Session 5- Menstrual Disorders Flashcards
what is amenorrhea
absensce of menstruation.
what is primary amenorrhea and what causes it
when a patient hasnt had a period by the age of 16 years old
congenital disorders- turners syndrome
hormonal disorders
structual disorders- imperforate hymen
secondary amenorrhea
when a patient has started having periods but then subswquently menstruation has stopped
after 6 months
what is PCOS
polycystic ovary syndrome
a syndrome of hyperandrogenism and chronic anovulation
how do patiest with PCOS present
secondary amenorrhea/ infertility
hirsutism
obesity
pathophysiology of PCOS
lack of pulsatile GnRH release theredore many folicles begin to develop but a dominent folicle is not selected to mature
these folicles respond to pituitary hormonesby producing an abnormal pattern of oestrogen secretion
what causes the chronic annovulation in PCOS
inappropriate feedback signals from the ovary to the hypothalamus/pituitary
what is oligomenorrhea
menstruation that has reduced in frequency, leading to a cycle length of greater than 35 days resulting in 4-9 oeriods a year
what is menorrhagia
heavy mentsrual bleeding either by onjective volume >80ml and/ or the subjective opinion of the patient that periods have become heavier ot that she is passing clots
what are fibroids
benign tumours of smooth muscle occuring in the myometrium
they are hormone dependant and so regress after the menopause but prior can lead to very heavy menstrual bleeding
what is dysmenorrhea
painful periods
chronic pelvic pain- can be a s a result of obstructive structural causes
what is a common cause of dysmenorrhea
endometriosis
-a condition characterised by ectopic endomentrial tissue that responds in the same way to hormonal stimulation as the endometrial lining of the uterus
this can irritate the peritoneum leading to pain, intra-abdominal adesions and sometime infertility
forming a differential diagnosis of the cause of menstrual disorders
hormonal- look at HPG axis, is there a problem with the release of GnRH if so all subsequent hormones will be low
structural- if not hPG then consider problem with the uterus or vagina- can be investigated with USS, MRI or intensive imaging - hysteroscopy, hysterosalpingography or laproscopy
system review- thyroid disorders can cause menorrhagia or oligomenorrhea
what is complete androgen insensitivity
X-linked recessive disorder
resistant to testosterone due to a defect in the androgen receptor
46 XY but normal female phenotype
testes may be palpable in the labia or inguinal area
absence of upper vagina, uterus and fallopian tubes
The testes should be surgically excised after puberty
if someone has primary amenorrhea and no pubertal development how would you investigate it
investigate as delayed puberty
if someone has primary amenorrhea and normal pubertal development how would you investigate it
exclude genital tract anaomaly
investigate as for secondary amenorrhea
if someone has primary amenorrhea and and an issue with pubertal development how would you investigate it
exclude chromosomal abnormality
exclude causes of hyperandrogenism
anatomical causes of secondary amenorrhea
scarring
-cervical stenosis
ovarian disorders
-Primary ovarian insufficiency (premature menopause)
how can thyroid disease cause secondary amenorrhea
- menstrual abnormalities common in both hyper and hypothyroidsm
- sever hyperthyroidism classically associated with amenorrhea
- may be proceeded by oligomenorrhea
- complex interplay between thyroid hormones and HPG axis
how can hyperprolactinemia cause secondary amenorrhea
raised prolactin levels
high prolactin levels interfere with the normal production of other hormones, such as oestrogen and progesterone- this can lead to irregular or missed periods
what is considered to be abnormal uterine bleedig
uterine bleeding outside of the parameters notes belpw
- duration greater than 8 days
- more frequently than every 24 days or less frequently than every 38 days
- intermenstrual bleeding or postcoital spotting
what are the common sites for endometriosis
ovaries endometrioma bladder rectum peritoneal lining and pelvic side walls
when is andenomyosis
endometrial tissue found deep within myometrium
dysmennorrhea management
NSAIDs Hormonal contraceptives -IUD -GnRH analogues -Surgery
