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Menstrual Disorders Flashcards

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1
Q

What does amenorrhea mean?

A

Absence of menstruation

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2
Q

What is primary amenorrhea?

A

When a patient has never had a period by the age of 16 years

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3
Q

What are some causes of primary ammenorrhea?

A

Turner’s syndrome - most common
Anatomical causes
Complete androgen insensitivity syndrome
Hypothalamic and pituitary disease

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4
Q

What is turner’s syndrome?

A

Female-only genetic condition where there is a missing X chromosome

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5
Q

What is the karyotype for turner’s syndrome?

A

45XO

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6
Q

What happens in turner’s syndrome?

A

The ovary doesn’t complete its normal development (dysgenesis) so you will have low estrogen

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7
Q

What would the lab results show with turners syndrome (oestrogen and FSH/LH)

A

Low oestrogen and high FSH/LH

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8
Q

Why would FSH and LH be high in turners syndrome?

A

ovarian failure and reduced ovarian feedback causes the AP gland to release FSH and LH as nothing is telling it not to

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9
Q

What happens if there is no oestrogen?

A

You get no pubertal changes

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10
Q

What would someone with turners present with?

A
  • short stature
  • short neck
  • lack of secondary sexual characteristics
  • horseshoe kidney on scan
  • brown spots
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11
Q

What will girls with turners syndrome need?

A

HRT when older to get breasts, female characteristics and periods

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12
Q

What are some of the health problems associated with turners syndrome?

A
  • coarctation of the aorta
  • horseshoe kidney
  • streak ovaries
  • infertility
  • osteoporosis
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13
Q

What anatomical causes can cause primary amenorrhea?

A

imperforate hymen - problem with the outflow tract (the hymen completely blocks the vagina as failed to perforate in fetal development)

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14
Q

What is mullerian agenesis?

A

Failure of the mullerian duct to formed resulting in a missing uterus - also called MRKH syndrome

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15
Q

What is complete androgen insensitivity syndrome?

A

It is an x-linked recessive disorder where you become resistant to testosterone due to a defect in the androgen receptor

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16
Q

What affects happen in CAIS?

A

A child born with this is genetically male but will have female phenotypes
-testes may be palpable in the labia or inguinal area

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17
Q

What is the treatment for CAIS?

A

Testes should be surgically excised after puberty

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18
Q

How is primary amenorrhea caused by hypothalamic and pituitary disease?

A
  • Isolated GnRH deficiency
  • no GnRH produced so no pituitary stimulation so no FSH/LH so no ovarian or uterine function so no oestrogen so no secondary sexual development
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19
Q

Why do CAIS have female phenotype?

A

XY chromosome so have testes developed

  • Anti-mullerian hormone and testosterone produced causing regression of mullerian structures
  • failure of androgen receptors so absence of male physical characteristics
  • Testosterone converts to oestrogen causing female phenotype
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20
Q

What is secondary amenorrhea?

A

no periods for more than 6 months after previously having them

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21
Q

What are physiological causes of secondary amenorrhea?

A
  • pregnancy (always rule out pregnancy)
  • contraception
  • menopause (periods may become irregular before stopping completely but it is still possible to get pregnant)
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22
Q

What are some physiologically causes of secondary amenorrhea?

A

Anatomical causes, PCOS, Endocrine

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23
Q

What are some anatomical causes of secondary amenorrhea?

A
  • Scarring

- Ovarian disorders

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24
Q

How does scarring cause secondary amenorrhea?

