Medix

  Definition and causes Painful periods. Primary dysmenorrhea No organ pathology. Usually starts 6-12 months post-menarche i.e. once cycle is established. Secondary dysmenorrhea Occurs later in life, secondary to organ pathology: Fibroids Adenomyosis and endometriosis. Adhesions Uterine polyps PID IUCD Signs and symptoms Primary dysmenorrhea: Symptoms worse on 1st or 2nd day of period. Crampy pain. Lower abdo pain radiating to back and groin. Associated symptoms: nausea, vomiting, diarrhoea, fatigue, headache. Secondary dysmenorrhea: Pain constant through period and possibly through luteal phase. Irregular or heavy bleeding. Dyspareunia Bloating Discharge Management NSAIDs: Ibuprofen, naproxen, or mefenamic acid. All are equally effective, though ibuprofen has fewest side effects. Hormonal: Combined contraceptive pill. Progestins: levonorgestrel IUS (Mirena), desogestrel (Cerazette), Depo-Provera. Treatment of underlying cause: Surgical removal of fibroids or endometriosis. Antibio...

  Background Overview Definition: failure to conceive despite regular unprotected intercourse. WHO defines it as 1 year, NICE used to define it as 2 years (but now doesn't specify). Investigate couples who are having difficulty after 1 year of trying. 85% of people conceive within 1 year, and 92% within 2 years. 50% are due to female causes, 30% male, and 20% unexplained. Sometimes both male and female causes are present. Female causes Usually ovulatory – commonly PCOS – or tubal – commonly PID or endometriosis. Age is the most important determinant of fertility. Declines steeply in late 30s. Ovulatory: WHO class 1 (HPO failure → hypogonadotrophic hypogonadal): anorexia nervosa, intense exercise, Kallmann syndrome (congenital ↓GnRH, anosmia). WHO class 2 (normogonadotrophic normoestrogenic): mainly PCOS, which causes 90% of anovulatory infertility. WHO class 3 (primary ovarian failure → hypergonadotrophic hypoestrogenic): amenorrhea including premature menopause, radiation or chemo...

  Definition and causes No periods. Primary amenorrhea Failure to start periods. May be a genetic or chromosomal cause, including Turner's and fragile X. Secondary amenorrhea Periods stop for more than 6 months, caused by STOP TAMPON. Usually due to HPO axis dysfunction: S tress Pituitary  T umour. O ver-exercise and weight loss. P sychiatric: anorexia nervosa. Others: T hyrotoxicosis A sherman's syndrome: adhesions. Early  M enopause. P COS O varian tumour. N eonatal: post-pregnancy and breastfeeding. Investigations Rule out pregnancy. Primary amenorrhea: Consider if 16 years old and has not experienced menarche, or is 14 years old and has had no breast development. If chromosomal sex disorder suspected, examine genitalia and consider karyotype testing. Secondary amenorrhea: ↑LH and ↑testosterone in PCOS (though both can be normal). ↑LH and ↑FSH in ovarian failure, inc. premature menopause. ↓LH and ↓FSH in hypothalamic dysfunction e.g. excess exercise. ↑Prolactin suggest...