S5 L1 Menstrual disorders Flashcards
Menstrual disorders
- What type of things to consider?
Menstrual disorders to be addressed
- 4 types
To be replaced by simple descriptive terms which cover:
- regularity of the cycle
- frequency of menstruation
- volume and duration of the menstrual flow
Menstrual disorders:
• Amenorrhoea- primary and secondary
• Oligomenorrhoea
• Menorrhagia- Heavy Menstrual Bleeding (HMB)
• Dysmenorrhoea
Amenorrhoea:
- What is this?
- 2 types
• Amenorrhoea = absence of menstruation
• Primary amenorrhoea: failure of menstruation by the age of 16 years in the presence of normal secondary sexual characteristics, or 14 years in the absence of other evidence of puberty.
May be as simple as delayed puberty, or something else…
• Secondary amenorrhoea: absent periods for at least six months in a woman who has previously had regular periods, or 12 months if she has previously had oligomenorrhoea (bleeds less frequently than six-weekly).
Causes of Amenorrhoea
Oligomenorrhoea
Menorrhagia/Heavy menstrual bleeding
Dysmenorrhoea
- Oligomenorrhoea: infrequent menstruation, >35 days i.e. 4- 9x/year
- Menorrhagia/Heavy menstrual bleeding (HMB): excessive menstrual blood loss (MBL) that interferes with the physical, social, emotional and/or material quality of life.
- The classic objective criteria of blood loss >80 mL/cycle may be applied for research purposes but not clinical use.
- Dysmenorrhoea: means pain at the time of menstrual bleeding. e.g. could be caused by malignancy, endometriosis
Causes - Primary Amenorrhea
- Type of causes
- Examples include…
Causes - Primary Amenorrhea
– Turner syndrome
Causes - Primary Amenorrhea
– Complete Androgen Insensitivity Syndrome
Have the external sex characteristics of females, but do not have a uterus (due to no duct forming…) and therefore do not menstruate and are unable to conceive a child (infertile).
Causes - Primary Amenorrhea
- Diseases in the hypothalamus and pituitary
Clinical checklist for Primary Amenorrhea
Secondary amenorrhea - Anatomical causes
Secondary amenorrhea - PCOS
- Symptoms
- Levels of hormones
- Insulin link
- Tests for it
- Treatment
Secondary amenorrhea - Endocrine
Secondary amenorrhea - Hypothalamic and pituitary disease
Physiological Amenorrhea
- 2 in specifically
Oligomenorrhoea
- What is this?
- Usually which phase is increased?
- Causes?
- Examples…
Can be a bit of a grey area when determining oligomenorrhoea or amenorrhoea
- More correct terminology- infrequent menstruation
- Usually due to prolonged follicular phase
- Can be constitutional (it can ‘just happen’)
- Most are directly or indirectly rooted in hormonal imbalance
- Examples include: PCOS; ovarian insufficiency; perimenopause; thyroid dysfunction; excessive exercise; eating disorders; hormonal contraception
Menorrhagia
- What is this?
- Specifics of it (description)
- What can happen between periods?
- How can it affect periods?
Abnormal uterine bleeding
•Abnormal uterine bleeding refers to uterine bleeding outside of the parameters noted below :
– Duration greater than eight days
– Flow greater than 80 mL/cycle or subjective impression of heavier-than-normal flow
– Occur more frequently than every 24 days or less frequently than every 38 days
– Intermenstrual bleeding or postcoital spotting
– Absence of menses
Abnormal uterine bleeding - different classifications
- Duraction of symptoms
- Underlying cause (way of remembering…)
- Types of symptoms
Abnormal uterine bleeding - fibroids
- What are fibroids
- Formation is driven by…
- Complications…
Abnormal uterine bleeding - Dysfunctional Uterine Bleeding (DUB)
- What is this?
- Subdivided into…
- Explainations of it…
Dysmenorrhea
- What is this?
- Common?
- Presentation?
Dysmenorrhea - Endometriosis
- What is this?
- Prevalence?
- Risk factors?
- Key hormone involved…
- Symptoms it can cause…
Dysmenorrhea - Endometriosis cont.
- Reason for it?
- Most common sites?
Endometriosis can occur anywhere in the body e.g. thorax, eyes, nose
Dysmenorrhea - Management
Impact of menstrual disorders
Impact:
• Physical
• Psychological
• Social
• Studies/Work
• Quality of life
• These all need to be kept in mind and taken into account
during assessment and management
