repro 3.2 menstrual dysfunction Flashcards
From when does the proliferative phase occur?
From the onset of menses to ovulation.
What’s the order of the blood vessels found within the uterine wall?
uterine artery radial arteries arcuate arteries straight arteries spiral arteries
How long is the average menstrual cycle?
21-35 days
What’s the average volume of blood lost per cycle?
37-48 ml/cycle
Whats the name given to heavy periods?
Menorrhagia
What are some cuases of menorhagia?
fibroids abnormal clotting cancer progesterone contraception the coil (IUCD)
What are fibroids?
Benign growths of fibrous and muscular tissue that develop in and around the uterus.
What are some types of fibroids?
intracavitary intramural submucosal subserosal pedunculated
What does DUB stand for?
Dysfunctional uterine bleeding
What is dysfunctional uterine bleeding?
heavy bleeding ewith no recognisable pathology or bleeding disorders. It’s a diagnosis based off the exclusion of other pathology.
syggest a method of reducing uterine bleeding.
endomtrial ablation, using a laser to singe some of the blood vessels.
What’s a long term fix for treatment of menorrhagia?
removal of the uterus, but should only be considered in women who are sure they dont want any more children.
What’s a major cause irregular bleeding?
contraceptives
What’s ammenorrhoea?
Abscence of periods.
What are the different classifications of ammenorrhoea?
Primary- never had a period
secondary- eg had periods before but have since stopped
What are some causes of secondary ammenorrhoea?
pregnancy weight loss some contraceptives PCOS Menopause pituitary tumours certain drugs, eg for cancer. severe stress
What broad impacts can menstrual disorders have?
physical- eg anaemia, tiredness
psychological-depression, anxiety, mood swings, irritability
Social- sports, swimming
Whats is dysmenorrhoea?
Painful periods
What is oligomenorrhoea?
irregular periods more than 35 days apart
What is PMS?
pre-menstrual syndrome- physical and emotional symptoms experiences during the second half of the cycle, so a week or so before menses which can lead to irritability, mood swings, breast tenderness, bloated, headaches, sleep problems etc.
What is primary ammenorrhoea?
the absense of menses without secondary characteristics by 14, or with secondary characteristics by the age of 16.
What’s the definition of seondary ammenorrhoea?
ceasing of menses, for more than 3 months in a woman who has regular periods, or 9 months in a woman who has irregular periods.
What are the 3 broad causes of primary amenorrhoea?
- problems with the outflow tract
- problems with the gonad/end organs
- problems with the hypothalamus/ pituitary.
What are some causes of outflow obstruction causing primary ammenorrhoea?
- mullerian agenesis,
- vaginal atresia
- imperforate hymen
What is Asherman’s syndrome?
-fibrosis of the endometrium leading to lack of hormonal control response.
What is an outflow obstruction cause of secondary amenorrhoea?
Asherman’s syndrome.
What are some ovarian/end organ causes of primary amenorrhoea?
- ovarian dysgenesis (eg Turners syndrome)
- androgen insensitivity
- FSH/LH receptor insensitivity
- congenital adrenal hyperplasia
What does hypergonadotrophic hypogonadism mean?
The gonads are underdevelopped, or have diminished functioning, which leads to less oestrogen production, so less negative feedback, causing an increase in the release of FSH and LH (hypergonadotrophic)
What happens in androgen insensitivity?
This is a condition of males, XY genotype, but the receptors for androgens including testosterone dont work. This causes lack of masculinisation of the external genitalia so the child will be phenotypically male, but will not have a uterus, ovaries etc.
What are some ovarian/end organ causes of secondary amneorrhoea?
- PCOS
- pregnancy
- menopause
What are some hypothalamic/pituitary causes of primary amenorhoea?
-Kallman’s syndrome
What is Kallmann’s syndrome?
There is a chromosomal abnormality leading to malfomraiton of the hypothalamus.
What are some hypothalamic causes of secondary amenorrhoea?
- excersize amenorrhoea
- stress ammenorrhoea
- weight related (eg anorexia nervosa)
What are some pituitary causes of secondary amenorrhoea?
- Sheehan’s syndrome
- Hyperprolactinaemia
- haemachromotosis
What is Sheehan’s syndrome?
necrosis of the pituitary gland following hypovolemic shock after childbirth.
How is prolactin related to the menstrual cycle?
It inhibits oestrogen production
it acts on the mammary glands for milk production
How is prolactin secretion controlled?
Dopamine inhibits.
TRH stimulates.
What are the 3 broad categories that hyperprolactinaemia can be a cause of?
physiological- eg sleep, stress, pregnancy
pharmacological- any dopamine antagonists will remove inhibition
pathological- prolactin secreting adenoma of pituitary gland, hypothyroidism
How does hypothyroidism cause hyperprolactinaemia?
Low levels of T3/4 lead to reduced negative feedback, so the they hypothalamus releases more TRH. as well as stimulating the release of TSH, it also stimulates the release of prolactin, causing hyperprolactinaemia.
Give examples of drugs that inhibits dopamine action.
- opiates
- anaesthesia
- H2 antagonists
What are the 3 main things seen in patients with PCOS?
- secondary amenorrhoea
- Physical signs including hirsutism and acne
- enlarged ovaries with many cysts on them.
What is the beleived cause of PCOS?
increased frequency of GnRH pulses leading to increased LH pulses and therefore increased androgen secretions. These androgens are commonly converted to testosterone.
In PCOS, why doesn’t menstruation happen?
follicles get stimulated for development but no dominant follicle is chosen.
They may still secrete inhibin (FSH inhibited)
What investigations do you do for PCOS?
- high testosterone levels
- hypersecretion of LH
- polycystic ovaries
Why might someone who has PCOS not show high levels of LH when you take a blood sample?
Because of the pulsatile nature.
