is normal

49
Q

What is the medical term for the following words;

  • irregular
  • heavy
  • absent
  • infrequent
A
  • metrorrhagia
  • menorrhagia
  • amenorrhea
  • oligomenorrhoea
50
Q

What is acute presentation of symptoms of AUB?

A

episode of heavy bleeding that is of sufficient quantity to require immediate clinical intervention to stop further blood loss

51
Q

What is chronic presentation of symptoms of AUB?

A

bleeding oh abnormal volume, duration, regularity or frequency that has been present for most of the previous 6 months

52
Q

What are some underlying causes of AUB?

A 
PALM-COIEN
Polyps
Adenomyosis
Leiomyoma (fibroid)
Malignancy/hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometirual
Iatrogenic
Not yet classified
53
Q

What other symptoms of bleeding could a woman get?

A

post-coital (bleeding after sex) or intermenstural (bleeding in-between periods)

54
Q

What is the most common cause of AUB?

A

fibrous - leiomyoma - benign tumour of uterine smooth muscle

55
Q

Why do fibroids get work during pregnancy?

A

because they are oestrogen dependent and will shrink after pregnancy and even more after menopause

56
Q

Can fibroids affect fertility?

A

Yes if they impinge on the uterine cavity

57
Q

What are the complications of fibroids?

A

heavy menstrual bleeding. fertility, torsion of fibroids causing pain (not normally painful)

58
Q

Who is most at risk of fibroids?

A

african descent women, no pregnancy before

59
Q

What is dysfunctional uterine bleeding?

A

diagnosed by ruling out everything else (diagnosis of exclusion)

60
Q

What are the subdivisions of DUB?

A

anovulatory and ovulatory

61
Q

What is the anovulatory DUB?

A

problems with ovulation - impaired positive feedback (not well understood)

62
Q

What is the ovulatory DUB?

A

secondary to increased prostaglandins and reduced vasoconstrictors - genetic

63
Q

What is dysmenorrhea?

A

painful menstruation - crampy and intermittently intense OR continuous dull ache

64
Q

Where is the pain with menstruation?

A

Lower abdomen and suprapubic area

65
Q

When do you get pain and what other symptoms can you get?

A

with the onset of menses - nausea, diarrhoea, general malaise

66
Q

Why do you get dysmenorrhea?

A

can either be primary or secondary - primary is when you have had pain since menses started and is unlikely to have a cause, secondary is the you have developed painful periods over time and likely to be due to cysts or endometriosis

67
Q

What is endometriosis?

A

When the lining grows outside the uterus - severity and extent has no correlation to the symptoms

68
Q

What are the risk factors of endometriosis?

A

early menarche, short cycles, heavy bleeding, low BMI

69
Q

What are some factors about endometriosis?

A

estrogen-dependent, benign, inflammatory disease

70
Q

What can endometriosis cause?

A

painful sex (dyspareunia), infertility chronic pain

71
Q

Where are the most common causes of endometriosis?

A

ovaries (looks like a chocolate cysts), bladder, rectum, peritoneal lining and pelvic side walls

72
Q

What is adenomyosis?

A

endometrial tissue found deep within myometrium - tends to cause heavy bleeding more than pain

73
Q

How can you manage dysmenorrhea?

A

NSAIDs, COCP, intrauterine device, Surgery (hysterectomy or take away scar tissue), alternative medicine (heat and ginger)

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