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Harrison's Internal Medicine Chapter 51. Menstrual Disorders and Pelvic Pain Menstrual Disorders and Pelvic Pain: Introduction Menstrual dysfunction can signal an underlying abnormality that may have long-term health consequences. Although frequent or prolonged bleeding usually prompts a woman to seek medical attention, infrequent or absent bleeding may seem less troubling, and the patient may not bring it to the attention of the physician. Thus, a focused menstrual history is a critical part of every female patient encounter. Pelvic pain is a common complaint that may relate to an abnormality of the reproductive organs but may also be of gastrointestinal, urinary tract,. | Chapter 051. Menstrual Disorders and Pelvic Pain Part 1 Harrison s Internal Medicine Chapter 51. Menstrual Disorders and Pelvic Pain Menstrual Disorders and Pelvic Pain Introduction Menstrual dysfunction can signal an underlying abnormality that may have long-term health consequences. Although frequent or prolonged bleeding usually prompts a woman to seek medical attention infrequent or absent bleeding may seem less troubling and the patient may not bring it to the attention of the physician. Thus a focused menstrual history is a critical part of every female patient encounter. Pelvic pain is a common complaint that may relate to an abnormality of the reproductive organs but may also be of gastrointestinal urinary tract or musculoskeletal origin. Depending on its cause pelvic pain may require urgent surgical attention. Menstrual Disorders Definition and Prevalence Amenorrhea refers to the absence of menstrual periods. Amenorrhea is classified as primary if menstrual bleeding has never occurred in the absence of hormonal treatment or secondary if menstrual periods are absent for 3-6 months. Oligoamenorrhea is defined as a cycle length 35 days or 10 menses per year. Both the frequency and amount of vaginal bleeding are irregular in oligoamenorrhea. It is often associated with anovulation which can also occur with intermenstrual intervals of 24 days or vaginal bleeding for 7 days. Frequent or heavy irregular bleeding is termed dysfunctional uterine bleeding if anatomic uterine lesions or a bleeding diathesis have been excluded. Primary Amenorrhea This is a rare disorder occurring in 1 of the female population. However between 3 and 5 of women experience at least 3 months of secondary amenorrhea in a given year. There is no evidence that race or ethnicity influence the prevalence of amenorrhea. However because of the importance of adequate nutrition for normal reproductive function both the age at menarche and the prevalence of secondary amenorrhea vary significantly .
