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 Menstrual cycle •Endometrial changes based on hormonal changes during ovarian cycle •Phases of MC: •Menstrual (1-5 days) •Proliferative (6-14 days) •Secretory (15-28) •Length of MC: 25-35 days •Length of bleeding (menstrual phase): 3-5; 7 max. •Blood loss: 1 ml/kg 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 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! 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 (endometriosis, fibroids...) •CT, MRI (fibroid, tumors, endometriosis) •Genetics, Endocrinology, Hematology • Adobe Systems Menstrual cycle and amenorrhoea Therapy •Based on cause •Hormonal: Estrogens, Gestagens, IUS •Surgical: uterine abrasion (curettage), RFA, thermal ablasion, hysterectomy Adobe Systems Menstrual cycle and amenorrhoea Hormonal therapy •Estrogens: in case of insufficient estrogen production in first 14 days of menstrual cycle (proliferative phase) •in most cases as a component of COC •Gestagens: in secretory phase •Combined oral contraception: anovulatory cycles •cyclical usage: 21 days active pills, 7 days placebo (withdrawal bleeding) •continuous usage: without bleeding •sequential usage: E only pills during fist part of MC, E+G pills thereafter Adobe Systems Menstrual cycle and amenorrhoea IUS •Intrauterine device: •T-shaped piece of plastic with copper inserten inside the womb •copper works as a spermicide: increasing the levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids •Intrauterine system (IUS) •the plastic T-shaped device containing progestin hormone (Levonorgestrel), which is released slowly from the IUS system to the blood •Levonorgestrel causing thickening of the cervical mucus •hormone is releasing continuously from 3 to 5 years Adobe Systems Adobe Systems Menstrual cycle and amenorrhoea Surgical therapy •Uterine abrasion (curettage) •procedure to remove tissue from inside your uterus •prior to curettage dilation (dilatation) of cervix is needed •RFA - Radiofrequency Endometrium Ablation •using high-energy radiofrequencie •Thermal (balloon) endometrial ablasion •special balloon filled with hot fluid to thin the endometrium •Hysterectomy – final solution •older women, want to have (more) children, cancer Adobe Systems Menstrual cycle and amenorrhoea Adobe Systems Adobe Systems Adobe Systems Menstrual cycle and amenorrhoea Thank you for your attention Adobe Systems Menstrual cycle and amenorrhoea Questions 1.Which of the following statements are true about menstruation? A)In a normal 28 day menstrual cycle you would expect menstruation to last approximately 10 days B)During menstruation the entire endometrium is shed C)During menstruation only the functional layer of the endometrium is shed, with the basal layer remaining intact D)Absence of menstruation always indicates an active pregnancy E) 2.At which point in the menstrual cycle is a woman most fertile? A)1-5 B)9-16 C)17-21 D)22-28 Adobe Systems Menstrual cycle and amenorrhoea Questions 1.Which of the following statements are true about menstruation? A)In a normal 28 day menstrual cycle you would expect menstruation to last approximately 10 days B)During menstruation the entire endometrium is shed C)During menstruation only the functional layer of the endometrium is shed, with the basal layer remaining intact D)Absence of menstruation always indicates an active pregnancy E) 2.At which point in the menstrual cycle is a woman most fertile? A)1-5 B)9-16 C)17-21 D)22-28 Adobe Systems Menstrual cycle and amenorrhoea Questions 1.Which of the following statements are true about menstruation? A)In a normal 28 day menstrual cycle you would expect menstruation to last approximately 10 days B)During menstruation the entire endometrium is shed C)During menstruation only the functional layer of the endometrium is shed, with the basal layer remaining intact D)Absence of menstruation always indicates an active pregnancy E) 2.At which point in the menstrual cycle is a woman most fertile? A)1-5 B)9-16 C)17-21 D)22-28 Adobe Systems Menstrual cycle and amenorrhoea Questions 3.At which stage in the uterine cycle does the proliferative phase occur? A)1-5 B)5-14 C)15-28 D)proliferative phase it‘s not even a real term 4.Hypermenorrhoea is not caused by: A)Endometrial polyp B)Asherman‘s syndrome C)Fibroid D)Adenomyosis E) Adobe Systems Menstrual cycle and amenorrhoea Questions 3.At which stage in the uterine cycle does the proliferative phase occur? A)1-5 B)5-14 C)15-28 D)proliferative phase it‘s not even a real term 4.Hypermenorrhoea is not caused by: A)Endometrial polyp B)Asherman‘s syndrome C)Fibroid D)Adenomyosis E) Adobe Systems Menstrual cycle and amenorrhoea Questions 3.At which stage in the uterine cycle does the proliferative phase occur? A)1-5 B)5-14 C)15-28 D)proliferative phase it‘s not even a real term 4.Hypermenorrhoea is not caused by: A)Endometrial polyp B)Asherman‘s syndrome C)Fibroid D)Adenomyosis E) Adobe Systems Menstrual cycle and amenorrhoea Questions 5.Polymenorrhoea means menstrual cycle: A)longer than 35 days B)shorter than 22 days C)longer than 22 days D)shorter than 35 days E) 6.Amenorrhoea can‘t be caused by: A)Hyperprolactinemia B)Polycystic ovarian syndrome (PCOS) C)Ovarian tumour D)Endometriosis Adobe Systems Menstrual cycle and amenorrhoea Questions 5.Polymenorrhoea means menstrual cycle: A)longer than 35 days B)shorter than 22 days C)longer than 22 days D)shorter than 35 days E) 6.Amenorrhoea can‘t be caused by: A)Hyperprolactinemia B)Polycystic ovarian syndrome (PCOS) C)Ovarian tumour D)Endometriosis Adobe Systems Menstrual cycle and amenorrhoea Questions 5.Polymenorrhoea means menstrual cycle: A)longer than 35 days B)shorter than 22 days C)longer than 22 days D)shorter than 35 days E) 6.Amenorrhoea can‘t be caused by: A)Hyperprolactinemia B)Polycystic ovarian syndrome (PCOS) C)Ovarian tumour D)Endomertiosis