Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Menstrual Disorders


Related Terms

  • Amenorrhea
  • Dysmenorrhea
  • Menorrhagia
  • Metrorrhagia
  • Oligomenorrhea

Differential Diagnosis

Specialists

  • Endocrinologist
  • Family Physician
  • General Surgeon
  • Gynecologist
  • Obstetrician/Gynecologist
  • Pathologist

Comorbid Conditions

  • Anorexia nervosa
  • Depression
  • Hyperthyroidism
  • Hypothyroidism
  • Obesity
  • Renal failure
  • Smoking
  • Stress disorder

Factors Influencing Duration

The severity and duration of symptoms, underlying cause, duration and frequency of bleeding, type of treatment, response to treatment, and individual's job requirements affect the length of disability. For amenorrhea, no disability is expected.

Medical Codes

ICD-9-CM:
625.2 - Menorrhagia
625.3 - Dysmenorrhea
625.8 - Other Specified Symptoms Associated with Female Genital Organs
626.0 - Amenorrhea
626.1 - Menstruation, Scanty or Infrequent
626.4 - Menstruation, Irregular
626.9 - Menstrual Disorders

Overview

Menstrual disorders are irregularities or abnormalities of the menstrual cycle, including the absence of menstrual periods (amenorrhea); cramping abdominal and/or pelvic pain associated with the menstrual period (dysmenorrhea); excessive or prolonged menstrual blood loss greater than 80 mL, or a period lasting more than 7 days (menorrhagia); and abnormal bleeding from the uterus at irregular intervals, especially outside the normal menstrual cycle, and sometimes of prolonged duration (metrorrhagia).

Failure to start menstruating by age 16 is called primary amenorrhea; secondary amenorrhea is the absence of periods for 3 consecutive months in a woman who previously had regular menstrual cycles. Primary dysmenorrhea is characterized by menstrual cramps and discomfort in the absence of pelvic disease; secondary dysmenorrhea is menstrual discomfort secondary to an underlying disease or pathology.

Incidence and Prevalence: Secondary amenorrhea affects about 5% to 7% of menstruating women annually (Bielak). Prevalence does not vary among racial groups and corresponds to the prevalence of causative diseases. Primary dysmenorrhea may affect as many as 50% of menstruating women and usually manifests in late adolescence and the beginning of the third decade of life (Calis). Secondary dysmenorrhea may begin in the twenties after years of normal periods and is most frequently encountered in women between ages 30 and 45 (Calis). Ten to twenty percent of all menstruating women experience menorrhagia; most are older than age 30 (Shaw).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Amenorrhea may occur as a result of many conditions. Primary amenorrhea is associated with a dysfunction of the hypothalamic-pituitary-ovarian axis that manifests as delay of puberty and the absence of breast development and pubic hair by age 13.5 to 14 years, a lack of reproductive organs (missing uterus or vagina), or a structural abnormality of the reproductive organs (blockage or narrowing of the cervix, imperforate hymen, vaginal septum).

Secondary amenorrhea is more common. Pregnancy, breast-feeding, and menopause are the most common causes of secondary amenorrhea for natural reasons in reproductive-age women. Secondary amenorrhea may result from endocrine disorders with hormonal imbalances, such as ovarian disorders (polycystic ovarian disease), diabetes, thyroid abnormalities (hyperthyroidism or hypothyroidism), pituitary tumors, premature menopause, and Cushing's syndrome. Other causes include chronic or systemic illnesses (cystic fibrosis, heart disease); genetic abnormalities; excessive exercise; chronic emotional stress; depression; obesity; excessive or rapid weight loss; reduced caloric intake, including self-starvation (anorexia nervosa); infections (e.g., syphilis, tuberculosis); drugs such as chemotherapeutic agents; anovulation associated with discontinuing birth control medications (although this type of amenorrhea usually only lasts 6 to 8 weeks, it can persist for a year or more); and uterine scarring.

