Session 4 - Disorders Of Menstruation

Question 1

List some common menstrual disorders.

Answer 1

Amenorrhoea (primary and secondary)
Oligomenorrhoea
Menorrhagia/Heavy Menstrual Bleeding
Dysmenorrhoea 
Intermenstrual bleeding
Dysfunctional uterine bleeding 
Premenstrual syndrome

Question 2

What is the difference between primary and secondary amenorrhoea?

Answer 2

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

Question 3

What is oligomenorrhoea?

Answer 3

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

Question 4

What is menorrhagia?

Answer 4

Heavy menstrual bleeding (HMB)

Excessive menstrual blood loss over consecutive cycles, more than 80ml per menstruation

Question 5

What is dysmenorrhoea?

Answer 5

Pain during menses, associated with ovulatory cycles

Question 6

What is dysfunctional uterine bleeding (DUB)?

Answer 6

Heavy and irregular menstrual bleeding that occurs secondary to anovulation.

Question 7

What is anovulation?

Answer 7

Anovulation is when the ovaries do not release an oocyte during a menstrual cycle.

Question 8

What is ovulation?

Answer 8

When the ovaries release an egg

Question 9

What is premenstrual syndrome (PMS)?

Answer 9

A cyclical disorder, occurring in the latter half of the menstrual cycle. Causes physical and psychological symptoms that resolve at the onset of bleeding. Common symptoms include acne, tender breasts, feeling tired, irritability and mood changes.

Question 10

What is premenstrual dysphoric disorder (PMDD)?

Answer 10

Condition where the woman experiences serve mod symptoms such as depression, irritability and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).

Question 11

What are the common causes of disorders of menstruation?

Answer 11

• Can be hormonal - HPO axis.
• Chromosomal anomalies e.g. MRHK syndrome, Turner’s syndrome, Androgen insensitivity syndrome, Swyer syndrome, congenital adrenal hyperplasia.
• Structural/anatomical abnormalities - uterine or vaginal e.g. fibroids, polyps.
• Other: bleeding diathesis, drugs, thyroid disease, chronic illness

Question 12

What are the physiological causes of amenorrhoea?

Answer 12

Prepuberty
Pregnancy
Menopause

Question 13

Give some structural causes of menstrual disorders?

Answer 13

Agenesis/hypoplasia of any part of the genital tract
Leiomyoma (uterine fibroids)
Imperforate hymen 
Vaginal septae
Asherman’s syndrome
Cervical stenosis

Question 14

What is a imperforate hymen?

Answer 14

A congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during foetal development. Causes menstrual blood to accumulate in the vagina and sometimes also the uterus. Treated by surgical incision of the hymen.

Question 15

Give some possible causes of menorrhagia.

Answer 15

Uterine fibroids - leiomyoma 
Uterine polyps
Endometrial cancer
Bleeding diathesis 
Copper IUCD
Drugs, e.g. warfarin

Question 16

What are the possible causes of irregular bleeding?

Answer 16

Hormonal contraception, especially the progesterone-only preparations
STIs/PID infection
Cervical ectopy or pathology, usually as postcoital bleed
Endometrial pathology - polyp or cancer
Ovarian cyst, the hormone secreting type

Question 17

What are the possible causes of dysmenorrhoea?

Answer 17

Primary - idiopathic. Due to the response of the uterus to prostaglandins causing painful contractions.
Secondary - endometriosis, obstructed menses.

Question 18

What is endometriosis?

Answer 18

Condition where endometrium is found growing in places outside of the lining of the uterus. Most often occurs on the ovaries, Fallopian tubes, on the outside wall of the uterus or around the bladder or bowel.

Question 19

What is a hysterectomy?

Answer 19

Surgical procedure to remove the uterus.