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WH: Menstrual Disorders Flashcards

1
Q

What is amenorrhoea

A

Lack of menstrual periods

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2
Q

what is primary amenorrhoea ? what age?

A

patient has never developed menstural periods
( not starting menstruation by 15 when there are other sings of puberty)

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3
Q

what could cause primary amenorrhoea ? (5)

A
  • Abnormal function of hypothalamus (hypogonadotorphic hypogonadism)
  • Abnormal function of gonads (hypergonadotrophic hypogonadism)
  • congenital structural abnormalities (imperforate hymen)
  • Congenital Adrenal hyperplasia
  • Androgen insensitivity syndrome
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4
Q

what is secondary amenorrhoea ?

A

patient has piously had periods that they stop

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5
Q

Causes of secondary amenorrhoea ? (7) most common ?

A
  • Pregnancy (most common)
  • menopause
  • Physiological stress
  • PCOS
  • Medications (hormonal)
  • Thyroid hormone abnormailites
  • Cushings
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6
Q

what physiological stress could cause secondary amenorrhoea ?

A
  • high exercise
  • low BMI
  • chronic disease
  • Physcosocial factors
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7
Q

What is irregular mesntruation

A

abrnomal uterine bleeding: abnormal
- Frequency
- Duration
- Volume of menses
- Regularity

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8
Q

What does irregular menstruation indicate? (2)

A
  • annovulation (lack of ovulation)
  • Irregular ovulation
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9
Q

what pathophysiology could cause irregular menstruation?

A
  • disruption of normal hormone levels
  • ovarian pathology
    (think HPG axis)
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10
Q

causes of irregular menstruation ? (6)

A
  • Extremes of reproductive age
  • PCOS
  • Psychosocial stress
  • eating disorder/chronic disease
  • Hormonal imbalance
  • thyroid disorder
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11
Q

What is intermenstural bleeding (IMB)

A

any bleeding that occurs between menstural periods

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12
Q

what is intermenstrual bleeding a red flag for?

A

red flag for cervical cancer but has more common causes

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13
Q

common causes of IMB?

A

intermenstrual bleeding
- hormone contraception
- Cervical ectropion/polyps
- STI
- pregnancy

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14
Q

What is dysmenorrhoea

A

Painful periods

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15
Q

What could cause dysmenorrhoea ?

A
  • Primary dysmenorrhoea (no underling pathology)
  • Endometriosis
  • Fibroids
  • PID
  • Copper coil
  • Cervical/endo cancer
  • PCOS
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16
Q

what is menorrhagia ?

A

heavy menstrual periods

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17
Q

What could cause menorrhagia ? (9)

A
  • Dysfunctional uterine bleeding
  • Extremes of reproductive age
  • fibroids
  • Endo
  • PID
  • Contraceptive (copper coil)
  • anticoags
  • Bleeding disorders
  • PCOS
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18
Q

What is post-coital bleeding a red flag for?

A

red flag for cervical cancer but other reasons more common

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19
Q

post coital bleeding causes? (4)

A
  • trauma
  • Atrophic vaginitis
  • cervical ectropion/polyps
  • endo/vaginal/cervical cancer
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20
Q

what could cause pelvic pain? (12)

A
  • UTI
  • Dysmenorrhoea
  • IBS
  • ovarian cysts
  • endo
  • PID
  • Ectopic pregnancy
  • Appendicitis
  • Mittelschmerz
  • Pelvic adhesions
  • Ovarian torsion
  • IBD
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21
Q

what vaginal discharge is concerning?

A

excessive
discoloured
foul smelling

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22
Q

what could cause abnormal vaginal discharge? (6)

A
  • BV
  • STI
  • foreign body
  • Pregnancy
  • Ovulation
  • Cervical ectropion
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23
Q

what is kallman syndrome ? what type of amenorrhoea does it cause?

A

Kallman syndrome
- genetic condition causing hypogonadotrophic hypogonadism with failure to start puberty (primary amenorrhoea)

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24
Q

Briefly describe hypogonadotrophic hypogonadism: defieicy in what ? due to abnormal functioning of what?