Although the exact cause of dysmenorrhea is uncertain, primary dysmenorrhea has been associated with the hormone prostaglandin, which is released during the menstrual period. Smoking, longer and heavier periods, and family history (genetic factors) are risk factors for dysmenorrhea. It is not associated with the typical discomfort that may occur just before a menstrual period (premenstrual syndrome). Secondary dysmenorrhea may be caused by abnormal growth of functional endometrial tissue outside the uterus (endometriosis), (growth of endometrial tissue within the muscular wall of the uterus (adenomyosis), fibroids (fibromas or leiomyomas in the uterine wall), an intrauterine device (IUD) used for contraception, postoperative adhesions, bacterial infection of the uterus and fallopian tubes (pelvic inflammatory disease [PID]), an obstructed cervix (cervical stenosis), and congenital malformation, among others.

Menorrhagia is usually due to an imbalance between the hormones estrogen and progesterone, but can also be caused by any disorder that affects the ovaries or the uterus, including fibroid tumors, polyps, adenomyosis, an intrauterine device (IUD) used for contraception, a pelvic infection, endometriosis, liver or kidney disease, bleeding disorders, and endocrine disorders, among other things. Sometimes no physical cause can be found. Menorrhagia can be a regular occurrence or may occur only once.

Metrorrhagia may result from hormonal imbalances, stress, miscarriage, gynecologic disorders (such as endometriosis), inflammation, and cancer (uterine, ovarian, or cervical), among other things.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report absence of or changes in the menstrual cycle and related symptoms. A thorough history must be obtained, including pubertal development; age at menarche (onset of menses); typical menstrual cycle (length, flow, number of days between menses); past and current medical conditions (especially chronic illnesses such as Crohn's disease); any symptoms suggesting central nervous system disease (visual changes, headaches); bleeding disorders (both personal and family); diet (including weight loss and exercise); medications, including contraception and the use of hormones; drug or alcohol use; sexual activity; acne or excessive hair growth (hirsutism); and family members' experience of puberty. A history of trauma and surgery should also be obtained.

Dysmenorrhea is characterized by cramping, labor-like pains in the lower abdomen that usually begins just prior to or at the start of the menstrual period. Pain may come and go in waves. Individuals may also report nausea, vomiting, and a dull pain in the lower back. In 10% of women, dysmenorrhea is painful enough to be incapacitating, or to interfere with work or leisure activities (Calis). In primary dysmenorrhea, cramps begin at menarche (the first menstrual period). Secondary dysmenorrhea typically begins after a few years of painless periods. In secondary dysmenorrhea, pain begins several days before and lasts throughout the menstrual period.

A woman with menorrhagia will typically report a large amount of blood loss during her menses. The average blood loss during a menstrual period is about 2 fluid oz (60 mL); women with menorrhagia may lose 3 oz (90 mL) or more. Although this may sound like a small amount, it can lead to severe anemia.

With metrorrhagia, a woman will complain of bleeding during the interval between periods.

Physical exam: Physical examination includes vital signs, height, weight, Tanner stage (a system for categorizing sexual development), general appearance (individuals with some genetic disorders may have a webbed neck or be unusually short), palpation of the thyroid and examination for other evidence of thyroid disease, examination of the breasts for galactorrhea (production of a milk-like substance), examination of the eyes, a thorough neurologic exam, and a search for signs of elevated androgen levels (male hormones that can cause acne or hirsutism in women).

A pelvic exam is usually performed to determine if a uterus is present (the absence of a uterus indicates androgen insensitivity syndrome or agenesis), to exclude pregnancy, and to evaluate the vaginal mucosa for any effects of estrogen, mucus secretion, or lack of mucus and a dry, pale vagina suggesting ovarian dysfunction.

For women with dysmenorrhea, a bimanual pelvic exam can determine if there is uterine tenderness, enlarged ovaries, or fibroid tumors.

Tests: The type of menstrual abnormality will determine the need for tests. Blood tests may include a complete blood count (CBC) to look for anemia or infection, chemistries and endocrine tests to assess for chronic disease, and measurement of thyroid and reproductive hormones. Diagnostic tests for dysmenorrhea, menorrhagia, and metrorrhagia may include pregnancy test, Pap smear, or urine and cervical cultures.

