Menstruation Flashcards
(68 cards)
What is dysmenorrhoea?
Excessive pain during menstrual period
How does dysmenorrhoea commonly present?
Lower abdominal or pelvic pain
Radiate to pelvis and thighs
+ malaise, nausea, vomiting, dizziness, diarrhoea
What investigations would you request for dysmenorrhoea?
High vaginal and endocervical swabs - infection?
Transvaginal USS - if masses on examination
Speculum exam
Cervical smear - if nearly due
Pelvic USS
Compare the pain in primary vs secondary dysmenorrhoea
primary: Pain at onset of menses. Often within first 2 years of menarche
secondary: Pain precede start of menses by days. Occur years after menarche
What can cause secondary dysmenorrhoea?
How is it managed in primary care?
Endometriosis Adenomyosis PID Adhesions Fibroids Non-gynae such as IBD and IBS
Refer all to gynae for investigation
What is primary dysmenorrhoea?
Pain in absence of any underlying pelvic disorder -
Diagnosis of exclusion
What causes primary dysmenorrhoea?
Excess release of prostaglandins from endometrial cells:
- Spiral artery vasospasm
- Increase myocetrial contractions
What are the risk factors for primary dysmenorrhoea?
Early menarche
Heavy periods
Smoking
Nullparity
How is primary dysmenorrhoea managed?
Stop smoking, TENS, heat
- NSAIDs (inhibit prostaglandin production)
- mefenamic acid and naproxen - Hormones: Monophasic use of COCP, IUS
How is primary amenorrhoea defined?
Menses not occurred by:
14 - absence of any secondary sexual characteristics
16 - other secondary sexual characteristics developing normally
How is secondary amenorrhoea defined?
Menstruation occurred before but has stopped for 6 successive months
What is oligomenorrhoea?
Irregular periods with intervals between cycles of >35 days or <9 periods in a year
What is a good way of categorising differentials of amenorrhoea?
Hypothalamic - low GnRH Pituitary Ovarian Genital tract Other
What are some causes for reduced GnRH i.e. hypothalamic amenorrhoea?
Secondary:
- Eating disorders
- Severe chronic conditions - thyroid
Primary:
- Kallmann syndrome (poor smell and hearing)
What pituitary issues can lead to amenorrhoea?
All secondary:
- Prolactinomas - prolactin suppress GnRH
- Other pituitary tumours - mass effect
- Sheehan’s syndrome - blood loss in childbirth
- Prolonged contraceptive use - down regulate pituitary
What ovarian issues can cause amenorrhoea?
Secondary:
- PCOS
- Premature ovarian failure
Primary:
- Turner’s syndrome
How is premature ovarian failure characterised?
Amenorrhoea + raised gonadotrophins (FSH and LH) before 40
What conditions affecting the genital tract can cause amenorrhoea?
Secondary: Ashermann’s syndrome - intrauterine adhesions following uterine surgery
Primary: Mechanical obstruction - imperforate hymen
What are the other causes of amenorrhoea?
Secondary:
- Pregnancy
Primary:
- Congenital adrenal hyperplasia
- Constitutional delay
What are the primary causes of amenorrhoea?
Congenital adrenal hyperplasia Constitutional delay Mechanical obstruction Turners syndrome Kallmann syndrome
What questions do you need to ask in a history about amenorrhoea?
Full menstrual history Poss. of pregnancy Galactorrhoea Vasomotor symptoms Acne, hirsutism, balding Exercise and eating habits
What investigations would you request for a women with amenorrhoea?
FSH and LH Total Testosterone BMI Pregnancy test Prolactin Thyroid function Pelvic USS Sex hormone binding globulin
What would a raised FSH and LH in the context of amenorrhoea indicate?
Ovarian failure
Turner’s
What would a normal to low FSH and LH in the context of amenorrhoea indicate?
Constitutional delay
Hypothalamic cause
