Menstual Disocrders Flashcards
What are common menstruated disorders
- Amenorrhoea- primary and secondary
- Oligomenorrhoea
- Menorrhagia/ Heavy Menstrual Bleeding (HMB)
- Dysmenorrhoea
- Intermenstrual bleeding (IMB)
- Dysfunctional uterine bleeding (DUB)
- Premenstrual syndrome (PMS)
What is amenorrhoea
• Amenorrhea: absence of menstruation
• Primary amenorrhoea: failure to establish menstruation by 16
years.
• Secondary amenorrhoea: cessation of previously normal
menstruation for >/= 6 months
What is oligomenorrhoea
Oligomenorrhoea: infrequent menstruation, >35 days i.e. 4-
9x/year
What is menorrhagia/HMB
Menorrhagia/Heavy menstrual bleeding (HMB): a complaint of
excessive menstrual blood loss over consecutive cycles or >80
mls per menstruation.
What is dysmenorrhea
Dysmenorrhoea: pain during menses, associated with
ovulatory cycles
What is DUB
Dysfunctional uterine bleeding (DUB): heavy and irregular
menstrual bleeding that occurs secondary to anovulation.
What is premenstual syndrome
Premenstrual syndrome (PMS): A cyclical disorder, occurring in latter half of the menstrual cycle. Symptoms could be physical or psychological and resolve with onset of menstruation.
What is premenstual dysphoric disorder
Premenstrual dysphoric disorder is the severe end of the spectrum with extreme mood symptoms
- very severe, psychiatric
What is imb
Intermenstrual bleeding. Due to infection eg STI?? Are they on any medication or contraception??
What are common causes of disorders of menstruation
• Can be hormonal- HPO AXIS
• Chromosomal anomalies e.g. Mayer-Rokitansky-Kustner-Hayer
(MRHK) syndrome - small non functional uterus, not proper cycle; XO-
Turner’s syndrome - streak of ovarian tissue ;
Androgen insensitivity syndrome - XY but physically female. Body and cells do not respond to testosterone ;
Swyer syndrome,
Congenital adrenal hyperplasia (CAH)
• Structural/Anatomical- uterine or vaginal e.g fibroids, polyps.
- Other:
- Bleeding diathesis
- Drugs - contraception, antipsychotics
- Thyroid disease
- Chronic illness
Describe amenorrhoea and causes
- Can be primary or secondary
- Physiologic causes: prepubertal; pregnancy; menopause.
- Pathology at the various levels of endocrine control:
- Hypothalamic
- Pituitary
- Ovarian
- Uterine/endometrial
- Gonadotrophin levels indicate the level of the pathology
What are structural causes of menstrual disorders
- Agenesis/hypoplasia at any level of the genital tract.
- Leiomyoma- uterine fibroids
- Imperforate hymen, vaginal septae - Could be heavy pain but no bleeding? - vaginal septae
- Asherman’s syndrome - adhesions in uterus eg due to previous procedure - uterus may stick to itself - blood doesnt come away or only some does
- Cervical stenosis -
Describe imperforate hymen
See slide
What are lassification of congenital uterine anomalies
See slide
What are caruses of menorrhagia
- Common causes
- Uterine fibroids- benign lesion - Leiomyoma - higher area to bleed
- Uterine polyps - projections in endometrium - increased SA - more bleeding
- Endometrial cancer
- Bleeding diathesis - warfarin -> will bleed
- Copper IUCD - she effect -> causes heavier building
- Drugs- e.g. warfarin
What are causes of irregular bleeding
• Could present as a change in usual pattern
• A feature of hormonal contraception, especially the
progesterone-only preparations
• Other causes:
• STI’s/PID- infection
• Cervical ectopy or pathology- usually as postcoital bleed
• Endometrial pathology- polyp or cancer
• Ovarian cyst – the hormone secreting type
What are causes of dysmenorrhoea
- Associated with ovulatory cycles
- Can be primary or secondary
- Primary is idiopathic, due to response of the uterus to local prostaglandins, hence painful contractions. Can be secondary to HMB.
- Secondary can be due to endometriosis or obstructed menses
Describe endrometriosis
Aren’t supposed to have enrometrial tissue here. Other areas activated - bleeding from unusual sites. Causes more pain , causes inflammation, leads to fibrosis over the years.. leads to cysts. . Painful intercourse . Painful Boswell movements as sigmoid colon is close to cul de sac
Describe pms
• Is subjective
• Cyclical
• Can be distressing and even debilitating
• Severe form- premenstrual dysphoric disorder
Luteal phase
What should be considered when taking a history for menstruated disorder
Comprehensive history- emphasis on age; menarche/onset of puberty; pain- cyclical or not; menstrual history- cycle, volume, change etc.; sexual history; medical history; symptoms of effects.
What should be considered on examination
• Examination- general, abdominal, speculum, bimanual.
• Presence or absence of secondary sexual characteristics, appearance of known chromosomal abnormalities or
abnormal facies
• Swellings/lumps/masses, discharge, pattern of hair growth
What investigations should be considered
- Investigations:
- Blood, hormone profile- gonadotrophins (FSH, LH); karyotype; thyroid function test, full blood count
- imaging- USS, MRI
- Hysteroscopy- diagnostic and therapeutic
- Laparoscopy- diagnostic and therapeutic
Describe the impact on menstrual disorders
• Physical - cancer? Etc
• Psychological - affect on life
• Social - cant go out
• These all need to be taken into account during management
Consider compliance when giving medication
What is th goal of management
• The goal of treatment is to correct the underlying condition.
• Part of management is the attitude to the patient- listen, empathy, acknowledgement of their symptoms. Be Humane.
• Back to the HPO axis!
• Pharmacological- use of gonadotrophins, progesterone,
COCP/HRT
• Surgical- depends on the condition