Imaging studies may include transabdominal or transvaginal ultrasound (sonography) of the abdomen and pelvis to identify masses such as ovarian tumors or fibroids; ultrasound is also helpful in assessing uterine size and shape. Computed tomography (CT) scan or magnetic resonance imaging (MRI) can detect pituitary tumors in the brain, while abdominal or pelvic CT or MRI can show tumors of the adrenal glands. An endometrial biopsy or laparoscopy may be considered.

Source: Medical Disability Advisor



Treatment

Treatment focuses on the cause of the disorder and any underlying conditions.

Treatment of amenorrhea includes correction of hormonal imbalances and induction of ovulation. Weight problems, excessive exercise, and anorexia and bulimia nervosa need to be addressed because of the long-term threat they pose to the woman's health. Similarly, stress and depression may be treated with use of appropriate medications and psychological counseling or stress reduction techniques.

Treatment of dysmenorrhea begins with reassurance and education and can include pain relievers (analgesics) and drugs that block the action of prostaglandin (nonsteroidal anti-inflammatory drugs [NSAIDs]). Birth control pills (oral contraceptives, used for 3 to 6 months) and non-contraceptive hormones can relieve symptoms by suppressing ovulation. Topical application of continuous, low-level heat may prove helpful to some individuals (Calis). Any identified underlying causes of secondary dysmenorrhea are also treated.

Treatment for menorrhagia depends on the age of the woman, the severity of the bleeding, whether or not she wants children in the future, and any underlying medical conditions. Hormone medications (estrogen, progesterone) can be used to reduce the bleeding. Progestin is the most frequently prescribed drug for women with menorrhagia (Shaw). If uterine fibroid tumors are the cause of menorrhagia, they can be surgically removed; some are treated with medications, uterine artery embolization, or ablation techniques. If an IUD is the cause, it can be removed. A dilation and curettage (D&C), in which the endometrial lining is scraped away, may be beneficial if the lining has thickened and is causing excessive bleeding. The endometrial lining can also be thinned (endometrial ablation) using laser or electrocautery. Recently developed ablation therapies include uterine thermal balloon therapy, in which a balloon catheter is inserted into the endometrial cavity, inflated, and heated (Shaw). Other second-generation techniques intended to provide simpler, quicker, safer, and more successful methods of reducing and treating the endometrial lining in cases of menorrhagia include cold treatments (cryoablation); hot saline solution irrigation (heated free fluid); endometrial laser ablation; microwave endometrial ablation; and radiofrequency (RF) ablation (Shaw). If menorrhagia is severe enough or does not respond to treatment, the uterus may be surgically removed (hysterectomy).

Metrorrhagia may be treated with hormones such as those in oral. If bleeding becomes profuse (hemorrhage), bed rest, D&C, and/or hospitalization may be required.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the nature and underlying cause of the menstrual disorder. Amenorrhea due to genetic abnormalities (e.g., absence of ovaries) may not respond to therapy. Some women with amenorrhea choose not to receive treatment if the underlying cause is not a health threat.

Dysmenorrhea due to hormone imbalances and prostaglandin production may respond well to medical treatment. Other underlying conditions responsible for dysmenorrhea have variable outcomes, depending on the severity of the condition and type of treatment. The outcome of endometriosis may also be good with treatment and reduction of the endometriosis using endometrial ablation. The prognosis for PID is more variable: infection generally resolves with antibiotic therapy, but unfortunately, PID can lead to scarring of the Fallopian tubes, causing infertility. Fibroids can usually be successfully treated with medication, uterine artery embolization, ablative techniques, or surgical removal. The outcome of reproductive tract cancers as a cause of dysmenorrhea varies with the type, stage of disease, and response to treatment.

A D&C procedure generally corrects menorrhagia. Endometrial ablation has been shown to successfully correct conditions of the endometrial lining (i.e., endometriosis) associated with menstrual irregularities.