A

abnormal function of hypo/AP => deficiency in LH + FSH
- causes low oestrogen

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25
Briefly describe hypergonadotrophic hypogonadism: defieicy in what ? due to abnormal functioning of what?
abnormal function of gonads ovaries fil to respond to gonadotrophin (LH + FSH) => no oestrogen => high LH + FSH, low sex hormones
26
hypothalamic causes of amenorrhoea? (3)
(hypogonadotrophic hypogonadism) - Functional disorders (eating disorders, exercise) - Severe chronic conditions (psychiatric, thyroid disease) - Kallmann syndrome
27
what type of inheritance is Kallmann syndrome ?
x-linked recessive disorder
28
Kallmann syndrome pathophysiology
underdevelopment of specific neurones in brain => filature of migration of GnRH cells => hypogonadotrophic hypogonadism => primary amenorrhoea
29
Pituitary causes of amenorrhoea ?
(hypogonadotrophic hypogonadism) - Prolactinomas - Other pituitary tumours - Sheehans syndrome (post-partum)
30
Ovarian causes of amenorrhoea/oligomenorrhoa ? (3)
- PCOS - Turners syndrome - Premature ovarian failure (early menopause - before 40)
31
Adrenal causes of amenorrhoea ?
congenital adrenal hyperplasia
32
physiological causes of amonorhoea ?
(secondary) - Pregnancy - lactation - Menopause
33
What is congenital adrenal hyperplasia ?
congenital deficiency 21-hydroxylase enzyme => underproduction of cortisol + aldosterone + overproduction of androgens (cause of primary amenorrhoea)
34
What type of inheritance is congenital adrenal hyperplasia ?
autosomal recessive
35
what is androgen insensitive syndrome ?
genetically males are unable to reopen to androgen hormones (testosterone) and excess converted to oestrogen => male genotype and female phenotype (female secondary characteristics)
36
Genetic abnormilaites causing primary amenorrhoea ?
- Turnerss syndrome - Kallmanns syndrome - androgen insensitivity syndrome
37
definition of secondary amenorrhoea ?
no mesntruation for more than 3 months after previous regular menstrual periods
38
How does hyperprolactinaemia cause secondary amenorrhoea ? what type of amenorhhoea is this?
raised prolactin supresses GnRH release from hypothalamus (hypogonadotrophic hypogonadism)
39
Hyperprolactinaemia treatment ?
dopamine agonist: cabergoline
40
what investigations would you do for amenorrhoea ?
- pregnancy test - LH + FSH - prolactin - TFT
41
what are patient with amenorrhoea associated with low oestrogen at higher risk of?
osteoporosis risk
42
What is PMS? during which phase?
premenstrual syndrome - psychological, emotional +physical symptoms that occur during the luteal phase (days prior to menstruation)
43
what is PMS caused by?
fluctuation of oestrogen + progesterone (not fully understood)
44
PMS presentation
- Low mood, anxiety, mood swings, irritability - bloating, fatigue, breast pain - Reduced confidence, cognitive difficulties, reduced libido
45
what is severe PMS that affects QOL ?
premenstrual dysphoric disorder
46
how is PMS diagnosed? when do symptoms improve ?
symptom diary shows cyclical changes - symptoms improve after menstruation
47
PMS management
- general healthy lifestyle (diet, exercise, alcohol, stress, sleep) - COCP - SSRI - CBT
48
What is menorrhagia?
heavy menstrual bleeding
49
average blood loss during menstruation ?
40ml
50
what counts as excessive blood loss? vol? symptom complaint?
>80ml - changing pad every 1-2 hours - bleeding lasting >7days - passing large clots
51
Causes of menorrhagia ? (9)
- dysfunctional uterine bleeding (no identifiable cause) - extremes of reproductive age - fibroids - PCOS - PID - Endo - Bleeding disorder - Anticoagulants - Copper coil
52
what investigations might you to for menorrhagia ?
- Pelvic exam + speculum + bimanual - consider hysteroscoy, TVUS
53
menorrhagia management categories ? (3)
- contraceptive - non-contraceptive - definitive
54
what contraceptive management is there for menorrhagia ? (3)
1) mirena coil 2) COCP 3) cyclical oral progestogens
55
what non-contraceptive managmetn is there for menorrhagia ?
- Tranexamic acid
56
what is a definitive management option for menorrhagia ? (2)
- endometrial ablation - hysterectomy
57
What is primary dysmenorrhoea ? secondary ?
primary: menstural pain occurring with no underlying pelvis pathology secondary: menstrual pain that occurs with an oassocaietd pelvic pathology
58
examples of secondary dysmenorrhoea causes ?
- endometriosis - adenomyosis - PID - Adhesions - non gynae (IBD, IBS)
59
what is the pathophysiology of parity dysmenorrhoea ? what chemical involved ?
thought to be due to excessive prostaglandin release by endometrial cells - prosaglandins => serial artery vasospasm (=> ischaemic necrosis) + increase myometrial contractions
60
features of primary dysmenorrhoea ? associated with ?
