Flashcards in Session 3 - Menstrual dysfunction Deck (31)
What is the average blood loss during a period?
What is amenorrhoea?
Absence of periods for at least 6 months
What two categories is amonerrhoea split into?
Primary and secondary
What is pirmary amenorrhoea?
Never had a period. Absence of menses by age 14 with absence of secondary sexual charateristics/ absence by age 16 with normal SSC
What is secondary amenorrhoea?
Established menstruation has ceased for 3 months in a woman with a history of regular cyclic bleeding, or nine months in a woman with a history of irregular periods. Normally in a women age 40-55.
What is oligomoenorrhea?
Infrequent periods occuring at intervals of 35 days - 6 months
What is dysmenorrhoea?
What is menorrhagia?
Heavy periods. (Excessive (>80ml), prolonged (> 7 days) uterine bleeding
What is cryptomenorrhoea?
Periods occur but not visible due to obstruction in outflow tract
What is pre-menstrual syndrome?
Collection of emotional symptoms, with or without physical symptoms related to a woman's menstrual cycle
What is dysfunction uterine bleed?
Abnormal bleeding, no obvious organic cause
What is an anovulatory cycle?
No ovulation/luteal phase, oligo/amenorrhoea +/- mennorrhagia
What are ovulatory cycles?
Normal menstrual cycle + dysmenorrhea/mastalgia
What is the origin of primary ammenorhea?
Origin is hypothalamic/pituitary, ovarian or outflow tract
What is hypothalamic/pituitary amenorrhoea?
Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate the endometrium of the uterus, giving amenorrhoea.
Give a cause of primary hypothalamic amenorrhoea?
Kallmann syndrome - Inability to produce GnRH
Give three causes of secondary hypothalamic ammenorhea
Exercise Amenorrhoea – Related to physical exercise
Eating disorders and weight loss (Obesity, anorexia or bulimia). Fall below critical weight of 47kg menses will cease (see above).
Give three causes of secondary pituitary amenorrhoea?
Sheehan syndrome - Hypopituitarism
Haemochromatosis – ‘Iron overload’
What is ovarian amenorrhoea?
In Ovarian Amenorrhoea the ovary does not respond to pituitary stimulation, giving low oestrogen levels. The lack of –‘ve feedback from oestrogen leads to elevated FSH levels in the menopausal range (Hypergonadotrophic amenorrhoea).
Give four causes of primary gonadal/end-organ amenorrhoea?
Gonadal dysgenesis – E.g. Turner Syndrome (45, X)
Androgen Insensitivity Syndrome
Receptor abnormalities for FSH and LH
Specific forms of congenital adrenal hyperplasia
Give five causes of secondary gonadal/end-organ amenorrhoea?
Menopause (Or premature menopause)
Polycystic Ovarian Syndrome
What is normal in amenorrhoea of outflow tract origin?
The hypothalamic-pituitary-ovarian axis
What is primary outflow tract obstruction? (Two causes?
Uterine – Mullerian agenesis. 15% of primary amenorrhoea
Vaginal – Vaginal atresia, cryptomenorrhoea, imperforate hymen
Give a cause of secondary outflow tract obstruction
Intrauterine Adhesions (Asherman’s syndrome)
What must be looked at in the histroy of someone with secondary amenorrhoea?
o Menstrual history
Ever had one before? What was your cycle like before?
o Weight change
o Chronic diseases, stress, diet
o Family history
Age at menopause, thyroid dysfunction, diabetes, cancer
Give parts of physical evaluation of secondary amenorrhoea
BMI – Weight change
Hair distribution – PCOS
Visual fields / Breast discharge – Hyperprolactinaemia
Give two potential treatments for amenorrhoea
Hormon replacement, if due to hormone insufficiency
Lifestyle change, if due to lifestyle (exercise, weight loss)
What is dysfunctional uterine bleeding?
The corpus luteum does not form to release progesterone. As a result oestrogen is produced continuously, causing overgrowth of the uterine bleeding and subsequent bleeding.
What is menorrhagia?
Menorrhagia is heavy vaginal bleeding that is not DUB. It is usually secondary to distortion of the uterine cavity, leaving the uterus unable to contract down on open venous sinuses in the zona basalis.
Give four causes, other than distortion of the uterine cavity, that can cause menorrhagia?