Abnormal Menstruation Overview

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Questions and Answers

What constitutes primary amenorrhea?

  • Absence of menstruation for more than 6 months
  • Irregular menstrual cycles beginning after 16 years
  • Menstruation occurring after a total absence
  • Menstruation failure by 16 years of age (correct)

Which of the following is a potential cause of secondary amenorrhea?

  • Absence of the outflow tract
  • Excessive exercise
  • Polycystic ovary syndrome
  • Pregnancy (correct)

What is the typical duration of normal menstruation?

  • 2-7 days (correct)
  • 5-14 days
  • 3-10 days
  • 1-5 days

Which symptom is NOT commonly associated with hypothalamic amenorrhea?

<p>Cyclical pain (A)</p> Signup and view all the answers

Which condition is most likely to cause anovulation?

<p>Premature ovarian failure (B)</p> Signup and view all the answers

Which of the following is a sign of prolactinoma?

<p>Visual disturbances (D)</p> Signup and view all the answers

What is the average age of menarche?

<p>13 years (A)</p> Signup and view all the answers

Which hormonal profile change is typically found in Polycystic Ovary Syndrome (PCOS)?

<p>Elevated LH levels (A)</p> Signup and view all the answers

What is the primary clinical feature of Polycystic Ovary Syndrome (PCOS)?

<p>Hyperandrogenism (B)</p> Signup and view all the answers

Which of the following is a common management strategy for heavy menstrual bleeding (HMB)?

<p>Hormonal preparations (A)</p> Signup and view all the answers

What is the definition of heavy menstrual bleeding (HMB)?

<p>Blood loss exceeding 80 ml and lasting more than 7 days (C)</p> Signup and view all the answers

What is a potential etiologic treatment for Polycystic Ovary Syndrome (PCOS)?

<p>Dopamine agonists (B)</p> Signup and view all the answers

Which of the following investigations is specifically indicated for dysmenorrhea?

<p>Pelvic ultrasound (D)</p> Signup and view all the answers

Which of the following conditions is NOT a known cause of dysmenorrhea?

<p>High blood pressure (C)</p> Signup and view all the answers

Which management option can be applied for abnormal uterine bleeding?

<p>All of the above (D)</p> Signup and view all the answers

What is the role of karyotyping in the management of related gynecological conditions?

<p>Assessing chromosomal abnormalities (A)</p> Signup and view all the answers

Flashcards

Menarche

The first menstrual period, typically occurring between the ages of 10 and 16, with an average onset at 13.

Secondary Amenorrhea

The absence of menstruation for more than 6 months, excluding pregnancy, lactation, and menopause.

Primary Amenorrhea

The absence of menstruation altogether by age 16.

Oligomenorrhea

A condition characterized by irregular or infrequent periods, typically spaced more than 35 days apart.

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Menorrhagia

Heavy or excessive menstrual bleeding.

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Metrorrhagia

Bleeding between menstrual periods.

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Polycystic Ovary Syndrome (PCOS)

A hormonal disorder characterized by irregular periods, excess androgen (male hormone) production, and the development of small cysts on the ovaries.

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Normal Menstruation

A condition where the lining of the uterus is shed if pregnancy doesn't occur.

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What is Polycystic Ovary Syndrome (PCOS)?

A common hormonal disorder characterized by irregular periods, excess male hormones, cysts on ovaries, and difficulty getting pregnant.

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What is Abnormal Uterine Bleeding (AUB)?

A group of symptoms related to abnormal or heavy bleeding from the uterus.

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What is Heavy Menstrual Bleeding (HMB)?

Heavy menstrual bleeding, also known as menorrhagia, is defined as blood loss exceeding 80 ml or lasting longer than 7 days.

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What is Dysmenorrhea?

Painful periods. Primary dysmenorrhea is usually caused by cramping in the uterus, while secondary dysmenorrhea is caused by underlying conditions like endometriosis or fibroids.

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What is Ultrasound?

A medical imaging technique that uses sound waves to create images of the inside of the body, commonly used to assess ovaries and uterus.

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What is a Thyroid Test?

A blood test that measures the levels of hormones produced by the thyroid gland, often used to assess overall health and hormone balance.

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What is an X-Ray of the Skull?

A medical imaging technique that uses X-rays to create detailed images of bones and tissues, often used to assess the pituitary gland.

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What is a CT Scan?

A medical imaging technique that uses X-rays taken from different angles to create cross-sectional images of the body, often used to assess the brain, pituitary gland, and other organs.

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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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