Source: Medical Disability Advisor



Complications

In general, any complications associated with menstrual disorders are related to the underlying condition. Complications of amenorrhea relate to complications of the underlying condition, including endocrine disorders, hormonal imbalance, congenital abnormalities of the reproductive tract, emotional disorders, and ovarian tumor or cyst. Prolonged amenorrhea is associated with increased incidence of osteoporosis and hip fracture. Complications of menorrhagia and metrorrhagia can include anemia.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In general, physical activity may need to be reduced or limited when symptoms are present. Specific restrictions or accommodations depend on underlying cause and resulting treatment. Women with amenorrhea caused by regular, heavy physical exercise and associated lean body mass may need to reduce their levels of activity and increase their proportion of body fat for regular menstrual cycles to resume. Pregnancy and diagnostic and therapeutic procedures may require time off from work. The necessary amount of time off depends on the extent of the procedure. Diagnostic laparoscopy may only require a few days for recovery, but abdominal hysterectomy may require 6 to 8 weeks off from work.

Risk: There is no job that leads to menstrual disorders.

Capacity: Individuals with underlying endometriosis, adenomyosis, and/or very large, symptomatic fibroids that require laparoscopy, endometrial ablation, or hysterectomy may have temporary restrictions on heavy lifting and prolonged standing. Capacity may be affected by the amount of bleeding experienced with menorrhagia if anemia occurs. Individuals with excessive blood loss during menses may need frequent restroom breaks for adequate management of feminine hygiene products. If a hysterectomy was performed, lifting must be kept to 10 pounds to avoid strain and allow internal healing during recovery.

Tolerance: With dysmenorrhea, tolerance factors include the severity and duration of symptoms (e.g., cramping, nausea, vomiting, low back pain). Menorrhagia severe enough to necessitate changing of tampons and/or feminine hygiene pads every hour may result in poor sleep and fatigue that may affect job performance the following day. Tolerance is typically not a concern with amenorrhea.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have symptoms of dysmenorrhea, such as cramping, labor-like pain in the lower abdomen that begins just prior to or at the start of the menstrual period?
  • Does individual report pain that comes and goes in waves?
  • Do nausea, vomiting, and a dull, lower backache accompany abdominal cramps?
  • Does primary dysmenorrhea respond to pain relievers and other treatments?
  • If not, were possibility of secondary dysmenorrhea and underlying causes investigated?
  • Does individual lose 3 oz (90 mL) or more of blood during an average menstrual period?
  • Was diagnosis of the specific menstrual disorder confirmed through pelvic exam and diagnostic testing (i.e., pregnancy test, Pap smear, or urine and cervical cultures)?
  • Were conditions such as congenital abnormalities, pregnancy, and ovarian disorders ruled out?
  • Were endometriosis, PID, or fibroid tumors of the uterus ruled out?
  • Was individual’s menstrual disorder diagnosed as amenorrhea, dysmenorrhea, menorrhagia, or metrorrhagia?

Regarding treatment:

  • Was underlying condition identified? Is it responding to treatment?
  • Has treatment included making any pertinent lifestyle modifications, as well as correcting any hormonal imbalance?
  • Do symptoms warrant a more aggressive treatment, such as endometrial ablation or hysterectomy?
  • Was hospitalization required?
  • If underlying cause was cancer, was it diagnosed and treated before it metastasized?

Regarding prognosis:

  • Is underlying condition responding to treatment?
  • Is the disorder expected to recur?
  • Does individual have a coexisting condition that may complicate treatment or affect recovery?
  • Has individual experienced complications related to the menstrual disorder, such as endocrine disorder, hormonal imbalance, congenital abnormalities of the reproductive tract, emotional disorders, ovarian tumors or cysts, or anemia?
  • If symptoms persist despite treatment, would individual benefit from consultation with a specialist (gynecologist, endocrinologist)?

Source: Medical Disability Advisor



References

Cited

Bielak, Kenneth M. , et al. "Amenorrhea." eMedicine. 29 Sep. 2014. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/252928-overview>.

Calis, Karim Anton, et al. "Dysmenorrhea." eMedicine. 1 Dec. 2014. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/253812-overview>.

Shaw, Julia A., et al. "Menorrhagia." eMedicine. 29 Sep. 2014. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/255540-overview>.

Source: Medical Disability Advisor






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