Repro 3.2 Menstrual Dysfunction Flashcards Preview

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Flashcards in Repro 3.2 Menstrual Dysfunction Deck (38):
1

What is primary amenorrhoea?

Absence of menses by age 14 with absence of secondary sexual characteristics or age 16 with normal ssc

2

What is secondary amenorrhoea?

Established menstruation has ceased:
for 3 months in a woman with a history of regular cyclic bleeding
for 9 months in a woman with a history of irregular periods

3

What are the potential origins of amenorrhoea?

Hypothalamic/pituitary
Ovarian
Outflow tract

4

If amenorrhoea is caused by obstruction of the outflow tract, what would the hormone levels be?

Normal - HPA axis is functional

5

What might disorders of the outflow tract might cause primary amenorrhea?

Uterine: Mullerian agenesis (15%)
Vaginal: Vaginal atresia, cryptomenorrhoea, imperforate hymen

6

What disorders of the outflow tract might cause secondary amenorrhoea?

Intrauterine adhesions (Asherman's syndrome)
Scarring from trauma, childbirth etc

7

How might the ovary or gonads cause amenorrhoea?

If it does not respond to pituitary stimulation - ovulation does not occur

8

What are possible causes of gonadal/end-organ cause of amenorrhoea?

Primary:
Gonadal dysgenesis
Androgen insensitivity syndromeReceptor abnormalities for FSH and LH
Specific forms of congenital adrenal hyperplasia

Secondary:
PREGNANCY
Premature menopause
Polycystic ovarian syndrome (PCO-S)
Drug-induced

9

What are the hormone levels of women with gonadal/end-organ disorders causing amenorrhoea?

High FSH and LH (typically in the menopausal range)
Low oestrogen

10

What tests might be required for patients with hypergonanotrophic amenorrhoea?

Chromosome testing - Turner's syndrome can cause this

11

What is hypogonadotropic amenorrhoea?

Inadequate levels of FSH lead to inadequately stimulated ovaries which then fail to produce enough oestrogen to stimulate the endometrium -> amenorrhoea

Pituitary/hypothalamic/central regulatory disorders

12

What is a hypogonadotropic cause of primary amenorrhoea?

Kallmann syndrome (genetic hypogonadotropic hypogonadism)

13

List some pituitary disorders causing of secondary amenorrhoea.

Sheehan syndrome (hypopituitarism)
Hyperprolactinaemia
Haemochromatosis (iron overload disorder)

14

List some hypothalamic disorders causing secondary amenorrhoea.

Exercise
Stress
Eating disorders - anorexia, bulimia, obesity
Weight loss

Hyper/hypothyroidism can also cause amenorrhoea

15

What features of a patients history are assessed to evaluate secondary amenorrhoea?

Menstrual history
Contraception
Pregnancy
Surgery
Medication
Weight change
Chronic diseases, stress, diet etc

16

What features of a patients family history need to be assessed to evaluate secondary amenorrhoea?

Age at menopause
Thyroid dysfunction
Diabetes
Cancer

17

What must be assessed in physical examination of a patient with secondary amenorrhoea?

BMI
Hair distribution
Thyroid
Visual fields
Breast-discharge?
Abdomen-masses? Tenderness?

18

What investigations should be done to diagnose the cause of amenorrhoea?

Pregnancy test
Blood - TSH, prolactin, FSH, LH
If hirsuitism is present - testosterone levels, DHEAS, androstenedione, 17-OH progesterone
LFT's - metastases?
Look for growths via MRIs

19

Define menorrhagia.

Excessive (>80ml) uterine bleeding
Prolonged (>7 days) regular

20

What is DUB?

Dysfunctional uterine bleeding - Excessively heavy, prolonged or frequent bleeding of uterine origin that is not due to pregnancy, pelvic or systemic disease
Anovulatory
Usually occurs at extremes of reproductive life

21

Define oligomenorrhoea.

Uterine bleeding occurring at intervals between 35 days and 6 months

22

Define dysmenorrhoea.

Lower anterior abdominal pain associated with periods

23

What is mastalgia?

Pain of the breast

24

What is an anovulation?

A menstrual cycle in which an oocyte is not released

25

What causes DUB?

Disturbance of the HPO axis changes the length of the menstrual cycle
No progesterone withdrawal from an oestrogen primed endometrium
Endometrium builds up with erratic bleeding as it breaks down

26

What investigations might be done for DUB?

hCG
TSH
Smear if appropriate

27

When would a sample of endometrium need to be taken from a patient with DUB?

>35
Ca risk factors
Tamoxifen use

28

How is DUB managed?

IV or IM conjugated oestrogen therapy if acute
Usually followed by OCP or progestogen
Cyclic progestogens fo 10-12 days each cycle
Consider mirena IUD
OCP

29

What is menorrhagia usually secondary to?

Distortion of the uterine cavity e.g. fibroids

30

What are some other causes of menorrhagia?

Uterus unable to contract down on open venous sinuses in the zone basal
Organic
Endocrinologic
Haemostatic
Iatrogenic

31

What aspects are assessed in a physical examination of a patient with menorrhagia?

Anaemia
obesity
Androgen excess eg hirsuitism, acne
Thyroid
Galactorrhoea
Liver/spleen
Pelvic-uterine
Cervical
Adnexal

32

What are the symptoms of fibroids?

Usually asymtomatic
Abnormal bleeding
Typical amenorrhagia

33

Usually what age are women suffering from fibroids?

40s

34

How are fibroids assessed?

Large fibroids may be palpable on bimanual examination (irregularly shaped uterus)
Examination by anaesthesia and curettage or by laparoscopy
Ultrasound may show presence of a mass but not distinguish from other tumours

35

How much menstrual blood loss is sufficiently great to have adverse effects?

>80ml

36

How is the amount of menstrual blood loss assessed?

Pad and tampon counts
Measure haemoglobin/haematocrit levels

37

What are the options of treatment for heavy menstrual loss?

Non-surgical : GnRH agonist
Surgical: Endoscopic resection or abdominal myomectomy or hysterectomy
Peri-menopausal women often benefit from spontaneous shrinkage with age

38

What are the disadvantages of a strict hysterectomy?

(includes removal of ovaries)
sudden onset of menopause as ovary is removed and loss of ovarian androgens