Dysmenorrhoea and Amenorrhoea
Terms in this set (25)
What is dysmenorrhoea?
recurrent pelvic pain associated with menstruation
What is the difference between primary and secondary dysmenorrhoea?
Primary dysmenorrhea refers to menstrual pain in the absence of any underlying pelvic pathology.
Secondary dysmenorrhea refers to menstrual pain associated with a specified organic etiology.
At what age is the presentation of dysmenorrhoea most prevalent? Why?
It is more prevalent during late adolescence, with the beginning of ovulatory cycles two to three years after the commencement of menstruation.
Peak incidence occurs during the late teenage years and early 20s.
What are the risk factors for primary dysmenorrhoea?
Early age of menarche
Heavy menstrual flow
Positive family history
(No correlation has been found with BMI or history of abortion)
What is secondary dysmenorrhoea most likely to be associated with?
Metrorrhagia (irregular bleeding)
What is the most common cause of secondary dysmenorrhoea?
infection (e.g., PID, abscess)
ovarian cysts (rarely, ovarian tumours)
What symptoms may accompany pelvic pain?
Cyclical vs non-cyclical pain
Dyspaerunia: deep vs superficial
Joint / muscular symptoms
What are the non-gynaecological differentials for dysmenorrhoea?
Urinary tract infections
Previous surgery / adhesions
Inflammatory bowel conditions
What is interstitial cystitis?
Inflammation of the submucosal and muscle layers of the bladder
- Urgency, frequency, nocturia
- Sterile urine cultures
What are the features of endometriosis?
Pain - varies markedly over the menstrual cycle
What investigations can be done for dysmenorrhoea?
(MRI ?indentification of small endometriosis deposits)
What are the treatment options for women with cyclical pain?
- OCP for 3-6 months (before consideration of diagnostic laparoscopy)
- OTC NSAIDs
What are the causes of adhesions?
- Dense vascular adhesions can be surgically removed (not fine adhesions)
What is an MSK cause of pelvic pain?
Spasm of the muscles of the pelvic floor
- Botulinum toxin injection
What is the difference between primary and secondary amenorrhoea?
Primary - may occur with or without other signs of puberty. Normal age 9-18 years (average - 12)
Secondary - 6 months of amenorrhoea after normal menstruation has commenced
What are the physiological causes of secondary amenorrhoea?
Describe sexual differentiation in the foetus
Sexually indifferent stage - 6 weeks
- Mullerian (paramesonephric) duct -> fallopian tubes, uterus, upper vagina
- Wolffian (mesonephric) duct -> epididymis, vas deferens, seminal vesicles, ejaculatory duct
What determines sex differentiation in the foetus?
SRY gene - in males
- sertoli cells secrete MIS (mullerian inhibiting substance) ->mullerian ducts degenerate
- Leydig cells secrete testosterone -> wolffian duct development -> male stuff
- absense of MIS leads to development of mullerian duct into female stuff
- absence of testosterone leads to degeneration of wolffian duct
What are the causes of primary amenorrhoea?
- Congenital abnormalities: imperforate hymen, cervical stenosis, absent uterus or vagina (e.g. MRKH),
congenital adrenal hyperplasia, androgen insensitivity syndrome
- Hormonal (HPA axis)
- Chronic illnesses e.g. cystic fibrosis
- Genetic disorders e.g. Turners syndrome
What questions should you ask in the history of primary amenorrhoea?
Medical / Surgical history
What examination should you do of patients with primary amenorrhoea?
General: BMI, genetic syndromes
Pubertal development stage
Genital / vaginal
What investigations should you do for patients with primary amenorrhoea?
Blood tests may include:
TSH, T3, T4
Other tests that may be done include:
Serum testosterone levels
What are the causes of secondary amenorrhoea?
Drugs (e.g. anti psychotics)
Hyper / hypo thyroidism
Congenital adrenal hyperplasia (CAH)
What are the symptoms/signs of secondary amenorrhoea?
Weight gain/ loss
Nipple discharge / galactorrhea
Acne / hirsutism
Urogenital atrophy / dyspareunia
What investigations are done for secondary amenorrhoea?
CT / MRI scan of the head
Hysteroscopy / Endometrial biopsy
Ultrasound of the pelvis
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