absence of menstruation
By the time a girl is 16 yrs old and she still didnt get it
What is the difference between primary and secondary amenorrhoea?
Primary – never had periods
Secondary – cessation of periods after they have begun (after a 3 month cessations of menses) previous menses now ceased for 6 cycles
>35 days ie 4-9x/year
Heavy menstrual bleeding (HMB): a complaint of excessive menstrual blood loss over consecutive cycles or >80 ml per menstruation.
pain during menses, associated with ovulatory cycles
• Intermenstrual bleeding (IMB)
Dysfunctional uterine bleeding (DUB)
heavy and irregular menstrual bleeding that occurs secondary to an ovulation.
what is turners syndrome!
she missed her turn!
results when one normal X chromosome is present in a female's cells and the other sex chromosome is missing or structurally altered
Premenstrual syndrome (PMS)
A cyclical disorder, occurring in latter half of the menstrual cycle.
it is the physical, psychological and behavioural symptoms that can occur in the 2 weeks before a woman's monthly period.
Premenstrual dysphoric disorder PMDD
While most women with PMS find their symptoms uncomfortable, a small percentage have symptoms severe enough to stop them living their normal lives.
This is the result of a more intense type of PMS known as premenstrual dysphoric disorder (PMDD).
The symptoms of PMDD are similar to those of PMS, but are more exaggerated and often have more psychological symptoms than physical ones.
Describe HPO axis
what chromosomal abnormalites can cause menstrual disorder?
- Mayer-Rokitansky-Kustner-Hayer (MRHK) syndrome
- XO- Turner’s syndrome
- Androgen insensitivity syndrome
- Swyer syndrome
- Congenital adrenal hyperplasia (CAH)
Common causes of the disorders of menstruation
Can be hormonal- HPO AXIS
Chromosomal anomalies e.g. Mayer-Rokitansky-Kustner-Hayer (MRHK) syndrome; XO- Turner’s syndrome; !ndrogen insensitivity syndrome; Swyer syndrome, Congenital adrenal hyperplasia (CAH)
Structural/Anatomical- uterine or vaginal e.g fibroids, polyps.
others: Bleeding diathesis - Drugs-Thyroid disease -Chronic illness
Physiologic causes of Amenorrhoea
how would u indicate the level of the pathology?
prepubertal- pregnancy- menopause.
Take fam history, maybe the family klhum don't have it
Structural causes of menstrual disorders
- Agenesis/hypoplasia at any level of the genital tract.
- Leiomyoma- uterine fibroids
- Imperforate hymen, vaginal septae (block blood from coming through)
- Asherman’s syndrome
- Cervical stenosis
What is Ashermans syndrome?
imperforate hymen>> is a congenital disorder where a hymen has NO opening & completely obstructs the vagina
"the bluish tinge is a sign" see pic
The hymen is a membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia,
An imperforate hymen >> arrow>> its closed! blood collecting in the vagina!
Classification of congenital uterine anomalies
Comon causes of Menorrhagia
Uterine fibroids- Leiomyoma
Drugs- eg warfarin
Ask her does she bleed when she brushes hair? Scratches herself? Lana ymkn a9lan its a bleeding disorder!!
common cause of primary amenhorrea?
What r Uterine fibroids and polyps?
Fibroids: are tissue growths, but they are NOT noted to be cancerous (most common type is Intramural)
Polyps: collection of endometrial tissue> can extend into endometrial cavity in the form of a polyp.
causes of Irregular bleeding ?
Dysmenorrhoea, Can be primary to? Secondary to?
what is it MOST commonly associated with?
Primary is idiopathic, due to response of the uterus to local prostaglandins, hence painful contractions.
Can be secondary to HMB
MOST commonly associated w/ endometriosis
where endometrial tissue is found in random places in our body!
everytime u have stimulation of the endometrium,
everywhere where u have this abnormal place of endometrial tissue will be stimulated as well!!
what qs would u ask in history taking?
- emphasis on age; menarche/onset of puberty;
pain- cyclical or not;
menstrual history- cycle,
volume, change etc; sexual history; medical history; symptoms of effects.
What are the 2 commonest causes of secondary amenorrhoea and what hormone tests will you use to distinguish them?
Pregnancy – Human chorionic gonadotrophin HCG
Fall in body weight – GnrH levels