Menstruation, Menopause and Menstrual Disorders

What is Menarche?

it is the first menstruation

What is precocious puberty?

it is when a child begins changing into that of an adult (puberty) too soon

What age of puberty for girls in considered precocious puberty?

girls before the age of 8 years old

What age of puberty for boys in considered precocious puberty?

boys before the age of 9 years old

What is the average age for girls to begin their first period (menarche) in the US?

the average age is 13 years old

How would the first period (menarche) be described for girls?

• initially irregular

• painless

• anovulatory (no ovulation)

How long can a period be irregular for a girl who just started their period?

periods are usually irregular for the first year of menarche

When does ovulation start after a girl gets her period?

they start ovulating after the first year of their period which is when periods become regular

What is the average menstrual cycle length among women?

it is 28 days long

What are some things that can affect the menstrual cycle?

• stress

• medications

• weight changes

• eating disorders

• strenuous exercise

• metal illness

• >20% underweight

What day of your menstrual cycle is the first day blood is seen?

day 1

What is Perimenopause?

it is the transitional phase during which ovulation function and hormone production decline

• periods become irregular again

What defines Menopause?

it is when a woman has not had a menses for 12 months

What are some characteristics of menopause?

• thinning of the labia

• vaginal dryness

• increase in lipids

• hot flashes

• insomnia

What are some treatments for Menopause?

• hormone replacement therapy

• herbs

• vitamins

• exercise

What are some risk factors for hormone replacement therapy for menopause?

• coronary artery disease

• stroke

• venous thromboembolism

• breast cancer

How should hormone replacement be prescribed for a patient with menopause?

it should always be prescribed at the lowest effective dose for the shortest possible time

What type of hormone replacement therapy will be needed for a patient with a uterus experiencing menopause?

she will need estrogen and progesterone

What is the risk for giving just estrogen hormone replacement therapy to a woman with a uterus experiencing menopause?

it puts her at a risk for endometrial hyperplasia & cancer

What are some non-pharmacological treatments for women going through menopause?

• relaxation techniques

• phytoestrogens

• isoflavone supplements (vitamin & calcium supplements)

• high fiber, low fat diet

• exercise

• sleep in a cold room, dressed in layers (helps with hot flashes)

• have a regular bedtime (helps with insomnia)

What are some examples of phytoestrogens (non-pharmacological) for women going through menopause?

• flax seeds

• soybeans

• tofu

• soy yogurt

What are some examples of isoflavone supplements (non-pharmacological) for women going through menopause?

• soy/red clover

• black cohosh

• vitamin E

What is primary amenorrhea?

• the failure of initiation of menses by age 13 in absence of secondary sexual characteristics

• the absence of menarche by age 15 regardless of the presence of normal growth and development of secondary sexual characteristics

What are some causes for primary amenorrhea?

• anatomical malformations

• endocrine disorders

• chronic disease

• eating disorders

• medication

What is secondary amenorrhea?

• 3 months or more cessation of menses after a period of menstruation in a woman with a history of regular menses

• 6 months or more cessation of menses after a period of menstruation in a woman with a history of irregular menses

What is the most common cause of secondary amenorrhea?

pregnancy is the most common cause

Amenorrhea is one the of the classic signs of what?

it is the classic sign of anorexia

What is the female athlete triad?

it is the combination of disordered eating, amenorrhea, and premature osteoporosis

What female athletes are more perceptible to the female athlete triad?

• gymnastics

• running

• cycling

• figure skating

What is Dysmenorrhea?

it is pain during or shortly after menstruation

What are the risk factors for dysmenorrhea?

• smoking

• obesity

What is primary dysmenorrhea?

it often has a biochemical basis & arises from the release of prostaglandins

When can dysmenorrhea starts to occur?

when a woman starts ovulating during menses

What are some non-pharmacological treatments for primary dysmenorrhea?

• heating pad

• warm bath

• message

• yoga

• acupuncture

• exercise

• decreased salt

• nutritional changes-natural diuretics- cranberry juice, watermelon, low fat diet, vegetarian diet

What is a pharmacological treatment for primary dysmenorrhea?

NSAID

• tell pt. that med side effect is GI upset

What is secondary dysmenorrhea?

it is pain during or shortly after menstruation acquired later in life and is associated with pelvic pathology

What is needed for a women having secondary dysmenorrhea?

a pelvic exam is needed

What else can a women need besides a pelvic exam for secondary dysmenorrhea?

a women may also need an ultrasound, dilation & curettage, endometrial biopsy or laparoscopy to diagnose depending on exam findings & associated symptoms

What is Pelvic Inflammatory Disease (PID)?

it is an infection that has ascended into the pelvic organ

What is a uterine fibroid?

it is a benign tumor(s) in the uterus

What is endometriosis?

it is the presence of endometrial tissue outside of the uterus

What are some non-pharmacological treatments for Premenstrual Syndrome (PMS)

• natural diuretics (foods)

• calcium

• vitamin B6

• evening primrose oil

• stop smoking

• limit sugar, salt, red meat, & caffeinated beverages

• regular exercise

• yoga

• massage

What are some pharmacological treatments for Premenstrual Syndrome (PMS)?

• NSAIDs

• Diuretics

• Oral contraceptives

• Antidepressants

What is Premenstrual Dysphoric Disorder (PMDD)?

it is cyclic symptoms occurring in the last 7-10 day of the menstrual cycle

Women with Premenstrual Dysphoric Disorder (PMDD) should be monitored for what?

they should be monitored for suicidal ideations

What are some symptoms of endometriosis?

• dysmenorrhea

• dyspareunia (painful intercourse)

• pelvic pain

• infertility

What are some treatment options for women with endometriosis?

• NSAIDs

• oral contraceptives

• medical menopause

• total hysterectomy

What is oligomenorrhea?

it is less than 9 menstrual cycles per year or cycle length greater then 35 days

What is hypomenorrhea?

it is an extremely light menstrual blood flow

What is Menorrhagia (hypermenorrhea)?

it is a heavy or prolonged menstrual bleeding

What is Metrorrhagia?

it is abnormal uterine bleeding between monthly periods

What is abnormal uterine bleeding?

it is any form of uterine bleeding that is irregular in amount, duration, or timing and is not related to regular menstrual bleeding

What is dysfunctional uterine bleeding?

it is abnormal vaginal bleeding that varies from a women’s normal menstrual cycle

• usually hormonal

What are some possible causes of oligomenorrhea or hypomenorrhea?

• oral contraceptives

• Depo Provera

• IUD

What are some possible causes of menorrhagia?

• early pregnancy loss

• hormonal imbalances

• inherited bleeding disorders

• medications (anticoagulants)

• uterine fibroids

• endometrial polyps

• endometrial cancer

What are some treatment options for menorrhagia?

• NSAIDs

• oral contraceptives

• Mirena IUD

• surgery for uterine fibroids, endometrial polyps, endometrial cancer

What is Oophorectomy (ovariectomy)?

it is the surgical removal of one or both ovaries

What is Salpingectomy?

it is the surgical removal of one or both fallopian tubes

What is a total hysterectomy?

it is the removal of the uterus and cervix

What is a partial hysterectomy?

it is the removal of the uterus, but keeping the cervix intact in the women’s body