Makindo Medical Notes"One small step for man, one large step for Makindo" |
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🌸 Menstrual Disorders – Clinical Overview for Medics Menstrual problems are among the most frequent gynaecological presentations in both primary care and secondary care. They can significantly impact quality of life and sometimes signal serious underlying pathology. Understanding the pathophysiology allows clinicians to differentiate between functional hormonal imbalances and structural or systemic causes. 🔑 Key mechanisms: - 🧬 Hormonal dysregulation: Hypothalamic–pituitary–ovarian (HPO) axis disturbances → irregular or absent cycles. - 🩸 Endometrial pathology: Unopposed oestrogen or impaired haemostasis → heavy bleeding. - 🔥 Inflammatory mediators: Prostaglandins and cytokines drive dysmenorrhoea and endometriosis. - ⚙️ Structural causes: Fibroids, polyps, ovarian cysts alter bleeding and pain patterns.
🌺 Menstrual Problem | 🔬 Pathophysiology | 🔎 Investigations | 💊 Management |
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Heavy Menstrual Bleeding (Menorrhagia) | 🩸 Excess endometrial proliferation due to unopposed oestrogen. Coagulopathy, thyroid disease, or uterine pathology (fibroids, polyps) may contribute. Defective vasoconstriction and fibrinolysis prolong bleeding. |
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Painful Periods (Dysmenorrhoea) | 🔥 ↑ Prostaglandin F2α → uterine hypercontractility & vasoconstriction → ischaemic pain. Secondary causes include endometriosis, adenomyosis, or fibroids. |
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Amenorrhoea / Oligomenorrhoea | ⚖️ Dysfunction at any level of the HPO axis. - Hypothalamic (stress, weight loss, excessive exercise) - Pituitary (hyperprolactinaemia, adenoma) - Ovarian (PCOS, premature ovarian insufficiency) - End-organ (uterine scarring, e.g. Asherman’s). |
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PMS / PMDD | 🌗 Cyclical symptoms in luteal phase. Dysregulated serotonin pathways interact with fluctuating oestrogen/progesterone. PMDD represents the severe end of the spectrum. |
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Polycystic Ovary Syndrome (PCOS) | ⚙️ Insulin resistance + ↑ LH/FSH ratio → ↑ ovarian androgen synthesis → anovulation, cystic ovaries, hirsutism. Long-term ↑ risk of T2DM, endometrial carcinoma. |
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Endometriosis | 🌱 Ectopic endometrial tissue → cyclical bleeding outside uterus → inflammation, scarring, adhesions. Mediated by prostaglandins and cytokines; hallmark = chronic pelvic pain, infertility. |
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