S4.2 Disorders of Menstruation

Question 1

Define amenorrhoea and its 2 types

Answer 1

Absence of menstruation
Primary amenorrhoea: failure to establish menstruation by 16 years.
Secondary amenorrhoea: cessation of previously normal menstruation for >6 months

Question 2

Define oligomenorrhoea

Answer 2

Infrequent menstruation, >35 days i.e. 4-9 times a year

Question 3

Define menorrhagia

Answer 3

Excessive menstrual blood loss over consecutive cycles

Question 4

Define dysmenorrhoea

Answer 4

Pain during menses
Associated with ovulatory cycles; higher presence of prostaglandins cause uterine contractions which reduce uterine blood flow leading to ischaemia

Question 5

Define Dysfunctional uterine bleeding

Answer 5

Heavy and irregular menstrual bleeding that occurs secondary to anovulation.

Question 6

Define premenstrual syndrome

Answer 6

A cyclical disorder with physical of physiological symptoms.

Can progress to Premenstrual dysphoric disorder

Question 7

List some common causes of menstrual disorders

Answer 7

Problems with the HPO axis
Turners or androgen insensitivity syndrome
Fibroids or polyps
Drugs

Question 8

List some causes of menorrhagia

Answer 8

Uterine fibroids or polyps
Endometrial cancer
Warfarin

Question 9

List some causes of irregular bleeding

Answer 9

Progesterone only pill
STI
Endometrial cancer

Question 10

List some causes of amenorrhoea

Answer 10

Prepubertal
Pregnancy
Menopause

Question 11

List some causes of dysmenorrhoea

Answer 11

Primary is from painful uterine contractions due to prostaglandins.
Secondary is due to endometriosis

Question 12

Define endometriosis

Answer 12

Endometrial glands or stroma growing outside of the uterine cavity.
Symptoms include pain, infertility, haematuria. Pain is dull, bilateral and occurs just before or during menstruation.

Question 13

What to ask in a history

Answer 13

Age of puberty onset
Cycle changes and volume
Sexual/medical history 
Pregnancy
Investigations - FBC, laparoscopy