Dysmenorrhoea- the medical term for menstrual cramps.
Secondary sexual development include the development of breasts, pubic hair etc
The most common cause of amenorrhoea encountered in routine practice are PCOS, hypothalamic amenorrhoea and premature ovarian failure.
Specialist will investigate underlying causes of amenorrhoea an well as woman’s estrogen levels/status, desire for fertility or contraceptive needs.
FPNSW Reproductive and Sexual Health (Clinical Practice Handbook, 2nd edition
Abnormal uterine bleeding presentation
Abnormal UterineBleeding and the Menstrual Cycle Susana Martinez
What is ‘normal’?O A ‘normal’ menstrual pattern is associated with a monthly bleed (every 21-35 days) with duration of seven days or less.O A blood loss of 80mls or less, is regarded as being in the normal range
Menstrual cycle ~ overviewO A regular menstrual patterns depends on the presence of a functioning reproductive hormone feedback system which includes the hypothalamus, anterior pituitary gland and ovaries, as well as normal uterine and vaginal anatomy.
Menstrual abnormalitiesO Menstrual abnormalities include irregular or absent periods, heavy or prolonged menstrual loss (for 3 cycles or more), inter-menstrual and post-coital bleeding, dysmenorrhoea and pre-menstrual disorders.
AmenorrhoeaO Primary amenorrhoeaO The absence of onset of menstruation – is regarded as abnormal by the age of 14 years in girls with no other secondary sexual development, and 16 in girls with normal secondary sexual development.
Causes of primary amenorrhoeaO Anatomical abnormalities (imperforate hymen, congenital absence of uterus or vagina)O Chromosonal anomalies causing failure to initiate pubertyO Hypogonadotrophic hypogonadism (failure to switch on puberty)O PCOSO Chronic illness or low body mass (or excessive exercise)
Secondary amenorrhoeaO The cessation of menstruation for a period of six months, after regular cycles have been established.
Causes of secondary amenorrhoeaO Hyphothalamic-pituitary reasons includes:O Weight loss (BMI <19 unlikely to have regular menstrual cycle)O Excessive exerciseO ObesityO Secondary to medication: hormonal contraception, antipsychotics, opiates, chemotherapy
Causes of secondary amenorrhoeaO Ovarian, uterine or vaginalO Polycystic Ovarian Syndrome (PCOS)O Premature ovarian failureO Other causesO Thyroid hormone deficiency or excessO Severe generalised disease
InvestigationsO Investigate after 6 months of secondary amenorrhoea which is not secondary to contraceptive use such as an implant, Depo injection or Mirena.O Pregnancy testO FSH, LH, Prolactin and TSH, oestrodialO Testosterone levelsO Consider pelvic/transvaginal ultrasoundO Consider bone density scan
Management of amenorrhoeaO Primary amenorrhoeaO Refer to a specialist for further investigationO Secondary amenorrhoeaO Referral to specialist (gynaecologist or endocrinologist) where diagnosis or management is not clear after initial investigation, and if patient is concerned about fertility.
DysmenorrhoeaO Dysmenorrhoea is a cyclical lower abdominal or pelvic pain occuring either before or during menstruation, or both.O Prevalence is difficult to estimate, but it is thought that dysmenorrhoea affects up to 70% of women at some time during reproductive age.
EndometriosisO Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction.O Condition found in women of reproductive age, from all ethnic and social groupsO Estimated prevalence is up to 10%.O Endometriosis often begins in adolescence
Adbormal Uterine Bleeding (AUB)O Abnormal uterine bleeding includes:O Heavy menstrual bleeding (HMB – previously called menorrhagia)O Intermenstrual bleeding (IMB) and post- coital bleeding (PCB)
Management of HMBO IUS (Mirena)O Combined COC (Qlaira)O Tranexamic acidO Nonsteroidal anti-inflammatory drugs (NSAIDs)O Progestogens (norethisterone (15mg) daily from days 5-26 of menstrual cycle or long acting injectable progestogens (DMPA -Depo)