Session 3 - Menstrual dysfunction Flashcards
(31 cards)
What is the average blood loss during a period?
30-45 ml
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?
Painful periods
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
Stress Amenorrhoea
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
Hyperprolactinaemia
Haemochromatosis – ‘Iron overload’
Hypo/hyperthyroidism
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?
Pregnancy Anovulation Menopause (Or premature menopause) Polycystic Ovarian Syndrome Drug-induced
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)