Menstrual Disorders Flashcards
What is Premenstrual syndrome?
Cyclical, physical and behavioural symptoms occuring in the luteal phase (time between ovulation and onset of menstruation)
What causes PMS?
A response to changing hormone levels - gonadal steroid hormones
What are the risk factors for PMS?
Post pubescent
Pre menopausal
Family history
Mood disorders
What are the signs and symptoms for PMS?
Abdominal bloating Fatigue Breast tenderness Headaches Irritability Increased appetite Forgetful
What are the investigations done to diagnose PMS?
Symptom diary
TFTs
FSH
Depression screening
What is the management for PMS?
Exercise and relaxation Diet high in complex carbs CBT SSRIs Surgery Herbal remedies - gingko, st johns wort
What is dysmenorhea?
Painful periods
What are the causes of primary dysmenorhea?
Excessive release of prostoglandins - spinal artery vasospasm and myometrial contractions
What are the causes of secondary dysmenorhea?
Underlying pelvic pathology - endometriosis, polyps, PID, IUD.
What are the risk factors for dysmenorhea?
Early menarche Long menstrual phase Heavy periods Smoking Nulliparity
What are the signs and symptoms of dysmenorhea?
Lower abdominal pain Crampy pain Uterine tenderness Nausea Dizziness
What are the investigations for dysmenorhea?
High vaginal swab
Transvaginal ultrasound
What is the management for dysmenorhea?
Primary - stop smoking, analgesia, hormonal therapy, heat pack, TENS machine.
Secondary - treat underlying cause.
What is amenorrhea?
Absence of menstrual periods, can be primary (absence of menarche) or secondary (cessation for more than 6 months)
What are the causes of amenorrhea?
Hypothalmic - eating disorders, exercise, psychiatric disorders.
Pituitary - prolactinomas, acromegaly, autoimmune disease.
Ovarian - PCOS, turners syndrome.
Adrenal gland - congenital adrenal hyperplasia.
What are the risk factors for amenorrhea?
Athletes
Stress
Genital tract abnormality
What are the signs and symptoms of amenorrhea?
Hirsutism Nausea Vision changes Headache Milky discharge from breasts Acne
What are the investigations to diagnose amenorrhea?
Pregnancy test FSH + LH Prolactin TFTs Pelvic ultrasound, MRI/CT Karyotyping
What is the management for amenorrhea?
Contraception to regulate periods
HRT
Calcium + Vit D supplements
What is PCOS?
Endocrine disorder characterised by excess androgen production and immature follicles on ovaries
What is the cause of PCOS?
Excess luteinising hormone from anterior pituitary gland stimulates ovarian production of androgens.
Insulin resistance = increase secretion which decreases sex binding globulin (more androgens circulating in blood)
What are the risk factors for PCOS?
Diabetes
Menstruation
Family history
What are the signs and symptoms of PCOS?
Oligorrhea Amenorhea Infertility Hirsutis, Obesity Acne Acanthosis Nigricans Male pattern hair loss HTN
What are the investigations to diagnose PCOS?
Bloods - testosterone, LH, FSH, progesterone
Ultrasound - peripheral ovarian follicles
What is the management of PCOS?
COCP
Manage obesity (if severe orlistat)
Clomifene and metformin (limited use can cause multiple pregnancy)
Antiandrogen medication (cyprotene, spironolactone, fineresteride) for hirsutism
