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Questions and Answers
What constitutes primary amenorrhea?
What constitutes primary amenorrhea?
Which of the following is a potential cause of secondary amenorrhea?
Which of the following is a potential cause of secondary amenorrhea?
What is the typical duration of normal menstruation?
What is the typical duration of normal menstruation?
Which symptom is NOT commonly associated with hypothalamic amenorrhea?
Which symptom is NOT commonly associated with hypothalamic amenorrhea?
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Which condition is most likely to cause anovulation?
Which condition is most likely to cause anovulation?
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Which of the following is a sign of prolactinoma?
Which of the following is a sign of prolactinoma?
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What is the average age of menarche?
What is the average age of menarche?
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Which hormonal profile change is typically found in Polycystic Ovary Syndrome (PCOS)?
Which hormonal profile change is typically found in Polycystic Ovary Syndrome (PCOS)?
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What is the primary clinical feature of Polycystic Ovary Syndrome (PCOS)?
What is the primary clinical feature of Polycystic Ovary Syndrome (PCOS)?
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Which of the following is a common management strategy for heavy menstrual bleeding (HMB)?
Which of the following is a common management strategy for heavy menstrual bleeding (HMB)?
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What is the definition of heavy menstrual bleeding (HMB)?
What is the definition of heavy menstrual bleeding (HMB)?
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What is a potential etiologic treatment for Polycystic Ovary Syndrome (PCOS)?
What is a potential etiologic treatment for Polycystic Ovary Syndrome (PCOS)?
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Which of the following investigations is specifically indicated for dysmenorrhea?
Which of the following investigations is specifically indicated for dysmenorrhea?
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Which of the following conditions is NOT a known cause of dysmenorrhea?
Which of the following conditions is NOT a known cause of dysmenorrhea?
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Which management option can be applied for abnormal uterine bleeding?
Which management option can be applied for abnormal uterine bleeding?
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What is the role of karyotyping in the management of related gynecological conditions?
What is the role of karyotyping in the management of related gynecological conditions?
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Study Notes
Abnormal Menstruation
- Normal menstruation involves shedding the uterine lining (endometrium).
- Menarche typically occurs between 10-16 years of age (average 13 years).
- Menstrual periods typically last 2-7 days.
- Normal blood loss averages 30-80 ml (3 napkins).
Types of Abnormal Menstruation
-
Amenorrhea: Absence of menstruation.
- Primary: Failure to menstruate by age 16.
- Secondary: Absence of menstruation for more than 6 months excluding pregnancy, lactation, or menopause.
- Hypomenorrhea: Scanty menstrual bleeding.
- Oligomenorrhea: Infrequent menstruation (more than 35 days apart).
- Menorrhagia: Excessive menstrual bleeding.
- Metrorrhagia: Bleeding between periods.
- Menometrorrhagia: Heavy bleeding during and between periods.
Causes of Amenorrhea
- Hypothalamic: Excessive exercise, low body weight, stress, drug use, chronic diseases, hypothalamic lesions.
- Pituitary: Adenomas (prolactinoma), necrosis (Sheehan's syndrome), surgery, radiotherapy.
- Ovarian (Anovulation): Polycystic ovary syndrome (PCOS), premature ovarian failure (POF).
- Endometrial: Mullerian defect, outflow tract abnormalities, scarring (Asherman syndrome).
Signs and Symptoms of Abnormal Menstruation
- Lifestyle factors (stress, weight, exercise).
- Hair growth, weight gain (potentially PCOS).
- Cyclical pelvic pain, congenital malformations.
- Headaches, galactorrhea (breast milk), visual disturbances (potentially prolactinoma).
- Past medical history (chronic thyroid, renal disease).
- Past surgical history (uterine evacuation).
- Drug history (potentially hypothalamic effects).
Investigations for Abnormal Menstruation
- Pregnancy test.
- Hormonal profile (FSH, LH, progesterone, estradiol).
- Prolactin level.
- Ultrasound.
- Thyroid function tests.
- X-ray of the skull (sella turcica).
- CT scan.
- Karyotyping.
Management of Abnormal Menstruation
- Etiologic treatment: Normalizing BMI (Body Mass Index).
- Hormonal treatment: Oral contraceptives, HRT (hormone replacement therapy), progesterone, dopamine agonists.
- Surgery: For specific causes like tumors or structural issues.
Polycystic Ovary Syndrome (PCOS)
- PCOS is a syndrome involving ovarian dysfunction.
- Clinical features: Oligomenorrhea/amenorrhea, hyperandrogenism, ultrasound features (polycystic ovaries), subfertility, elevated serum LH levels, and raised insulin resistance.
Abnormal Uterine Bleeding (AUB)
- Heavy menstrual bleeding (HMB): Excessively heavy bleeding (>80ml) lasting more than 7 days.
- Etiology: Systemic causes (hypothyroidism, coagulopathy, diabetes, obesity), local causes (polyps, carcinoma, fibroids, adenomyosis, IUDs).
- Investigative methods: History and physical exam, pelvic ultrasound, cytology (biopsy and histology), endometrial biopsy, hysteroscopy, dilatation and curettage, hormonal profile, blood tests (hemogram, thyroid function).
Dysmenorrhea
- Definition: Pain during menstruation.
- Types: Primary (no identifiable cause) or secondary (caused by other conditions).
- Causes: Endometriosis, adenomyosis, pelvic inflammatory disease (PID), cervical stenosis, hematometra.
- Investigations: High vaginal and endocervical swabs, transvaginal ultrasound scan (TVUS), diagnostic laparoscopy.
- Management: Non-steroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives, LNG-IUS, surgery.
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Description
This quiz delves into the various types of abnormal menstruation, including amenorrhea, hypomenorrhea, and menorrhagia. Learn about the normal menstrual cycle and the causes behind menstrual abnormalities. Test your knowledge on this crucial aspect of women's health.
