1. Chapter 10. ABNORMAL MENSTRUAL CYCLES Reid L. Norman, PhD Professor, Pharmacology and Neuroscience, TTUHSC

2. Learning Objectives Describe the terminology of normal and abnormal menstrual functionDescribe the terminology of normal and abnormal menstrual function List the causes of menstrual dysfunctionList the causes of menstrual dysfunction Understand the consequences of menstrual dysfunction in young womenUnderstand the consequences of menstrual dysfunction in young women Know the health concerns due to menstrual dysfunctionKnow the health concerns due to menstrual dysfunction

3. Menstrual cycle terminology Eumenorrhea – regular menstrual cycles of 25-38 daysEumenorrhea – regular menstrual cycles of 25-38 days Oligomenorrhea – menstrual cycles of 39- 90 daysOligomenorrhea – menstrual cycles of 39- 90 days Amenorrhea – when menstrual cycles are more than 90 days or when menstruation is absentAmenorrhea – when menstrual cycles are more than 90 days or when menstruation is absent

4. Eumenorrhea Normal, regular menstruation which lasts for 3-5 days but a range of 2-7 days is considered normalNormal, regular menstruation which lasts for 3-5 days but a range of 2-7 days is considered normal Average blood loss is 35 cc or a little over an ounceAverage blood loss is 35 cc or a little over an ounce This usually reflects regular, cyclic ovulation and no underlying organic problemsThis usually reflects regular, cyclic ovulation and no underlying organic problems

5. Oligomenorrhea When menstrual cycles are irregular and longer than 39 daysWhen menstrual cycles are irregular and longer than 39 days This condition is common when women are just starting (at puberty) or ending (at menopause) their reproductive lifeThis condition is common when women are just starting (at puberty) or ending (at menopause) their reproductive life

6. Causes of oligomenorrhea PCOS – polycystic ovary syndromePCOS – 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 sometime during their life5 – 10 % of women will experience this sometime during their life

7. 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 contribute to this problemOther stresses (psychological) may also contribute to this problem

8. 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

9. Amenorrhea Pregnancy is the most common causePregnancy is the most common cause Anorexia nervosa – eating disorder, potentially lethalAnorexia nervosa – eating disorder, potentially lethal Female athlete triadFemale athlete triad AmenorrheaAmenorrhea Eating disorderEating disorder osteopeniaosteopenia

10. Amenorrhea Loss of bone is a major risk with this conditionLoss of bone is a major risk with this condition Generally, this condition is due to loss of hypothalamic GnRH secretion which results in low LH and FSH release and low estrogen and progesterone levelsGenerally, this condition is due to loss of hypothalamic GnRH secretion which results in low LH and FSH release and low estrogen and progesterone levels