Chapter 10. ABNORMAL MENSTRUAL CYCLES

Reid L. Norman, PhDReid L. Norman, PhD

Professor, Pharmacology and Professor, Pharmacology and Neuroscience, TTUHSCNeuroscience, TTUHSC

Learning Objectives

• Describe the terminology of normal and Describe the terminology of normal and abnormal menstrual functionabnormal menstrual function

• List the causes of menstrual dysfunctionList the causes of menstrual dysfunction• Understand the consequences of menstrual Understand the consequences of menstrual

dysfunction in young womendysfunction in young women• Know the health concerns due to menstrual Know the health concerns due to menstrual

dysfunctiondysfunction

Menstrual cycle terminology

• Eumenorrhea – regular menstrual cycles of Eumenorrhea – regular menstrual cycles of 25-38 days25-38 days

• Oligomenorrhea – menstrual cycles of 39-Oligomenorrhea – menstrual cycles of 39-90 days90 days

• Amenorrhea – when menstrual cycles are Amenorrhea – when menstrual cycles are more than 90 days or when menstruation is more than 90 days or when menstruation is absentabsent

Eumenorrhea

• Normal, regular menstruation which lasts Normal, regular menstruation which lasts for 3-5 days but a range of 2-7 days is for 3-5 days but a range of 2-7 days is considered normalconsidered normal

• Average blood loss is 35 cc or a little over Average blood loss is 35 cc or a little over an ounce an ounce

• This usually reflects regular, cyclic This usually reflects regular, cyclic ovulation and no underlying organic ovulation and no underlying organic problemsproblems

Oligomenorrhea

• When menstrual cycles are irregular and When menstrual cycles are irregular and longer than 39 dayslonger than 39 days

• This condition is common when women are This condition is common when women are just starting (at puberty) or ending (at just starting (at puberty) or ending (at menopause) their reproductive lifemenopause) their reproductive life

Causes of oligomenorrhea

• PCOS – polycystic ovary syndrome PCOS – polycystic ovary syndrome • Ovary becomes filled with cystsOvary becomes filled with cysts• Excess androgen productionExcess androgen production• Excess facial and body hairExcess facial and body hair• Usually anovulatory cyclesUsually anovulatory cycles• 5 – 10 % of women will experience this 5 – 10 % of women will experience this

sometime during their lifesometime during their life

Causes of oligomenorrhea

• Low energy availability – possible causesLow energy availability – possible causes• DietingDieting• Eating disordersEating disorders• Excessive exerciseExcessive exercise• Body image concernsBody image concerns• Other stresses (psychological) may also Other stresses (psychological) may also

contribute to this problemcontribute to this problem

Causes of oligomenorrhea

• HypothyroidismHypothyroidism• HyperprolactinemiaHyperprolactinemia• Chronic diseaseChronic disease• Social unrest (such as wars)Social unrest (such as wars)• Move to a new, unfamiliar environmentMove to a new, unfamiliar environment

• Go away to collegeGo away to college• IncarcerationIncarceration

Amenorrhea

• Pregnancy is the most common causePregnancy is the most common cause• Anorexia nervosa – eating disorder, Anorexia nervosa – eating disorder,

potentially lethalpotentially lethal• Female athlete triadFemale athlete triad

• AmenorrheaAmenorrhea• Eating disorderEating disorder• osteopeniaosteopenia

Amenorrhea

• Loss of bone is a major risk with this Loss of bone is a major risk with this conditioncondition

• Generally, this condition is due to loss of Generally, this condition is due to loss of hypothalamic GnRH secretion which results hypothalamic GnRH secretion which results in low LH and FSH release and low in low LH and FSH release and low estrogen and progesterone levelsestrogen and progesterone levels