5.1 Menstrual disorders Flashcards
(24 cards)
define primary amennorhoea
failure to establish menstruation by 15 in normal secondary sexual characteristics, or 13 if not
define secondary amennorhoea
cessation of menstruation for 3-6 months in women with previously normal periods, or 6-12 if oligomenorrhoea if not
causes of primary amenorrhoea with normal secondary sexual characteristics
-imperforate hymen
-vaginal septum
-absent vagina
-absent uterus
causes of primary amenorrhoea without normal secondary sexual characteristics
-chromosomal/hormonal cause e.g turner syndrome
-hypothalamic pituitary dysfunction e.g. constitutional, isolated GnRH deficiency
hormone levels in turner syndrome
low oestrogen
high FSH LH
causes of primary amenorrhoea with incongruous pubertal development
-androgen insensitivity syndrome (XY but female external)
causes of secondary amenorrhoea
-stress, eating disorder
-hypo/hyperthyroidism
-PCOS
-prolactinoma
-cushings, Addisons, adrenal tumour
-cervical stenosis
causes of physiological secondary amenorrhoea
-preganacy
-breast feeding
-contraception
-menopause
triad for PCOS
menstrual irregularity, androgen excess (hirsutism, acne, hair loss), obesity
diagnosis of PCOS
infrequent/no menstruation
high testosterone
US scan for polycystic ovaries
management of PCOS
lifestyle advice
screen for T2DM
cyclical progesterone
how do hyper and hypo thyroid affect periods?
usually
hyper: fewer
hypo: heavy
what’s functional hypothalamic amenorrhoea?
weight loss and excess exercise, emotional stress
in gymnasts, athletes
risk of bone loss due to low oestrogen
cause of oligomenorrhoea
-PCOS
-thyroid dysfunction
-eating disorders/excess exercise
-hormonal contraception
-perimenopuase
what are uterine fibroids?
begin tumours of SMCs and fibroblasts in myometrium
risk factors for leiomyoma
-age (until menopause)
-early menarche
-older age at pregnancy
-family history
red flags in menorrhagia
-post menopausal bleeding
-ascites
-pelvic mass
-postcoutal bleeding
management of dysfunctional uterine bleeding
FBC!!!!!
-IUS
-tranexamic acid/ NSAID
-combined pill/ progesterone only
compare types of dysmenorrhoea
primary: 6-12 months after menarche, production of uterine prostaglandins during menstruation
secondary: after years of OK periods, caused by underlying pelvic pathology, pelvic inflammatory disease or IUD
test for endometriosis
laparoscopy
risk factors for endometriosis
-early menarche
-late menopause
-delayed pregnancy
-smoking
-family history
-low BMI
complications of endometriosis
-adhesions
-chronic pain
-infertility
-endometriomas
-reduced QoL
management of primary amenorrhoea
NSAID/paracetamol
oral contraceptive
conservative advice
management of secondary amenorrhoea
manage symptoms
surgical if fertility priority
referral of red flag symptoms
