Menstrual Disorders Flashcards
What is the difference between primary and secondary amenhorrea?
Primary: no menstruation by age 16
Secondary: 6 months of amenhorrea in a woman who has previously had periods
What are the causes of amenhorrea?
Physiological: menopause, breastfeeding, pregnancy
Hypothalamic disorders: stress, weight change
Ovarian: PCOS, Turner’s syndrome
Uterine: Congenital anomalies
Other endocrine: Cushing syndrome
What are the key questions not to miss in an amenhorrea history?
Have you ever had periods? How long has it been?
Do they have secondary sexual characteristics?
Sexually active/contraception? Could she be pregnant?
Weight change/excess exercise?
Estrogen deficiency: hot flushes?
Androgen excess: acne, hair growth?
Headaches/blurred vision/discharge from the breast? (prolactinoma)
What are the key features of the amenhorrea exam?
BMI Secondary sexual characteristics Hirsituism/acne Obvious abdo mass If any neuro symptoms do fundoscopy
What investigations do you do for amenhorrea?
BHCG LH FSH Prolactin TSH Androgen screen Pelvic/vaginal ultrasound
What are the causes of heavy menstrual bleeding?
Systemic: platelet disorders/thyroid
Pelvic: uterus (fibroids,endometrial hyperplasia), carcinoma of cervix, adenomyosis, incomplete miscarriage
Dysfunctional uterine bleeding
Which key things are you looking for on a menorrhagia exam?
Signs of anemia Signs of hypothyroidsim Signs of androgen excess Signs of liver disease Bimanual: adnexal masses, tender uterus Cervical inspection
What investigations are important for menorrhagia?
bHCG FBC TSH Pipelle/endometrial biopsy (if >45 or BMI >30) Pelvis USS
How do you manage heavy periods?
Mirena Tranaxemic acid NSAIDs COC Depo Provera
