Session 5- Menstrual Disorders

Question 1

what is amenorrhea

Answer 1

absensce of menstruation.

Question 2

what is primary amenorrhea and what causes it

Answer 2

when a patient hasnt had a period by the age of 16 years old

congenital disorders- turners syndrome
hormonal disorders
structual disorders- imperforate hymen

Question 3

secondary amenorrhea

Answer 3

when a patient has started having periods but then subswquently menstruation has stopped

after 6 months

Question 4

what is PCOS

Answer 4

polycystic ovary syndrome

a syndrome of hyperandrogenism and chronic anovulation

Question 5

how do patiest with PCOS present

Answer 5

secondary amenorrhea/ infertility
hirsutism
obesity

Question 6

pathophysiology of PCOS

Answer 6

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

Question 7

what causes the chronic annovulation in PCOS

Answer 7

inappropriate feedback signals from the ovary to the hypothalamus/pituitary

Question 8

what is oligomenorrhea

Answer 8

menstruation that has reduced in frequency, leading to a cycle length of greater than 35 days resulting in 4-9 oeriods a year

Question 9

what is menorrhagia

Answer 9

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

Question 10

what are fibroids

Answer 10

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

Question 11

what is dysmenorrhea

Answer 11

painful periods

chronic pelvic pain- can be a s a result of obstructive structural causes

Question 12

what is a common cause of dysmenorrhea

Answer 12

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

Question 13

forming a differential diagnosis of the cause of menstrual disorders

Answer 13

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

Question 14

what is complete androgen insensitivity

Answer 14

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

Question 15

if someone has primary amenorrhea and no pubertal development how would you investigate it

Answer 15

investigate as delayed puberty

Question 16

if someone has primary amenorrhea and normal pubertal development how would you investigate it

Answer 16

exclude genital tract anaomaly

investigate as for secondary amenorrhea

Question 17

if someone has primary amenorrhea and and an issue with pubertal development how would you investigate it

Answer 17

exclude chromosomal abnormality

exclude causes of hyperandrogenism

Question 18

anatomical causes of secondary amenorrhea

Answer 18

scarring
-cervical stenosis

ovarian disorders
-Primary ovarian insufficiency (premature menopause)

Question 19

how can thyroid disease cause secondary amenorrhea

Answer 19

• 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

Question 20

how can hyperprolactinemia cause secondary amenorrhea

Answer 20

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

Question 21

what is considered to be abnormal uterine bleedig

Answer 21

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

Question 22

what are the common sites for endometriosis

Answer 22

ovaries
endometrioma
bladder
rectum
peritoneal lining and pelvic side walls

Question 23

when is andenomyosis

Answer 23

endometrial tissue found deep within myometrium

Question 24

dysmennorrhea management

Answer 24

NSAIDs
Hormonal contraceptives
-IUD
-GnRH analogues 
-Surgery