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Identify 7 common menstrual disorders

- Amenorrhoea

- Oligomenorrhoea

- Menorrhagia

- Dysmenorrhoea

- Intermenstrual bleeding (IMB)

- Dysfunctional uterine bleeding (DUB)

- Premenstrual syndrome (PMS) 


What is amenorrhea ?

Amenorrhea is the absence of menstruation


Distinguish between primary and secondary amenorrhea

- Primary amenorrhoea: failure to establish menstruation by 16 years

- Secondary amenorrhoea: cessation of previously normal menstruation for ≥ 6 months 


Identify some physiological causes of amenorrhea

- Prepubertal

- Pregnancy

- Menopause


How can pathology be determined in amenorrhea?

- Pathology occurs at the various levels of endocrine control

Gonadotrophin levels indicate the level of the pathology 


Identify the different types of pathology in amenorrhea

- Hypothalamic

- Pituitary

- Ovarian

- Uterine/endometrial


What is oligomenorrhea?

Oligomenorrhoea is infrequent menstruation >35 days i.e. 4-9x per year 


What is menorrhagia/heavy menstrual bleeding?

Menorrhagia/HMB is a complaint of excessive menstrual blood loss over consecutive cycles or >80 mls per menstruation


Identify 6 common causes for menorrhagia

- Leiomyoma (uterine fibroids)

- Uterine polyps

- Endometrial cancer

- Bleeding diathesis

- Copper from IUD coil 

- Drugs e.g. warfarin 


What is dysmenorrhea?

Dysmenorrhoea is pain during menses, associated with ovulatory cycles 


Distinguish between primary and secondary dysmenorrhea

- Primary dysmenorrhea is idiopathic, due to response of the uterus to local prostaglandins, hence painful contractions

- Secondary dysmenorrhea can be due to endometriosis or obstructed menses 


What is dysfunctional uterine bleeding?

DUB is heavy and irregular menstrual bleeding that occurs secondary to an ovulation


What is premenstrual syndrome?

- PMS is a cyclical disorder, occurring in latter half of the menstrual cycle

- Symptoms could be physical or psychological and resolve with onset of menstruation


What is premenstrual dysphoric disorder?

Premenstrual dysphoric disorder is the severe end of the spectrum of PMS with extreme mood symptoms 


Outline the Female HPO axis


Identify 7 possible causes of menstrual disorders

- Hormonal e.g. HPO axis

- Chromosomal anomalies

- Structural/Anatomical (uterine or vaginal)

- Bleeding diathesis

- Drugs

- Thyroid disease

- Chronic illness 


Identify 4 chromosomal abnormalities which can cause menstrual disorders

- Turner’s syndrome

- Androgen insensitivity syndrome

- Swyer syndrome

- Congenital adrenal hyperplasia (CAH) 


Identify 5 structural causes of menstrual disorders

- Agenesis/hypoplasia of the genital tract

- Leiomyoma

- Imperforate hymen & vaginal septae

- Asherman’s syndrome

- Cervical stenosis


Be able to identify an imperforate hymen


Be able to identify uterine fibroids


Oligomenorrhea is a feature of hormonal contraception but also has other causes.

Identify 4 of them

- Infection (STI/PID)

- Cervical ectopy or pathology

- Endometrial pathology (polyp or cancer)

- Ovarian cyst


Identify 7 components of a comprehensive history on a patient with a menstrual disorder

- Emphasis on age

- Onset of puberty

- Pain – cyclical or not

- Menstrual history – cycle, volume, change etc

- Sexual history

- Medical history

- Symptoms


What 4 types of examinations should one perform when examining a patient with a menstrual disorder?

- General

- Abdominal

- Speculum

- Bimanual


What 5 things should one look out for when performing an examination on a patient with a menstrual disorder?

- Presence or absence of secondary sexual characteristics

- Appearance of known chromosomal abnormalities 

- Swellings/lumps/masses

- Discharge

- Pattern of hair growth 


Identify and describe 4 types of investigations one can perform for a patient with a menstrual disorder

Blood hormone profile – gonadotrophins, karyotype, thyroid function, FBC 

- Imaging – USS, MRI

- Hysteroscopy – diagnostic and therapeutic

- Laparoscopy – diagnostic and therapeutic 


Outline the pharmacological and surgical management of menstrual disorders

- Pharmacological – use of gonadotrophins, progesterone, combine oral contraceptive pill and hormone replacement therapy

- Surgical – depends on the condition