Read from Dr. Sheila Rani’s notes!

Normal menstruation

  • normal volume
    • 30ml – 80ml
  • interval between cycles
    • 28 days
  • duration of flow
    • 2-7 days

Amenorrhea

  • absence of menstruation in excess of 6 months

Primary:

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Rokitansky’s syndrome

    • no onset of menstruation by age 16 with normal sexual development
    • no onset of menstruation by age with no normal sexual development
    • Causes: Outflow tract
      • imperforate hymen/vaginal atresia
      • hypoplasia of vagina
      • testicular feminisation
      • Mayor-Rokitansky-Kuster-Hauser (Mullerian Agenesis)
    • Causes: Ovary
      • Turner’s syndrome
      • Ovarian agenesis (failure of development)
      • Resistant ovary syndrome
        • Increase in FSH
      • Premature menopause
    • Causes: Hypothalamo-pituitary axis
      • Hyperprolactinemia
      • Anorexia nervosa
      • Kallman’s syndrome
        • hypogonadism
      • Hypothyroidism

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Secondary

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Polycystic ovarian syndrome

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Asherman’s syndrome

    • Absense of maturation in excess of 6 months in a previously menstruation woman
      • 6 months if cycles were regular
      • 12 months if cycles were irregular
    • Causes
      • pregnency, menopause, anovulation
      • premature ovarian failure
      • hypothalamic-pituitary dysfunction
      • hyperprolactinemia
      • Polycycstic ovarian syndrome
        • recurrent miscarriages
        • hyperandrogenism
        • high LH
        • weight gain
      • Androgen producing tumour
      • Asherman’s syndrome
      • Thyroid dysfunction
      • Hemochromatosis
      • Drug induced
        • drugs that increase prolactin
          • cimetidine
          • metoclopramide
          • methyldopa
          • haloperidol
        • drugs that induce menopausal state
          • GnRH analog
          • Danazol
        • Contraceptive agents
          • progestogens (Depo, implant)
          • Post-pill

Oligomenorrhea

  • reduction in frequency of menstruation (6 weeks-6 months)
    • more than 6 months: amenorrhea
    • low oestrogen level

Menorrhagia

  • menstrual blood loss of 80ml or more
  • Causes
    • Dysfunctional Uterine Bleeding (DUB)
      • loss of coordinated cyclic hormonal changes
      • age determinates
        • 20 yo
          • secondary to anovulation
        • 20-40 yo
          • PID, IUCD, OCP
          • Adenomyosis
          • Endometriosis
          • Tryroid disease
        • >40 yo
          • Anovulation
          • rule out neoplasia
      • no organic cause
    • Organic pelvic lesions (benign/malignant)
      • leiomyomas
      • endometriosis/adenomyosis
      • endometrial polyps
      • endometrial hyperplasia
      • infections (PID, TB)
      • Intrauterine contraceptive device
    • Extragenital problems
      • coagulopathies, endocrinopathies, iatrogenic
    • Pregnancy complications
    • Age dependent causes
      • prepubertal DUB
      • perimenarchal DUB
        • lack of development of HPO axis
        • absense of regular LH
        • Continued unopposed oestrogens
      • reproductive
      • post menopausal
        • diminished no. of follicles in ovary
        • FSH high
        • Circulating estradiols low
        • fail to ovulate, corpus luteum function fails
        • unopposed oestrogen

Atrophy of endometrium

  • total absence of oestrogen/ failure of uterine receptors to become responsive to oestrogen
    • postmenopausal
    • rupture of dilated capillaries beneath atrophic surface epithelium

Dysmenorrhea

  • pain during menstruation

Investigations

  • Haematology
    • Hb, platelet count, PT, APTT, bleeding time
    • Thyroid functions: TSH, T3, T4
  • Diagnostic tests
    • uterine curettage (D&C)
      • hysteroscopy
    • Ultrasound
    • Laparoscopy

Treatment

  • Medical

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  • Surgical
    • Endometrial curretage
    • Endometrial ablation
    • Hysterectomy

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Terri is obsessed with making medical school as painless as possible. She studies and compiles medical school notes in a concise, easy-to-understand format. She also enjoys reading contributions by others. She is an investor in sustainability projects. Her ideal weekend is wine tasting and experimenting on bread-making. She has yet to master the art of Sourdough baking.

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