Menstrual Dysfunction Flashcards
Primary amenorrhea
- No period by age 17
Secondary amenorrhea
- Had a period, but no longer does
*#1 cause = pregnancy
Oligomenorrhea
- Cycles >q 35 days
Polymenorrhea
- Cycles <q>
</q>
Menorrhagia (hypermenorrhea)
- Heavy bleeding that occurs on a regular basis
Menorrhagia (non cyclic bleeding)
- Bleeding that occurs whenver it wants
Menometrorrhagia
- Bleeding all over the place (no cycle to it)
Infertility
- No conception after one year of unprotected intercourse
*depends on how old the pt. is
Causes of abnormal bleeding (Puberty)
- Coagulation disorders
- Genetic problems
- Congenital defects
Causes of abnormal bleeding (reproductive age women)
- Pregnancy
- Premature ovarian failure
- Hormonal or anatomic problems
- Hyperplasia or malignancy
Causes of abnormal bleeding (post menopausal women)
- Amenorrhea is normal
- Cancer
- Anatomic abnormalities
Normal menstrual cycle
- Cyclic bleeding
- First day of bleeding is day #1
- Length 21-35 days
- Ovulation is 14 days prior to menses
*if a women has a 21 day cycle, she ovulates on day 7 (14 days prior)
- Normal menses is a hormone withdraw bleed
- Amt of flow varies from woman to woman
Organs to consider when presented with menstrual irregularity
- Hypothalamus
- Pituitary
- Thyroid
- Adrenal glands
- Ovaries
- Uterus
- Vagina
Causes of hypothalamus induced amenorrhea
- Stress
- Exercise
*runners may have seasonal variation in menses due to light exposure and melatonin
- Anorexia nervosa
Causes of elevated prolactin
- DRUGS
- Pituitary tumors
- Nipple stimulation
Elevated prlactin suppresses…
- Estrogen production
Sheehan’s Syndrome
- Pituitary infarct
- Results in metabolic disorders where after having a baby no milk production can occur
- Assoc. w/ post partum hemorrhage and hypotension
DHEAS
- Dehydro Epi Aldosterone Sulfate
*“S” part is important (sulfate); comes from the adrenals, rest of it from ovaries
- Potent androgen from adrenal glands
- Neg. feedback on FSH
Polycystic Ovary Syndrome (PCOS)
- Excess androgen of ovarian origin
- Excess estrogen in a steady state
- Multiple follicles in arrested development
- Insulin resistance
- Infertility due to anovulation
- Amenorrhea or abnormal bleeding
Factors of infertility
- Male factor: 40%
- Female factor: 40%
- Unknown: 20%
Female infertility causal factors
- Pituitary disorders
- Thyroid disorders
- Adrenal disorders
- Ovarian disorders
- Uterine/Mullerian disorders including endometriosis
- Cervical factors
Determinants of menarche and menopause onset
- Menarche is determined by genetics and environmental factors
- Menopause is solely genetically determined
PALM-COEIN Classification system for abnormal bleeding
Uterine causes
- Polyps (AUB-P)
- Adenomyosis (AUB-A)
- Leiomyoma (AUB-L)
- Malignancy (AUB-M)
Nonstructural causes
- Coagulopathy (AUB-C)
- Ovulatory Dysfunction (AUB-O)
- Endometrial (AUB-E)
- Iatrogenic (AUB-I)
