Menstrual Disorders Flashcards
What are the negative impacts of menstrual cycle disorders?
Negative impact on QoL, reproductive health
Long-term detrimental health effects such as:
- Increased risk of osteoporosis with amenorrhea (due to E deficiency)
- Increased risk of metabolic disorders and diabetes with PCOS
[AMENORRHEA]
What is amenorrhea?
No menstrual bleeding in a 90 day period (3 cycles)
Can be primary/functional, or secondary
- Primary/Functional: absence of menses by age 15 in females who never menstruated (rare)
- Secondary: Absence for 3 cycles in a previously menstruating female, occurs more frequently in (1) <25yo with hx of menstrual irregularities, (2) Competitive athletics with low body fat, (3) Massive weight loss
*Postulated reason: when theres low body fat, GnRH secretion drops, FSH and LH secretion drops, thus no hormonal secretion and no menstrual cycle
[AMENORRHEA]
What are the 3 broad categories of etiology in Amenorrhea?
- Anatomical cause
- E.g., pregnancy, uterine structural abnormalities
- Endocrine disturbances leading to chronic anovulation
- No ovulation, no E and P pdn, no menstrual cycle
- Anovulation: egg not released from ovary during menstrual cycle
- Ovarian insufficiency/failure
- No ovulation, no E and P pdn, no menstrual cycle
[AMENORRHEA]
Discuss the treatment (non-pharm and pharm) of Amenorrhea
Treatment depends on underlying cause (e.g., anatomical or endocrine)
Non-pharmacological:
- Weight gain (if low body fat)
- Reduce exercise intensity (if athlete)
- Stress management (if stress)
Pharmacological:
- COC
- E only / P only (depend on the problem)
- Copper IUD (can cause heavier bleeding in amenorrhea)
*Topical hormonal gel can be used (large amounts not required like in contraception)
[MENORRHAGIA]
What is Menorrhagia?
Defined as menstrual blood loss >80ml per cycle OR bleeding >7 days per cycle
However, not a hard definition, can be defined as heavy menstrual bleeding
[MENORRHAGIA]
What are the possible pathophysiology of Menorrhagia?
- Uterine related factors
- Fibroids
- Adenomyosis
- Endometrial polyps
- Gynecologic cancers, uterine cancers
- Alterations in (hypothalamic-pituitary-ovarian) HPO axis - too much FSH/LH
- Coagulopathy factors (affect blood clotting, hence more bleeding)
- Cirrhosis
- von Willebrand disease
- Idiopathic thrombocytopenic purpura
[MENORRHAGIA]
What are the pharmacological treatment options for Menorrhagia?
Pharmacological:
(If contraception is desired)
- COC
- Progestin IUD
- P only
- P injection
(If contraception NOT desired)
- NSAIDs (reduce elevated prostaglandin levels)
- Transexamic acid (slows down the breakdown of clots, helps blood to clot; *in practice used for nose bleeds and heavy periods)
- Cyclic progesterone (P but taken at intervals, not everyday like in contraception)
[MENORRHAGIA]
What are the non-pharmacological treatment options for Menorrhagia?
Endometrial ablation (remove whats growing at the uterus)
Hysterectomy (remove the entire uterus)
[DYSMENORRHEA]
What is dysmenorrhea? Describe how it occurs
Crampy pelvic pain with or just before menses
Can be primary or secondary
- Primary: release of prostaglandins and leukotrienes cause vasoconstriction and cramp
- Secondary: due to anatomical or physiological cause (e.g., endometriosis - tissue lining the womb grows outside of uterus)
[DYSMENORRHEA]
What are some non-pharmacological treatment for Dysmenorrhea?
Topical heat therapy
Exercise
Acupuncture
Low-fat vegetarian diet
[DYSMENORRHEA]
What are some pharmacological treatment for Dysmenorrhea?
1st line: NSAIDs
2nd line: COC
3rd line: Progestin injections / Progestin IUD (less menses => less PG release => less cramps)
[PREMENSTRUAL SYNDROME - PMS]
What is PMS?
Cyclic pattern of symptoms that occur 5 days before menses that resolve at onset of menses
Somatic (physical): bloating, headache, weight gain, fatigue, dizziness/nausea, appetite changes
Affective (mood): anxiety/depression, angry outburst, social withdrawal, forgetfulness, tearful, restlessness
*Most do not impair daily activities
[PREMENSTRUAL SYNDROME - PMS]
What is premenstrual dysphoric disorder (PMDD)
Severe mood symptoms - PMDD
=>Treat as psychiatric condition
[PREMENSTRUAL SYNDROME - PMS]
What are the pharmacological treatment for PMS?
Non-pharmacological has low evidence, but what might be some examples
PHARM:
1. Selective serotonin reuptake inhibitors
2. COC - better for physical symptoms, but not so much for mood
NON-PHARM:
- Increase exercise
- Increase vitamins
- Decrease caffeine, sugar, sodium
[POLYCYSTIC OVARY SYNDROME - PCOS]
What is PCOS?
Ovaries produce an abnormal amount of androgens
Small cysts (fluid-filled sacs) form in the ovaries
=> Presentation:
- Irregular menstrual bleeding
- Androgen excess (acne, hirsutism, obesity, metabolic disorders/insulin resistance)
