Menstrual problems and the menopause Flashcards
What is menorrhagia?
Heavy periods - >80 mls per cycle
What is dysmenorrhoea?
Painful periods
What is intermenstrual bleeding?
Bleeding between periods not caused by coitus
What is psot coital bleeding?
Vaginal bleeding after sex
What is oligomenorrhoea?
Infrequent periods
What is amenorrhoea?
No periods (can be primary or secondary)
What would you want to ask about in a menstrual history?
MR FLOPPI DICS
- Menopause
- Regularity
- Flow - light/heavy, flooding, clots
- Last menstrual period
- Odd bleeding - Post coital, post menopausal, intermenstrual
- Dysmenorrhoa
- Initiation - menarche
- Cycle - days on, days off, Contraception
- Smear history
What is regarded as normal menstrual cycle length?
4-5 days on/21-35 days off
What is the mean blood loss from menstruation?
30-40 mls
What are features of normal menstruation?
- Duration between two and seven days
- Flow less than 80 mL
- Occurring in cycles of 24 to 35 days
What are symptoms of normal menstruation?
- Abdominal pain and cramps
- Vaginal bleeding
- Nausea
- Diarrhoea
- Sweating
- Fatigue
- Irritability
- Dysphoria (unhappiness)
What is primary amenorrhoea?
Menstruation has not occured yet - pre-menarche
When does primary amenorrhoea need investigation?
16 year old or 14 year old with no breast development
What is secondary amenorrhoea?
When periods stop for >6 months other than due to pregnancy
What is primary dysmenorrhoea?
Pain without organ pathology - often starting with anovulatory cycles after menarche. It is crampy with ache in the back or groin, worse during the first day or two
What are options for managing primary dysmoenorrhoea?
- NSAIDs - mefenamic acid - during menstruation
- Paracetamol
- COCP
What is secondary dysmenorrhoea?
Dysmenorrhoea with pathology - e.g. adenomyosis, endometriosis, PID, fibroids
What are causes of secondary dysmenorrhoea?
- Adenomyosis
- Endometriosis
- PID
- Fibroids
What should you always screen for in a woman with post-coital bleeding?
Chlamydia
What are causes of post-menopausal bleeding?
!!Endometrail cancer until proven otherwise!!
- Vaginitis (often atrophic)
- Foreign bodies - pessaries, tampons
- Carcinoma of cervix/vulva
- Endometrial/cervical polyps
- Oestrogen withdrawal
What should you always test for in secondary amenorrhoea?
PREGNANCY!! - most common cause of amenorrhoea in woman of childbearing age
What is the most likely cause of primary amenorrhoea if secondary sexual characteristics are absent?
Most likely delayed puberty. Should also consider genetic causes - turner’s syndrome, androgen insensitivity
What is the most likely cause of primary amenorrhoea if secondary sexual characteristics are present?
Can just be normal variant
Anatomical causes:
- Congenital absence of uterus
- Imperforate hymen
Can exercise cause priamry amenorrhoea?
Yes - if excessive
Can low body weight cause primary amenorrhoea?
Yes
What can cause primary amenorrhoea?
- Chromosomal problem - turner’s etc.
- Hypothlalamic - Physiological delay, weight loss/anorexia, heavy exercise, GnRH deficiency
- Pituitary - partial/total hypopituitarism, hyperprolactinaemia, adenoma, trauma
- Ovarian - True agenesis, prem. ovarian failure, PCOS
- Primary hypothyroid
- Adrenal hyperplasia
- Imperforate hymen
What are causes of secondary amenorrhoea?
- Physiological - pregnancy, lactation, menopause
- Hypothalamic - weight loss, heavy exercise, stress
- Pituitary - hyperprolactinaemia, hypopituitarism
- Ovarian - PCOS, prem. ovarian failure, surgery/radio/chemo, virilising ovarian tumours
- Primary hypothyoridism
- Adrenal hyperplasia/tumour
- Hysterectomy
- Endometrial ablation
- Minera IUS