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Flashcards in Abnormalities Of The Menstrual Cycle Deck (28):
0

Define amenorrhea

Absence of periods for a least six months

1

Define menorrhagia

Heavy periods

2

Define dysmenorrhea

Painful periods

3

Define oligomenorrhea

Delays between periods of more than 35 days up to 6 months

4

What is pre-menstrual syndrome?

A group of symptoms experienced in the week before menstruation

5

What is primary amenorrhea?

Absence of menses by age 14 with absence of secondary sexual characteristics or
Absence of menses by age 16 with normal secondary sexual characteristics

6

What is secondary amenorrhea?

Where an established menstruation has ceased for three months in a woman with a history of regular cyclic bleeding
Or
Ceased for 9 months in a woman with a history of irregular periods

7

Causes of secondary amenorrhea?

Pregnancy
Menopause
Weightloss

8

What are some outflow tract problems that can cause primary amenorrhea?

Müllerian agenesis - 15% of primary amenorrhea
Vaginal atresia - so you have crytomenorrhea
Imperforate hymen

9

What are some outflow tract problems that can cause secondary amenorrhea?

Intrauterine adhesions (Asheman's syndrome)
-front and back walls of the uterus stick together due to fibrosis

10

What are some gonadal or end-organ disorders which can cause amenorrhea?

When the ovary fails to respond to pituitary stimulation
-caused by gonadal dysgenesis or premature menopause

11

What indicates hypergonadotrophic amenorrhea?

Chromosome testing in younger people
Low oestrogen

12

What do gonadal abnormalities tend to be linked to when thinking about where the problem for amenorrhea lies?

Linked to high FSH
Typically in the menopausal range

13

What are some primary causes of gonadal disorders?

Gonadal dysgenesis
-Turner's syndrome (XO)
Androgen insensitivity syndrome (testicular feminisation syndrome)
Receptor abnormalities for hormones FSH and LH
Specific forms of congenital adrenal hyperplasia

14

What are some secondary causes of gonadal disorders?

Pregnancy
Anovulation
Menopause
Premature menopause
Polycystic ovarian syndrome
Drug-induced

15

Explain how central regulatory disorders can lead to amenorrhea

Problem at the pituitary or hypothalamus
Inadequate levels of FSH lead to inadequately stimulated ovaries
Fail to produce enough oestrogen to stimulate the endometrium causing amenorrhea
Linked to low FSH leading to hypogonadotrophic amenorrhea
Potentially still fertile

16

What are some primary causes of hypogonadotrophic amenorrhea?

Hypothalamic
-Kallman syndrome, where hypothalamic neurones for GnRH release fail to migrate into the hypothalamus during development. Either fail to start or complete at puberty

17

What are some secondary causes of hypogonadotrophic amenorrhea?

Hypothalamic
-exercise amenorrhea
-stress amenorrhea
-eating disorders
-weight loss

Pituitary
-Sheehan syndrome
-hyperprolactinaemia
-haemochromatosis
-hypo/hyperthyroidism

18

What do you need to consider when evaluating secondary amenorrhea?

Menstrual history
Contraception
Pregnancy
Surgery
Medication
Weight change
Chronic diseases
Stress
Diet
Family history
-age at menopause
-thyroid dysfunction
-diabetes
-cancer

19

What physical examination should be done with secondary amenorrhea?

BMI
Hair distribution
Thyroid
Visual fields
Breasts - any discharge
Abdomen - mass or tenderness

20

How should amenorrhea be managed?

Rule out pregnancy
If history suggests
-ovarian - axis problem: TSH, prolactin, FSH, LH
-chronic disease - ESR, LFTs
-CNS - MRI
-Hirsuitism (lots of hair): high testosterone, check 17-OH progesterone

21

Define menorrhagia

Excessive (>80ml) uterine bleeding or prolonged (>7days)

22

Define dysfunctional uterine bleeding

Abnormal bleeding but no obvious cause
Could be excessively heavy, prolonged or frequent bleeding
Not due to pregnancy, pelvic or systemic disease
Anovulatory

23

When does dysfunctional uterine bleeding commonly occur?

In extremes of reproductive life and in patients with polycystic ovary syndrome

24

Pathogenesis of ovulatory dysfunctional uterine bleeding?

Progesterone secretion is prolonged because oestrogen levels are low.
Causes irregular shedding of the uterine lining

25

Pathogenesis of anovulatory dysfunction uterine bleeding?

Corpus luteum which produces progesterone does not form because there is no ovulation
Therefore oestrogen is produced continuously, causing an overgrowth of the endometrium
Period is delayed and when it happens, can be very heavy

26

Management of DUB?

Progesterone or OCP

27

How can distortion of the uterine cavity lead to menorrhagia?

Uterus unable to contract down on open venous sinuses in zona basalis