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Flashcards in 8 - Menstrual Disorders Deck (25)
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1
Q

What is amennorhea?

A

Can be primary or secondary

2
Q

What are some causes of primary and secondary amennorhea?

A

Primary: congenital disorders, imperforate hymen, hormonal disorders, constitutional delay of puberty

Secondary: pregnancy, weight loss, menopause, endocrine issues

3
Q

What is the most common cause of primary amennorhea and what are some characteristics of this disease?

A

- Turners Syndrome, 45 X

  • Streak gonads
  • Low estradiol and high FSH/LH as no negative feedback
4
Q

What are some anatomical causes of primary amennorhea?

A
  • Imperforate hymen
  • Transverse vaginal septum due to failure of UGS and mullerian duct to fuse
  • MRKH syndrome
5
Q

Why does AIS lead to primary amennorhea?

A

- 46 XY but female phenotype

  • Need to excise testes after puberty due to risk of testicular cancer
  • May feel testes in labia or inguinal area

- Absence of upper vagina, uterus and fallopian tubes

6
Q

What is Kallman syndrome?

A
  • Delayed or absent puberty alongside anosmia
  • Form of idiopathic hypogonatrophic hypogonadism
  • Autosomal dominant or X Linked Recessive
7
Q

What is the most common cause of secondary amenorrhea and what are the symptoms associated with this?

A
  • PCOS
  • Hyperandrogenism and chronic anovulation
  • Secondary amennorhea, infetility, hirsutism, obesity
  • May be asymptomatic
  • Elevated LH
8
Q

What is the pathogenesis of PCOS?

A
  • Lack of pulsatile GnRH release due to androgens
  • Many follicles develop but dominant one not selected
  • Follicles produce abnormal oestrogen secretion
9
Q

What are women with PCOS at increased risk of and how is this risk reduced?

A
  • Endometrial malignancy due to abnormal oestrogen secretion
  • Diabetes and CVS disease due to insulin resistance
  • Lifestyle advice and OC pill
10
Q

How can hypothyroidism lead to secondary amenorrhea?

A
  • Usually hyperthyroidism
11
Q

How can hyperthyroidism lead to secondary amennorhea?

A
12
Q

What are some causes of hyperprolactinaemia and how can it lead to amennorhea?

A

Prolactin inhibits GnRH release

13
Q

What are some hypothalamus and pituitary disorders that lead to amenorrhea?

A

- Prolactinoma (give dopamine agonist)

- Sheehan syndrome (ischaemic necrosis during birth)

- Functional hypothalamic amenorrhea (weight loss, excessive exercise, emotional stress, gymnasts, anorexia)

14
Q

When diagnosing the cause of amennorhea what can you first rule out?

A

Physiological causes:

  • Pregnancy
  • Menopause
15
Q

What is oligomenorrhoea?

A
16
Q

What is menorrhagia and what pathologies should you consider if you are presented with this?

A

- Heavy menstrual bleeding

  • >80ml (pad is 10ml)
  • Opinion that periods heavier or passing clots
  • Think about endometrial growths, clotting disorders, anaemia
17
Q

How can we split uterine bleeding into different parameters to describe it?

A

Also if having abnormal uterine bleeding can be acute or chronic (6 months)

18
Q

What are some causes of abnormal uterine bleeding and what are some accompanying symptoms?

A
  • Can be structural or non-structural
  • Heavy, irregular, infrequent, frequent, prolonged, shortened
  • Postcoital, intermenstrual
19
Q

What is the most common cause of AUB?

A

- Fibroids: benign tumour of uterine smooth muscle (myometrium)

  • Oestrogen dependent so will clear when menopause and worse in pregnancy
  • Can cause heavy menstrual bleeding, recurrent pregnancy loss but dont tend to cause pain unless degenerating or torsion
20
Q

What is dysfunctional uterine bleeding?

A

- When can find no structual or systemic cause for abnormal bleeding

  • Common at extremes of reproductive life and is diagnosis of exclusion
  • Subdivided into anovulatory and ovulatory
21
Q

What can be some causes of irregular periods?

A
  • Hormonal contraceptions
  • Hormone secreting ovarian cysts
  • Menopause
  • Infective causes
22
Q

What is dysmenorrhea?

A

- Painful menstruation to the point where it is interfering with quality of life. Often leads to chronic pelvic pain and result of obstructive causes

  • Associate with malaise, diarrhoea, nausea
  • Primary since menarche or secondary
23
Q

What is the most common cause of dysmennorhea?

A

Endometriosis

  • Ectopic endometrial tissue that responds to hormonal stimulation the same way as the uterus does
  • Can irritate the peritoneum leading to pain, intraabdominal adhesions and infertility
24
Q

How can we manage the symptoms of dysmenorrhea?

A
  • NSAIDs
  • Hormonal contraceptions, IUD and COCP
  • GnRH analogues
  • Surgery e.g hysterectomy and break adhesions
  • Heat, ginger, TENS, acupuncture
25
Q

How do you gather a differential diagnosis for

  • Amenorrhoea?
  • Menorrhoagia?
  • Dysmenorrhoea?
A
  1. Look at HPG values to see if hormonal
  2. If no issue then look at structural problems, e.g MRI, USS, laparoscopy

3. System review, e.g thyroid disorders