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Flashcards in 3.2 Deck (28):
1

Define amenorrhoea

Absence of periods for at least 6 months.

2

What is primary amenorrhoea?

Never had a period
Absence of menses by age 14 with absence of secondary sexual characteristics.
OR
Absence of menses by 16 with normal secondary sexual characteristic development.

3

What is secondary amenorrhoea?

Established menstruation has ceased for three 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 women aged 40-55.

4

Define menorrhagia.

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

5

Define Dysmenorrhoea

Painful periods

6

Define oligomenorrhoea

Infrequent periods occurring at intervals of 35 days - 6 months.

7

Define cryptomenorrhoea

Periods occur but not visible due to obstruction in outflow tract.

8

Define Dysfunctional Uterine Bleeding

Abnormal bleeding
Excessively heavy, prolonged or frequent
Origin that is not due to pregnancy, pelvic or systemic disease.

9

What are anovulatory cycles?

No ovulation/luteal phase
Olio/amenorrhoea +/- menorrhagia

10

What are ovulatory cycles?

Normal menstrual cycles + Dysmenorrhoea and mastalgia (sore breasts)

11

What are the origins of amenorrhoea?

Hypothalamic/pituitary
Ovarian/gonadal
Outflow tract (uterus, cervix, vagina)

12

How can primary/secondary outflow tract amenorrhoea be caused? What is the FSH level?

Outflow tract origin
HPO axis is functional so FSH is normal?

Primary:
Uterine - Mullerian agenesis
Vaginal - vaginal atresia, cryptomenorrhoa, imperforacte hymen
Stenosed cervix

Secondary:
Intrauterine adhesions (Asherman's syndrome)

13

Describe gonadal/end organ amenorrhoea. Primary and secondary causes? FSH levels?

Ovary does not respond to pituitary stimulation.
Low oestrogen levels.
Lack of negative feedback --> High FSH (hypergonadotrophic amenorrhoea).

Primary:
Gonadal dysgenesis (Turner's)
Androgen insensitivity syndrome
Receptor abnormality for FSH/LH
Congenital adrenal hyperplasia

Secondary:
Pregnancy
Anovulation
MEnopause
Polcystic ovarian syndrome
Drug induced

14

What is hypothalamic/pituitary amenorrhoea? FSH levels?

Inadequate FSH levels lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate the endometrium of the uterus --> amenorrhoea.
(Hypogonadotrophic)

15

Describe causes of primary and secondary hypothalamic amenorrhoea.

Primary hypothalamic:
Kallmann Sydrome - inability to produce GnRH (therefore FSH)

Secondary hypothalamic:
Exercise amenorrhoea
Stress
Eating disorder and weight loss (below 47kg menses cease).

Secondary pituitary
Sheehan syndrome - hypopituitarism
Hyperprolactinaemia
Hypo/hyperthyroidism

16

How to evaluate secondary amenorrhoea?

Menstrual history - regularity?
Contraception
Pregnancy
Surgery
Medication
Weight change
Chronic disease
Stress
Diet
Family history
- Thyroid, age at menopause, diabetes
Physical exam
- BMI, hair (PCOS), thyroid, breast discharge (hyperprolactinaemia)

17

How is amenorrhoea managed?

Hormone replacement if due to hormonal insuffieciey
Lifestyle changes
Laser ablation of endometrium - destroy endometrial basalis layer - renders woman incapable of producing endometrium.

18

Describe dysfunctional uterine bleeding

Excessive heavy, prolonged or frequent bleeding of uterine origin, not due to pregnancy, pelvic or systemic disease.

19

When does DUB occur?

Usually Anovulatory
90% when ovulation is not occurring.
Corpus luteum des not form to release progesterone
Oestrogen is produced continuously causing uterine overgrowth.

10% occurs when ovulation is occurring
Progesterone secretion is prolonged because oestrogen is low.
Irregular shedding and erratic bleeding

20

how DUB diagnosed?

Exclusion
hCG, TSH - Exclude pregnancy and thyroid
Smear to exclude cancer
Sample endometrium

21

Management of DUB?

Oestrogen therapy followed by progesterone.

22

What is menorrhagia? When does it occur? Causes?

Heavy vaginal bleeding that is not DUB.
Secondary to distortion of the uterine cavity, leaving the uterus unable to contract down on open venous sinuses in the zone basal is.

Usually ovulatory

Causes:
Organic, endocrine, haemostatic, iatrogenic

23

What are fibroids and how are they diagnosed?

Benign tumours of myometrium
Increased blood supply and neovascularisation
Diagnosed:
Bimanual examination
Ulatrsound
Hysteroscopy - into womb via vagina
Laparoscopy - into womb via abdominal incision
Bopsy

24

How is menorrhagia assessed?

FBC - Hb
Pictoral blood loss assessment - pad/tampon counts
>80ml for >7days excessive and prolonged

25

How is menorrhagia managed?

Progesterone
Hysterectomy/endometrial resection

26

What are the advantages of removing ovaries in hysterectomy? Disadvantages?

Reduced risk of ovarian and breast cancer

Ovaries produce female hormones that play a part in osteoporosis protection, sexual desire and pleasure.
Sudden onset of menopause

27

How can normal menstrual cycle be disrupted?

Contraception
O/P imbalance
PCOS
Pregnancy
EArly micarriage

28

What causes period pain?

Muscular wall of womb contracts and presses against nearby blood vessels, briefly cutting off oxygen supply to the womb.