lower abdo or pelvic pain - crampy, lasts 48-72 hrs - associated with malaise/N+V/diarhoea/dizziness
61
primary dysmorrhoea Mx ?
lifestyle: stop smoking - pharmacological NSIADs (inhibits the production of prostaglandins) - 2nd line: COCP, mirena coil
62
What is HRT ? in who is it used ?
used I perimenopausal + PM women to alleviate symptoms of menopause
63
what brings on the sx of the menopause ? associated with what ?
sx associate with decline in oestrogen (so HRT: exogenous oestrogen)
64
what hormones are in HRT ?
oestrogen - plus progesterone given to women that have a uterus (to prevent endometrial hyperplasia/thicken of endo => endo cancer secondary to unopposed oestrogen)
65
what is unopposed oestrogen ?
oestrogen without protection of progesterone
66
Generally, what HRT recommended for: women that have periods ?
cyclical HRT with cyclical progesterone + regular breakthrough bleeds
67
Generally, What HRT recommended for: PM women with uterus + more than 12 months without periods?
continuous HRT
68
no hormonal Tc for menopause Sx ?
- lifestyle change (diet, stop smoking, increase exercise, reduce alcohol, reduce caffein, reduce stress) - CBT - SSRI, venlafaxine - gabapentin - clonidine
69
what is clonidine used for ?
redue BP + reduce HR => reduce hot flushes (vasomotor sx of menopause)
70
indications for HRT ? (6)
- replaying hormones in premature ovarian insufficiency (even without sx) - hot flushes, night sweats (sx of reduced vasomotor) - improve low mod - low libido - poor sleep - reduce osteoporosis risk
71
benefits of HRT ? (3)
- improved sx - improved QOL - reduce osteoporosis risk
72
HRT risks ? (4)
- increase breast cancer risk (combined HRT) - increase endo cancer risk (so add progestogen if have uterus) - increase VTE risk (so use patches rather than pill) - stroke
73
HRT contraindications ? (7)
- undiagnosed abnormal bleeding - endometrial hyperplasia/cancer - breast cancer - uncontrolled hypertension - VTE - liver disease - pregnancy
74
does cyclical or continuous HRT have better endo protection ?
continuous HRT has better endo protection than cyclical HRT
75
what different options for oestrogen are there for HRT ?
oral, transdermal (gel/patches) -transdermal: better for poor oral Mx, increase VTE risk, CVD, headaches
76
why is progesterone used in HRT ?
reduce risk of end-hyperplasia + cancer in women with uterus (helpful for reduced libido, depression)
77
what different types of progestogen are used in HRT ?
oral, transdermal, IUS (mirena) - C19: derived from testosterone (helpful in low libido) - C21: derived from progesterone (helpful in depression/acne)
78
what can mirena be used for ? (3)
- HRT - contracpetion - Menorrhagia
79
are patches or pills typically better for HRT ?
patches tend to be better due to reduced VTE risk
80
what HRT regime for woman with no uterus ?
oestrogen only pill or patch
81
what HRT regime for premenopausal woman with periods ?
cyclical combined tablet/patch/mirena coil PLUS oestrogen only pills/patches
82
example regime for PM women with uterus?
continuous combine tablet/patch, mirena coil PLUS oestrogen only pills/patches
83
additional HRT mx ? when check up ?
follow up 3 months after starting HRT - SE usually settle with time, takes 3-6 months to get full effects
84
is HRT contraception ?
nope - but mirena or POP (in addition to HRT) is
85
HRT SE ?
oestrogen: nausea, bloating, breast swelling, breast tenderness, headaches - progesterone: mood swings, bloating, fluid retention, weight gain, acnei
86
If you are getting HRT SE, what should you consider ?
changing pill => patch different progestogen
87
how to stop HRT ?
rescued gradually or stopped abruptly
88
What is premature ovarian insufficiency ? due to what ?
It is menopause <40 yrs - due to decline invariant activity => early menopause sx
89
what are the hormone levels like in premature ovarian insufficiency ? what hyper/hypogonadotorphin things is this ?
hypergonadoprophic hypogonadism (under activity of ognads) - high LH + high FSH - Low estradiol
90
causes of premature ovarian insufficiency ? (5) most common ?
- idiopathic (50%) - iatrogenic (chemo, radiotherapy, oophorectomy) - autoimmune - genetic - infection (mumps, cytomegalovirus)
91
premature ovarian insufficiency px ? (3)
oligomenorrhoea or secondary amenorrhea - sx of low oestrogen (hot flushes, night seats, vaginal dryness)
92
premature ovarian insufficiency dx ?
typical monpasual sx PLUS elevated FSH (in a women <40 yrs)
93
what conditions are associated with the reduced oestrogen in premature ovarian insufficiency ? (5)
- CVD - Stroke - Osteoporosis - Cognitive impairment - Dementia
94
premature ovarian insufficiency Mx ?
HRT - traditional HRT - or COCP

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