Menstrual Disorders Flashcards
Definitions of :
Amenorrhea
Oligomenorrhoea
Menorrhagia
Dysmenorrhagia
Amenorrhea: absence of menstruation
Oligomenorrhoea: infrequent periods
Menorrhagia: Heavy menstrual bleeding
Dysmenorrhagia: painful menstrual bleeding
Difference between primary and secondary amenorrhoea?
Primary: When a women over the age of 16 has never had a period
Secondary: absence of periods for >6months in a woman that previously had them
Common causes of Amenorrhoea
- Physiological: lactation, menopause, pregnancy
- Hypothalamic/pituitary disorders:
- stress, weight change, excessive exercise and various drugs
- Prolactinomas or damage; eg Sheehans Syndrome
- Ovarian Anomalies
- Turners (XO)
- Gonadal agenesis (XX or XY )
- PCOS
- Uterine and Outflow Tract Disorders
- TB
- Asherman’s syndrome: damage to the endometrium with adhesions secondary to curettage
What is Sheehan’s syndrome
postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth
What is the commonest endocrine disorder in the world and how does it cause amenorrhoea and oligomenorrhoea?
PCOS
- Complex condition of ovarian dysfunction thought to affect between 5-20% of women of reproductive age.
- Both hyperinsulinaemia and high levels of luteinizing hormone are seen in PCOS and there appears to be some overlap with the metabolic syndrome.
However the actual underlying aetiology is not understood
Features of PCOS
- Subfertility and infertility
- menstrual disturbances: oligomenorrhea and amenorrhoea
- hirsutism, acne (due to hyperandrogenism)
- obesity
- Acanthosis nigricans (due to insulin resistance)
Can I have PCOS and not know it?
Yes, although ~20-30% of women are thought to have the appearance on USS, only ~5-10% have the syndrome.
This is an important distinction as the syndrome is associated with T2DM, obesity and endometrial hyperplasia and carcinoma.
What is required to make a definative diagnosis for PCOS
2 of the 3 criteria
- Oligo and / or anovulation which commonly manifest as oligomenorrhea or irregular and unpredictable bleeding pattern.
- Clinical (hirsuitism,acne) and /or biochemical (raised free testosterone) evidence of androgen excess (hyperandogenisation)
- Polycystic ovary/ies on transvaginal USS- 12 or more follicles in either ovary measuring 2-9mm in diameter and/or increased ovarian volume >10ml
Investigations for menorrhagia
- FBC
- Transvaginal ultrasound if symptoms suggest a structural abnormality
Treatment for a patient with menorrhagia if they do not require contraception
- mefenamic acid 500mg tds or tranexamic acid 1 g tds
- Start on the first day of period
Treatment for a patient with menorrhagia who does require contraception
- Mirena IUD : first line treatment
- COCP
- Long acting progesterones eg; depo provera
- Surgical treatments include hysterectomy (a major operation, achieved by either the abdominal or vaginal route) or endometrial ablation
Common causes for intermenstrual and post-coital bleeding?
- Cervical ectropian
- Cervical polyps
- Cervicitis (Chlamydia a common cause)
- Cervical cancer
What is a cervical ectropian?
- it’s a normal occurrence with the transformation zone being visualised on the surface of the cervix and this may sometimes cause bleeding after sex.
- More common in women using the COCP
Definition of ‘postmenopausal bleeding’
Any bleeding following one year of no periods
Causes of post menopausal bleeding?
- atrophic vaginitis (thinning of the vaginal mucosa due to estrogen withdrawal)
- Endometrial or cervical polyps
- Hormone Replacement Therapy
- ALWAYS important to rule out carcinoma
