Menstrual Disorders Flashcards
What is Amenorrhea?
What are the 2 types
Absence of menstruation
Primary and secondary
Compare Primary and Secondary Amenorrhea (Secondary is more common)
Primary;
- Patient has never had a period by age of 16
Secondary;
- Patient hasn’t menstruated in 6 months (12 months if she has had oligomenorrhoea)
List 3 causes of Primary Amenorrhea
- Congenital disorders (Turners Syndrome, ovaries don’t develop/ Complete Androgen Insensitivity Syndrome)
- Hormonal disorders
- Structural disorders (Imperforate hymen, vaginal septum, absent vagina/ uterus)
List 3 structural disorders that can cause Primary Amenorrhea
- Absent Vagina/ Uterus
- Vaginal Septum (Can be transverse to longitudinal)
- Imperforate hymen (Hymen without opening completely obstructs Vagina, so blood gathers in vagina or uterus)
List 6 causes of Secondary Amenorrhea
- Weight loss
- Menopause in older woman
- Physiological causes, such as pregnancy
- Polycystic Ovarian Syndrome (Raised LH)
- Thyroid disease
- Hyperprolactinaemia (PRL inhibits GnRH)
What is Oligomenorrhoea?
What is 1 cause?
- Reduced frequency of menstruations
(Cycle length>35 days, therefore 4-9 periods a year) - Thyroid disorders
Polycystic Ovarian Syndrome (PCOS) is a syndrome of Hyperandrogenism and Chronic Anovulation.
How do patients present?
- Secondary Amenorrhea/ Infertility
- Hirsutism
- Obesity
Describe the Physiology of PCOS
- Lack of Pulsatile GnRH Release-> Many follicles develop but no dominant follicle selected mature
- Follicles produce abnormal pattern of oestrogen secretion-> Inappropriate feedback signals from ovary to Hypothalamus/ Ant Pit
What are 2 things that women with PCOS are at increased risk of?
- Endometrial malignancy due to abnormal oestrogen secretion
- Diabetes+Cardiovascular disease due to Insulin Resistance
What are the 4 types of Abnormal Uterine Bleeding?
- Menorrhagia: Heavy
- Oligomenorrhoea: Infrequent
- Dysfunctional: Unknown cause
- Dysmenorrhea: Painfl
Define Menorrhagia
What do we look for in these patients?
Heavy menstrual bleeding either;
- By objective volume >80ml
- Subjective opinion of patient that periods are heavier OR that she is passing clots
- Anaemia
List 4 causes of Menorhagia
- Structural problems (Benign/ malignant growths in endometrium)
- Clotting disorders
- Anticoagulation therapy
- Thyroid disorders
Abnormal Uterine Bleeding refers to uterine bleeding outside of what 5 parameters?
- Duration> 8 days
- Flow >80ml OR subjective opinion of heavier than normal flow
- Absence of menses
- Intermenstrual bleeding/ poistcoital spotting
- More frequently than every 24 days/ less frequently than every 38 days
Fibroids are the most common cause of Abnormal Uterine Bleeding.
What are they? How are they related to oestrogen?
- Benign tumours of uterine smooth muscle (myometrium)
- Dependent on oestrogen so regress after menopause
(Can lead to heavy Menorrhagia)
Dysfunctional Uterine Bleeding is the most common cause of Menorrhagia.
What is it?
Uterine bleeding, where no structural or systemic cause for the abnormal bleeding can be found
What are the 2 types of abnormalities in Dysfunctional Uterine Bleeding?
- Abnormalities in cycle regularity
- Abnormalities in amount of blood lost in each cycle
What is Dysmenorrhea? (Occurs in 45 to 95% of women of reproductive age)
What does it often lead to?
Painful periods- Crampy and intermittent OR continuous dull ache
Chronic pelvic pain
What is a common cause of dysmenorrhea?
What 3 things can this lead to?
Endometriosis
Ectopic endometrial tissue can irritate peritoneum leading to;
- Pain
- Intra abdominal adhesions
- Sometimes infertility
What are the 4 most common sites where Endometriosis can occur?
- Ovaries
- Bladder
- Rectum
- Peritoneal lining and pelvic side walls
What is an Endometrioma/ ‘Chocolate Cyst’?
What is Adenomyosis?
A cyst formed from Endometriosis occurs in ovaries
Endometrial tissue found in myometrium
How Is dysmenorrhea managed?
- NSAIDs
- Hormonal contraceptives (Inhibit oestrogen, E.g COCP)
- GnRH analogues
- Surgery
