BIOL 80A Final | Disorders of the Menstrual Cycle

what percentage of women are estimated to experience menstrual irregularities?

an estimated 14% to 25% of women experience them

what is amenorrhea?

absence of a period; the absence of menstruation in a nonpregnant premenopausal woman (primary and secondary)

what is oligomenorrhea?

infrequent periods; when a woman regularly has periods more than 35 days apart, or have periods as infrequently as 6-8 times per year

what is dysmenorrhea?

painful periods; pelvis pain during the menstrual cycle (menstrual cramps)

what is abnormal uterine bleeding (AUB; menometrorrhagia)?

irregular, heavy, and/or prolonged periods

what is primary amenorrhea?

when a woman has not begun her menstrual cycle by the age of 15 or within five years of the first signs of puberty (such as developing breasts)

what are the causes of primary amenorrhea?

chromosomal/genetic issues, hormonal issues in the brain/pituitary gland (or other endocrine tissues), structural or developmental issues with reproductive, extreme stress, athletic training, or anorexia

how can you test for primary amenorrhea?

blood test (hormones), genetic test, physical exam, ultrasound, MRI

what is secondary amenorrhea?

when previously normal menstrual periods stop for 3 or more months.

what are the causes of secondary amenorrhea?

pregnancy, lactation, peri-menopause, some hormonal birth control, endocrine disorders, chronic stress or illness, some medications, uterine surgery

how can you test for secondary amenorrhea?

blood test (hormones, and pregnancy), genetic test, physical exam, ultrasound, MRI

is there potential overlap between secondary amenorrhea and oligomenorrhea?

yes, there can be overlap between secondary amenorrhea and oligomenorrhea

what percentage of women are affected by oligomenorrhea?

up to 13.5% of women are affected

in what percentage range of female athletes is oligomenorrhea reported at some point in their life?

it is reported in 6-60% of female athletes

how can you test for oligomenorrhea?

blood test (hormones, and pregnancy), physical exam, ultrasound, CT, MRI

how can you treat oligomenorrhea?

it depends on the cause, but often hormonal birth control to regulate reproductive hormone imbalance

what are the causes of oligomenorrhea?

kind of normal in menarche and perimenopause, disruption of the H-P-O axis (e.g. chronic illness, extreme stress, excessive stress, excessive exercise, poor nutrition, eating disorders), hormone imbalance/endocrine disorders, some medications

what is polycystic ovarian syndrome (PCOS)?

a hormonal imbalance that is caused by the ovaries producing excess androgens (e.g. testosterone).

what does polycystic ovarian syndrome (PCOS) effect?

it effects/interferes with normal female reproductive hormone cycling, and ovulation, leading to irregular periods (and infertility)

polycystic ovarian syndrome (PCOS) affects what percentage of women of reproductive age?

5-15%

what is the leading cause of female infertility?

polycystic ovary syndrome (PCOS)

what is the most common hormonal disorder in females of reproductive age?

polycystic ovary syndrome (PCOS)

what is polycystic ovarian syndrome (PCOS) characterized by?

irregular menstrual periods, hyperandrogenism, and polycystic ovaries

what are androgens?

a class of hormones

what is the most common androgen?

testosterone

which organs typically produce testosterone in the body?

ovaries (in typical amounts) and adrenal glands

what happens to testosterone production in polycystic ovary syndrome (PCOS)?

the ovary makes a lot more testosterone

what is hyperandrogenism?

a condition caused by excess testosterone production in PCOS

what is the exact cause of PCOS?

the exact cause of PCOS is unknown

what are some signs and symptoms of PCOS?

oligomenorrhea, excess facial and body hair, acne, “male-pattern” baldness or thinning hair, many cysts on the ovaries, skin tags, obesity, infertility

what percentage of people with PCOS have obesity?

40-80%

is it possible to have PCOS and have no symptoms?

yes

how can you test for polycystic ovarian syndrome (PCOS)?

blood test (hormones and glucose), physical exam, ultrasound

PCOS is associated with higher risk for what other health conditions?

impaired glucose tolerance and diabetes mellitus, obesity, infertility, cardiovascular disease and high blood pressure, depression, anxiety, sleep apnea, endometrial cancer

how can you treat polycystic ovarian syndrome (PCOS)?

lifestyle modification (stress, sleep, nutrition and exercise), hormonal birth control and/or anti-androgen therapy, medications to aid with insulin sensitivity/glucose processing, medications that aid in diabetes and weight management, IF PCOS is associated with increased weight/obesity then managing weight is a priority

what bodily function causes the pain associated with dysmenorrhea?

smooth muscle contraction in the uterus

what chemical plays a key role in causing the smooth muscle contractions that lead to menstrual pain?

prostaglandins

what is primary dysmenorrhea?

menstrual cramps that last up for 72 hours

what is primary dysmenorrhea associated with?

nausea, vomiting, diarrhea, constipation, headaches, dizziness, fatigue, and sleep difficulties

how can you treat primary dysmenorrhea?

often includes NSAIDS, heat application, lifestyle (sleep, nutrition, exercise), magnesium, hormonal birth control, and acupuncture can help

how can you test for primary dysmenorrhea?

physical exam, ultrasound, STI tests, pap test

what is secondary dysmenorrhea?

when painful periods are due to a condition or an infection in the reproductive organs

what causes secondary dysmenorrhea?

fibroids, endometriosis, ovarian cysts, pelvic inflammatory disease (PID)

how can you test for secondary dysmenorrhea?