A

Cervical stenosis can cause scarring

  • also asherman syndrome
  • scarring can be caused by repeated infections or operations
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25
What is asherman syndrome?
scarring of the uterus (not the cervix)
26
What ovarian disorders cause secondary amenorrhea?
Primary ovarian insufficiency | -premature menopause - depletion of oocytes before 40
27
What does a depletion of oocytes cause (hormones)?
no oestrogen so no inhibin so high FSH
28
What is PCOS?
Polycystic ovary syndrome - it is a group of symptoms e.g. hyperandrogegism and chronic anovulation
29
What would a patient with PCOS present with?
secondary amenorrhea, infertility, hirsutism (hair growth on face), obesity
30
Why does PCOS occur?
lack of pulsatile GnRH - many follicles begin to develop but a dominant follicle is not selected to mature - these follicules respond to pituitary hormones by secreting abnormal oestrogen pattern
31
Why are PCOS women at risk of endometrial malignancy?
Abnormal oestrogen can cause over proliferation of the endometrium
32
What do tests show with PCOS?
- raised insulin resistance - elevated LH - need to do USS
33
What does raised insulin resistance cause?
diabetes risk
34
What is the treatment for PCOS?
- COCP | - lifestyle advice
35
Why does thyroid disease cause secondary amenorrhea?
Thyroid imbalances causes hyperthyroidism - don't know why though
36
How does hyperprolactinemia cause amenorrhea?
too much prolactin supresses GnRH so don't get FSH or LH so no oestrogen so amenorrhea
37
Why would someone get hyperprolactinemia?
- physiological (breastfeeding raises prolactin and so does pregnancy) - Dopamine inhibits anterior pituitary to inhibit secretion of prolactin but if you have drugs which target dopamine receptors, the effect will increase prolactin release - side effect of hypothyroidism (will increase TRH and stimulate AP to release TSH but also prolactin) - Tumours on the AP causing prolactin to be realeased
38
What is a prolactinoma?
adenoma in the pituitary causing release of prolactin
39
How is prolactinoma treated?
instead of surgery, give a drug that acts like dopamine to inhibit prolactin release from the AP
40
What is sheehan syndrome and when would it develop?
Necrosis of pituitary secretory cells - it would develop if a women suffers a sever haemorrhage during childbirth resulting in a blood pressure drop due to volume loss - due to the increased size of the pituitary gland in pregnancy it is much more sensitive to hypotension and hypoxia
41
When would functional hypothalamic amenorrhea?
Occurs if there is weight loss, excessive exercise, emotional stress - gymnasts, anorexics
42
How does functional hypothalamic amenorrhea occur?
abnormal GnRH causes absence of the LH surge so you get annovulation and therefore decreased oestrogen
43
What can the decreased oestrogen cause?
osteoporosis and risk of bone loss
44
What is AUB?
abnormal uterine bleeding
45
What is frequency?
how often a women is having her period - 24-38 days if reduced - too frequent if prolonged - infrequent
46
What is regularity?
Calculating the difference between longest and shortest cycle in 6 months regular - less than 7-9 days irregular - more than 7-9 days
47
What is Duration of flow?
How many days is the woman bleeding for? normal - less than 8 days prolonged - more than 8 days
48
What is volume?
how much is the woman bleeding? it can be subjective 5-80ml is normal
49
What is the medical term for the following words; - irregular - heavy - absent - infrequent
- metrorrhagia - menorrhagia - amenorrhea - oligomenorrhoea
50
What is acute presentation of symptoms of AUB?
episode of heavy bleeding that is of sufficient quantity to require immediate clinical intervention to stop further blood loss
51
What is chronic presentation of symptoms of AUB?
bleeding oh abnormal volume, duration, regularity or frequency that has been present for most of the previous 6 months
52
What are some underlying causes of AUB?
``` PALM-COIEN Polyps Adenomyosis Leiomyoma (fibroid) Malignancy/hyperplasia Coagulopathy Ovulatory dysfunction Endometirual Iatrogenic Not yet classified ```
53
What other symptoms of bleeding could a woman get?
post-coital (bleeding after sex) or intermenstural (bleeding in-between periods)
54
What is the most common cause of AUB?
fibrous - leiomyoma - benign tumour of uterine smooth muscle
55
Why do fibroids get work during pregnancy?
because they are oestrogen dependent and will shrink after pregnancy and even more after menopause
56
Can fibroids affect fertility?
Yes if they impinge on the uterine cavity
57
What are the complications of fibroids?
heavy menstrual bleeding. fertility, torsion of fibroids causing pain (not normally painful)
58
Who is most at risk of fibroids?
african descent women, no pregnancy before
59
What is dysfunctional uterine bleeding?
diagnosed by ruling out everything else (diagnosis of exclusion)
60
What are the subdivisions of DUB?
anovulatory and ovulatory
61
What is the anovulatory DUB?
problems with ovulation - impaired positive feedback (not well understood)
62
What is the ovulatory DUB?
secondary to increased prostaglandins and reduced vasoconstrictors - genetic
63
What is dysmenorrhea?
painful menstruation - crampy and intermittently intense OR continuous dull ache
64
Where is the pain with menstruation?
Lower abdomen and suprapubic area
65
When do you get pain and what other symptoms can you get?
with the onset of menses - nausea, diarrhoea, general malaise
66
Why do you get dysmenorrhea?
can either be primary or secondary - primary is when you have had pain since menses started and is unlikely to have a cause, secondary is the you have developed painful periods over time and likely to be due to cysts or endometriosis
67
What is endometriosis?
When the lining grows outside the uterus - severity and extent has no correlation to the symptoms
68
What are the risk factors of endometriosis?
early menarche, short cycles, heavy bleeding, low BMI
69
What are some factors about endometriosis?
estrogen-dependent, benign, inflammatory disease
70
What can endometriosis cause?
painful sex (dyspareunia), infertility chronic pain
71
Where are the most common causes of endometriosis?
ovaries (looks like a chocolate cysts), bladder, rectum, peritoneal lining and pelvic side walls
72
What is adenomyosis?
endometrial tissue found deep within myometrium - tends to cause heavy bleeding more than pain
73
How can you manage dysmenorrhea?
NSAIDs, COCP, intrauterine device, Surgery (hysterectomy or take away scar tissue), alternative medicine (heat and ginger)

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