Adobe Systems Tvarožek S., Meixnerová I. Menstrual cycle and amenorrhoea 2020 Department of Gynecology and Obstetrics Brno University Hospital and Masaryk University, Faculty of Medicine head: doc. MUDr. Vít Weinberger, Ph.D Obstetrics and Gynecology - lectures Adobe Systems Menstrual cycle and amenorrhoea Kliknutím vložíte text. Kliknutím vložíte text. Kliknutím vložíte text. Kliknutím vložíte text. Adobe Systems Menstrual cycle and amenorrhoea Menstrual cycle •Endometrial changes based on hormonal changes during ovarian cycle •Menarche 12-15 •Length of MC: 25-35 days •Length of bleeding (menstrual phase): 3-5; 7 max. = eumenorrhoea •Blood loss: 1 ml/kg •Menopause 45-55 Adobe Systems Menstrual cycle and amenorrhoea Obsah obrázku interiér, mísa, stůl, vsedě Popis se vygeneroval automaticky. Adobe Systems Menstrual cycle and amenorrhoea •Phases of MC: •menstrual •proliferative •secretory Jméno předkládajícího proděkana s tituly https://theugandaagus.wordpress.com/2019/10/21/how-to-calculate-safe-period-to-avoid-pregnancy/ Jméno předkládajícího proděkana s tituly Toronto Notes 33rd Edition (2017) Adobe Systems Menstrual cycle and amenorrhoea Disorders of menstrual cycle •Frequency disorders •Intensity disorders •Irregular uterine bleeding •Premenstrual disorders (PMS, PMDD) •Dysmenorrhoea Adobe Systems Menstrual cycle and amenorrhoea Frequency disorders •Polymenorrhoea – MC shorter than 22 days •Oligomenorrhoea – MC longer than 35 days •Amenorrhoea – no bleeding •primary •secondary Adobe Systems Menstrual cycle and amenorrhoea Primary amenorrhoea •failure of initiation of menses by age 15 •Hypothyroidism •Hyperprolactinemia •PCOS •Anatomic abnormalities (cryptomenorrhoea) – vaginal septum, imperforate hymen, Rokitanski syndrom) •Turner syndrome 45X0, Swyer syndrome XY dysgenesis •Other (pituitary tumour, IBD, chronic infections ….) • Adobe Systems Menstrual cycle and amenorrhoea Secondary amenorrhoea •cessation of regular menses for three months •PCOS •Hyperandrogenism – ovarian tumour, adrenal androgen secreting tumour •Premature ovarian failure •Autoimmune – thyroid disease, DM 1 •Addison‘s disease •Hyperprolactinaemia • Adobe Systems Menstrual cycle and amenorrhoea Secondary amenorrhoea •cessation of regular menses for three months •Hyper/hypothyroidism •Pituitary adenoma, Sheehan‘s syndrome •Asherman syndrome •Oclusion of cervical canal (iatrogenic) – cryptomenorrhea •Anorexia •Always exclude pregnancy at first! Obsah obrázku text Popis se vygeneroval automaticky. Adobe Systems Menstrual cycle and amenorrhoea Intensity disorders •Hypermenorrhoea (Menorrhagia) •heavy menstrual bleeding •soaking a pad/tampon at least every 2 hours, or bleeding lasting for >7 days •Hypomenorrhoea •short and extremely light menstrual blood flow • Adobe Systems Menstrual cycle and amenorrhoea Hypermenorrhoea causes •Uterine fibroids (myomas) •Endometrial polyp •Ovarian dysfunction •Adenomyosis •IUD •Endometrial cancer •Medication (Warfarin, LMWH, Xa inhibitors) Adobe Systems Menstrual cycle and amenorrhoea Oligomenorrhoea causes •COC •Eating disorders (anorexia, bulimia) •Perimenopausal women •Adolescent girls •Antipsychotics, Antiepileptics • Adobe Systems Menstrual cycle and amenorrhoea Irregular uterine bleeding •Metrorrhagia (NOT Menorrhagia) •dysfunctional intermenstrual uterine bleeding •Causes: Cervical/Uterine cancer, Endomeriosis, polyps, uterine fibroids, juvenile metrorrhagia, PCOS... • Adobe Systems Menstrual cycle and amenorrhoea Diagnosis •Menstrual calendar •Gynaecologic examination (polyps, fibroids) •Ultrasound (endometrium thickness, fibroids...) •Hormonal examination •FSH, LH, Prolactine,E2, Progesterone •Testosterone, SHBG, TSH, T4 •Functional cytology • Adobe Systems Menstrual cycle and amenorrhoea Diagnosis •Functional tests (Estrogen, Progesterone,...) •Hysteroscopy (polyps, adenomyosis, fibroids) •Endometrial biopsy •Laparoscopy •CT, MRI •Genetics, Endocrinology, Hematology • Adobe Systems Menstrual cycle and amenorrhoea Therapy •Based on cause •Hormonal: Estrogens, Gestagens •Surgical: uterine abrasion (curettage), RFA, thermal ablasion, hysterectomy Adobe Systems Menstrual cycle and amenorrhoea Thank you for your attention