physical exam, ultrasound, STI tests, hysteroscopy, laparoscopy

what is the most common benign tumor affecting women?

fibroids

what percentage of women are affected by fibroids?

approximately 40-80% of women

in which layer of the uterus do fibroids originate

the uterine smooth muscle layer (myometrium)

what hormone are fibroid growths dependent on?

circulating estrogen levels

what are some symptoms of fibroids?

excessive bleeding, painful periods (dysmenorrhea), abdominal bloating, pain during sex

what are some tests for fibroids?

physical exam, ultrasound, CT, MRI, hysteroscopy

what is endometriosis?

a condition in which endometrial cells grow outside of the uterus in other areas, such as the surface of the ovaries and fallopian tubes (rarely, outside the intestinal and urinary tracts, very rarely outside the lungs and heart)

what are some symptoms of endometriosis?

can be extremely variable, and include dysmenorrhea, heavy periods (menorrhagia), diarrhea, constipation, bloating, pain during sex, infertility

what are some causes of endometriosis?

largely unknown; retrograe flow, immune and hormone disorders, family history of endometriosis

what is laparoscopic surgery?

a minimally invasive surgery that uses small incisions to perform operations in the abdomen or pelvis; can help in some diagnoses and subsequent surgical procedures

what are the main benefits of laparoscopic surgery compared to open surgery?

less pain, a shorter recovery time, and less scarring. other benefits can include less blood loss, a lower risk of infection, and a shorter hospital stay

what are ovarian cysts?

common growths that develop on or inside your ovaries.

what percentage of women are affected by benign (harmless) ovarian cysts?

~10% of women

what percentage of ovarian cysts are caused by serious conditions?

1%

what are the symptoms of ovarian cysts?

most often, none— however, during sex, it can cause dysmenorrhea, oligomenorrhea, bloating, and pain. they can also range in size significantly (1-3 cm to greater than 10cm). in RARE cases, they can twist (torsion) or rupture, which then become emergencies

what causes ovarian cysts?

normal developing follicles, abnormal cell reproduction (benign), endometriosis, PCOS, very rarely cancer

how can you test for ovarian cysts?

physical exam, ultrasound, laparoscopy

how can you treat ovarian cysts?

have them monitored first, then possibly treated with hormonal birth control or laparoscopic removal

what is pelvic inflammatory disease (PID)?

an infection in the uterus, fallopian tubes, and/or ovaries

what causes pelvic inflammatory disease (PID)?

the spread of untreated sexually transmitted infections (STIs), most commonly gonorrhea and chlamydia

what percentage of chlamydia and gonorrhea accounts for pelvic inflammatory disease cases?

90%

which reproductive organ does PID affect, and what can happen if untreated

uterus, fallopian tubes, ovaries; can lead to infertility, chronic, infection, and damage

how many females in the U.S. get PID each year?

more than 1 million

how many people become infertile each year because of PID?

more than 100,000

in what age range does PID occur most frequently in females?

between 15 and 25 years old

what percentage of women experience PID over their lifetime?

4.4%

how can you treat pelvic inflammatory disease (PID)?

typical treatment is with antibiotics to heal the causing infection

what are the symptoms of pelvic inflammatory disease (PID)?

pain — ranging from mild to severe — in the lower abdomen and pelvis

unusual or heavy vaginal discharge that may have an unpleasant odor

unusual bleeding from the vagina, especially during or after sex, or between periods

pain during intercourse

fever, sometimes with chills

painful, frequent, or difficult urination

what are the short-term complications of pelvic inflammatory disease (PID)?

abscesses in the fallopian tube or ovaries

what are the long-term complications of pelvic inflammatory disease (PID)?

ectopic pregnancy, infertility, and chronic pelvic pain

what happens if you don’t treat pelvic inflammatory disease (PID)?

inflammatory damage, resulting in scarring, adhesions, and partial or total obstruction of the uterine tubes — which can result in loss of the ciliated epithelial cells along the fallopian tube lining, resulting in impaired egg transport and increased risk for infertility and ectopic pregnancy

what is the key to preventing PID complications?

early diagnosis and prompt treatment with antibiotics

what is abnormal uterine bleeding (AUB)?

any vaginal bleeding that is heavy, long, irregular, or occurs between periods; includes menorrhagia (heavy/long periods) and metorrhagia (bleeding between periods), often combined as menometrorrhagia

what are common signs of AUB?

soaking a pad/tampon hourly, bleeding >7 days, spotting between periods, large clots (>quarter size), anemia, bleeding after menopause

what are common causes of AUB?

hormone imbalance (PCOS, thyroid), uterine growths (polyps, fibroids, endometriosis), pregnancy issues, STIs (chlamydia, gonorrhea), thyroid/liver/kidney disease, meds, bleeding disorders, pre-cancer/cancer (rare)

when is abnormal uterine bleeding (AUB) normal?

common during menarche (start of periods) & perimenopause (transition to menopause) due to natural hormone fluctuations

how is abnormal uterine bleeding (AUB) diagnosed?

blood tests (CBC, hormones), pap smear, physical exam, ultrasound, hysteroscopy (can include biopsy)

what are common treatments for AUB?

hormonal birth control (progesterone, IUDS), tranexamic acid (reduces loss), iron supplements (for anemia), surgery (if needed), managing underlying conditions (PCOS, thyroid)

how prevalent is abnormal uterine bleeding (AUB)?

affects 10-30% of women, often underreported