Session 3 - Part II

Question 1

Define Amenorrhoea

Answer 1

Absence (6 months) of a menstrual period in a woman of reproductive age

Question 2

Define Menorrhagia

Answer 2

Abnormally heavy (>80ml) and prolonged (>7 days) menstrual period at regular intervals

Question 3

Define Dysmenorrhea

Answer 3

Pain during menstruation that interferes with daily activites

Question 4

What are the 2 types of Dysmenorrhoea?

Answer 4

Primary

Secondary

Question 5

Define Oligomenorrhoea

Answer 5

Light or infrequent menstrual periods in a woman of child bearing age

Question 6

What is Pre-menstrual syndrome?

Answer 6

Physical, Psychological and behavioural symptoms that can occur in the 2 weeks before a woman’s menstruation

Question 7

What is Primary Amenorrhoea?

Answer 7

Absence of menses by age 14 with absence of Secondary sexual characteristics
Absence of menses by age 16 with secondary sexual characteristics present

Question 8

What is Secondary Amenorrhoea?

Answer 8

Where an established menstruation has ceased for 3 months in a woman with a history of regular cyclic bleeding or 9 months in a woman with a history of irregular periods

Question 9

What are the 3 types of issues causing Amenorrhoea?

Answer 9

Hypothalamic/Pituitary
Ovarian
Outflow tract

Question 10

How can you tell if Amenorrhoea is due to an outflow tract problem?

Answer 10

The levels of FSH levels are normal as the hypothalamic pituitary ovarian axis is working

Question 11

What are some of the outflow tract issues that cause Primary Amenorrhoea?

Answer 11

Uterine - Mullerian agenesis (Uterus doesn’t develop)

Vaginal - Vaginal atresia, Imperforated hymen

Question 12

What are some of the outflow tract issues that cause Secondary Amenorrhoea?

Answer 12

Intrauterine adhesions (Asherman's syndrome)
Trauma

Question 13

What are some of the Gonadal issues that cause Amenorrhoea?

Answer 13

Gonadal dysgenesis

Usually ovarian abnormalities are linked to elevated FSH levels

Question 14

What are some Gonadal disorders that cause Primary Amenorrhoea?

Answer 14

Turner syndrome = low oestrogen, high FSH (Causes Gonadal dysgenesis)
Receptor abnormalities for FSH/LH
Congenital adrenal hyperplasia
Androgen insensitivity syndrome

Question 15

What are some Gonadal disorders that cause Secondary Amenorrhoea?

Answer 15

Pregnancy
Anovulation
Menopause
Premature menopause
Drug induced
Polycystic ovarian disease

Question 16

What are some Hypothalamic/Pituitary disorders that can cause Amenorrhoea?

Answer 16

Inadequate levels of FSH (Inadequately stimulated ovaries fail to produce enough oestrogen to stimulate endometrium)
*Generally woman with Hypogonadotrophic amenorrhoea are potentially fertile)

Question 17

What are some Hypothalamic/Pituitary disorders that cause Primary Amenorrhoea?

Answer 17

Kallmann syndrome (Necrosis of Pituitary)

Question 18

What are some Hypothalamic/Pituitary disorders that cause Secondary Amenorrhoea?

Answer 18

Exercise Amenorrhoea
Stress Amenorrhoea
Eating disorders/Weight loss
Pituitary - Sheehan syndrome, Hyperprolactinaemia, haemochromatosis
Hyper/Hypo thyroidism

Question 19

What is DUB?

Answer 19

Dysfunctional Uterine Bleeding (Anovulatory)

No progesterone withdrawal from an oestrogen primed endometrium so it builds up with erratic bleeding as it breaks down

Question 20

How can you treat DUB?

Answer 20

Conjugated oestrogen/progesterone therapy

Cyclic progestogen for 10 –> 12 days of each cycle

Question 21

What are Fibroids?

Answer 21

Benign grows of the uterine wall, they increase surface area so you get heavier bleeding

Question 22

How can you manage DUB?

Answer 22

NSAIDS

IUS (Meerina coil)