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Repro1 > Menstual Disocrders > Flashcards

Menstual Disocrders Flashcards

1
Q

What are common menstruated disorders

A
  • Amenorrhoea- primary and secondary
  • Oligomenorrhoea
  • Menorrhagia/ Heavy Menstrual Bleeding (HMB)
  • Dysmenorrhoea
  • Intermenstrual bleeding (IMB)
  • Dysfunctional uterine bleeding (DUB)
  • Premenstrual syndrome (PMS)
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2
Q

What is amenorrhoea

A

• Amenorrhea: absence of menstruation
• Primary amenorrhoea: failure to establish menstruation by 16
years.
• Secondary amenorrhoea: cessation of previously normal
menstruation for >/= 6 months

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3
Q

What is oligomenorrhoea

A

Oligomenorrhoea: infrequent menstruation, >35 days i.e. 4-

9x/year

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4
Q

What is menorrhagia/HMB

A

Menorrhagia/Heavy menstrual bleeding (HMB): a complaint of
excessive menstrual blood loss over consecutive cycles or >80
mls per menstruation.

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5
Q

What is dysmenorrhea

A

Dysmenorrhoea: pain during menses, associated with

ovulatory cycles

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6
Q

What is DUB

A

Dysfunctional uterine bleeding (DUB): heavy and irregular

menstrual bleeding that occurs secondary to anovulation.

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7
Q

What is premenstual syndrome

A

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.

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8
Q

What is premenstual dysphoric disorder

A

Premenstrual dysphoric disorder is the severe end of the spectrum with extreme mood symptoms
- very severe, psychiatric

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9
Q

What is imb

A

Intermenstrual bleeding. Due to infection eg STI?? Are they on any medication or contraception??

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10
Q

What are common causes of disorders of menstruation

A

• 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
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11
Q

Describe amenorrhoea and causes

A
  • 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
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12
Q

What are structural causes of menstrual disorders

A
  • 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 -
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13
Q

Describe imperforate hymen

A

See slide

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14
Q

What are lassification of congenital uterine anomalies

A

See slide

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15
Q

What are caruses of menorrhagia

A
  • 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
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16
Q

What are causes of irregular bleeding

A

• 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

17
Q

What are causes of dysmenorrhoea

A
  • 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
18
Q

Describe endrometriosis

A

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

19
Q

Describe pms

A

• Is subjective
• Cyclical
• Can be distressing and even debilitating
• Severe form- premenstrual dysphoric disorder
Luteal phase

20
Q

What should be considered when taking a history for menstruated disorder

A 
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.
21
Q

What should be considered on examination

A

• 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

22
Q

What investigations should be considered

A
  • 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
23
Q

Describe the impact on menstrual disorders

A

• 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

24
Q

What is th goal of management

A

• 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

Repro1 (20 decks)

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