Session 3 - Menstrual dysfunction

Question 1

What is the average blood loss during a period?

Answer 1

30-45 ml

Question 2

What is amenorrhoea?

Answer 2

Absence of periods for at least 6 months

Question 3

What two categories is amonerrhoea split into?

Answer 3

Primary and secondary

Question 4

What is pirmary amenorrhoea?

Answer 4

Never had a period. Absence of menses by age 14 with absence of secondary sexual charateristics/ absence by age 16 with normal SSC

Question 5

What is secondary amenorrhoea?

Answer 5

Established menstruation has ceased for 3 months in a woman with a history of regular cyclic bleeding, or nine months in a woman with a history of irregular periods. Normally in a women age 40-55.

Question 6

What is oligomoenorrhea?

Answer 6

Infrequent periods occuring at intervals of 35 days - 6 months

Question 7

What is dysmenorrhoea?

Answer 7

Painful periods

Question 8

What is menorrhagia?

Answer 8

Heavy periods. (Excessive (>80ml), prolonged (> 7 days) uterine bleeding

Question 9

What is cryptomenorrhoea?

Answer 9

Periods occur but not visible due to obstruction in outflow tract

Question 10

What is pre-menstrual syndrome?

Answer 10

Collection of emotional symptoms, with or without physical symptoms related to a woman’s menstrual cycle

Question 11

What is dysfunction uterine bleed?

Answer 11

Abnormal bleeding, no obvious organic cause

Question 12

What is an anovulatory cycle?

Answer 12

No ovulation/luteal phase, oligo/amenorrhoea +/- mennorrhagia

Question 13

What are ovulatory cycles?

Answer 13

Normal menstrual cycle + dysmenorrhea/mastalgia

Question 14

What is the origin of primary ammenorhea?

Answer 14

Origin is hypothalamic/pituitary, ovarian or outflow tract

Question 15

What is hypothalamic/pituitary amenorrhoea?

Answer 15

Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate the endometrium of the uterus, giving amenorrhoea.

Question 16

Give a cause of primary hypothalamic amenorrhoea?

Answer 16

Kallmann syndrome - Inability to produce GnRH

Question 17

Give three causes of secondary hypothalamic ammenorhea

Answer 17

 Exercise Amenorrhoea – Related to physical exercise
 Stress Amenorrhoea
 Eating disorders and weight loss (Obesity, anorexia or bulimia). Fall below critical weight of 47kg menses will cease (see above).

Question 18

Give three causes of secondary pituitary amenorrhoea?

Answer 18

Sheehan syndrome - Hypopituitarism
 Hyperprolactinaemia
 Haemochromatosis – ‘Iron overload’

Hypo/hyperthyroidism

Question 19

What is ovarian amenorrhoea?

Answer 19

In Ovarian Amenorrhoea the ovary does not respond to pituitary stimulation, giving low oestrogen levels. The lack of –‘ve feedback from oestrogen leads to elevated FSH levels in the menopausal range (Hypergonadotrophic amenorrhoea).

Question 20

Give four causes of primary gonadal/end-organ amenorrhoea?

Answer 20

 Gonadal dysgenesis – E.g. Turner Syndrome (45, X)
 Androgen Insensitivity Syndrome
 Receptor abnormalities for FSH and LH
 Specific forms of congenital adrenal hyperplasia

Question 21

Give five causes of secondary gonadal/end-organ amenorrhoea?

Answer 21

	Pregnancy
	Anovulation
	Menopause (Or premature menopause)
	Polycystic Ovarian Syndrome
	Drug-induced

Question 22

What is normal in amenorrhoea of outflow tract origin?

Answer 22

The hypothalamic-pituitary-ovarian axis

Question 23

What is primary outflow tract obstruction? (Two causes?

Answer 23

 Uterine – Mullerian agenesis. 15% of primary amenorrhoea

 Vaginal – Vaginal atresia, cryptomenorrhoea, imperforate hymen

Question 24

Give a cause of secondary outflow tract obstruction

Answer 24

 Intrauterine Adhesions (Asherman’s syndrome)

Question 25

What must be looked at in the histroy of someone with secondary amenorrhoea?

Answer 25

o	Menstrual history
	Ever had one before? What was your cycle like before?
o	Contraception
o	Pregnancy
o	Surgery
o	Medication
o	Weight change
o	Chronic diseases, stress, diet
o	Family history
	Age at menopause, thyroid dysfunction, diabetes, cancer

Question 26

Give parts of physical evaluation of secondary amenorrhoea

Answer 26

	BMI – Weight change
	Hair distribution – PCOS
	Thyroid
	Visual fields / Breast discharge – Hyperprolactinaemia 
	Abdomen-masses? Tenderness?

Question 27

Give two potential treatments for amenorrhoea

Answer 27

Hormon replacement, if due to hormone insufficiency

Lifestyle change, if due to lifestyle (exercise, weight loss)

Question 28

What is dysfunctional uterine bleeding?

Answer 28

The corpus luteum does not form to release progesterone. As a result oestrogen is produced continuously, causing overgrowth of the uterine bleeding and subsequent bleeding.

Question 29

What is menorrhagia?

Answer 29

Menorrhagia is heavy vaginal bleeding that is not DUB. It is usually secondary to distortion of the uterine cavity, leaving the uterus unable to contract down on open venous sinuses in the zona basalis.

Question 30

Give four causes, other than distortion of the uterine cavity, that can cause menorrhagia?

Answer 30

Organic
Endocrine
Haemostatic
Iatrogenic

Question 31

What are the two main actions one must do when menorrhagia is suspected?

Answer 31

Take history

Take full blood count