Identify 7 common menstrual disorders
- 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
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
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
- 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
- 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
What 4 types of examinations should one perform when examining a patient with a menstrual disorder?
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
- 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