Menstrual pathology Flashcards
What is the definition of primary amenorrhoea?
When an individual has not had a period by the time they have reached 15 years old but do have secondary sexual characteristics
OR
When an individual has not had a period by the time they have reached 13 years old and have no secondary sexual characteristics
What is the definition fo secondary amenorrhoea?
When an individual has not had a period for 3 to 6 months but had a menstrual cycle previously.
OR
When an individual has not had a period for 6-12 months with previous Oligomenorrhoea.
What causes primary amenorrhoea?
- Gonadal dysgenesis : Turners syndrome (45X)
- Androgen insensitivity syndrome
- Functional hypothalamic amenorrhoea: secondary to anorexia
- Congenital malformations of the genital tract
- Congenital adrenal hyperplasia
- Imperforate hymen
What causes secondary amenorrhoea?
- Hypothalamic amenorrhoea - excessive stress, exercise
- PCOS
- Hyperprolactinaemia
- Ashers syndrome
- Thyrotoxcosis
- Sheehan’s syndrome
Which investigations should be carried out in a patient with amenorrhoea?
- Pregnancy test
- U+E’s, LFT’s, FBC
- Thyroid screen
- Coeliac screen
- Prolactin
- Gonadotrophins
- Androgen levels
- Oestradiol
What is dysmenorrhoea?
Excessive pain during the menstrual period
What is primary dysmenorrhoea?
Excessive pain during a period with no identifiable underlying pelvic pathology. It presents within 1-2 years of menarche.
Pain usually starts just before or within a few hours of the period starting.
What is secondary amenorrhoea?
Excessive pain during a period with an underlying pelvic pathology. The pain usually starts 3-4 days before the onset of the period.
What are some of the causes of secondary amenorrhoea?
- Endometriosis
- Adenomysosis
- Pelvic inflammatory disease
- Fibroids
- Intrauterine devices
What is menorrhagia?
Heavy periods that are considered to be >80ml per menses
What investigations should be carried out for all women with menorrhagia?
- FBC
- Pelvic examination should be carried out
- Transvaginal USS is indicated in women whereby other features suggest underlying pathology, such as IMB, PCB, pelvic pain and/or pressure symptoms.
What is the management of menorrhagia in women who do not require contraception?
Mefenamic acid 500mg TDS or Tranexamic acid 1g TDS. Both of these should be started on the first day of the period.
What is the management of menorrhagia in women who require contraception?
IUS (Mirena)
COCP
Long acting progestogens
What are some causes of menorrhagia?
- Dysfunctional uterine bleeding: (idiopathic)
- Fibroids
- Annovulatory cycles: often occur towards the end of a womans reproductive years.
- Hypothyroidism
- Intrauterine devices
- Pelvic inflammatory disease
What is post menopausal bleeding?
This is where a woman at an age that menopause is expected has vaginal bleeding after 12 months of amenorrhoea. It can occur in younger women due to premature ovarian failure or premature menopause.
