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Gyn: Abnl Bleeding
Abnormal Uterine Bleeding, Amenorrhea, and Dysmenorrhea
| Question | Answer |
|---|---|
| Is there a surge in LH and FSH in a woman on OCP? | No. |
| Big boggy uterus, lots of bleeding and trouble getting pregnant may suggest | Asherman's Syndrome |
| Anatomic causes of irregular bleeding | fibroids, noncompliance to birth control pills, Coumadin, Depo-Provera (spotty then stops), foreign bodies (IUD), vascular anomalies, malignancy, coagulation defects, infections |
| How long is a Depo-Provera shot good for? | 3 months |
| Cycles | Menses, Proliferative Phase, Ovulation |
| _______ produced by the follicle stimulates teh endometrium to grow in height | Estradiol. Progesterone receptors incresae in numbers |
| The follicle becomes a corpus luteum and has a life span of | 10 days |
| ____ produces progesterone | Coprus luteum |
| If implantation does not occur, the corpus luteum involutes and _____ is withdrawn | progesterone |
| Menorrhagia | Heavy menses (>80mL |
| Metrorrhagia | irregular menses |
| menometrorrhagia | irregular/heavy bleeding |
| polymenorrhea | <21 day interval |
| Oligomenorrhea | >35 day intervals |
| AUB = | DUB (ovulatory: dysfunctional Uterine Bleeding) + Structural (organic) bleeding |
| Differential Diagnosis of AUB | Complications of pregnancy, trauma, cancer, benign pelvic pathology, systemic disease, Iatrogenic (medications) |
| Pain of ovulation | Middleschmertz |
| STDs to screen for with bleeding | HPV, Chlamydia, Gonorrhea, Trichomonas. Often if it is post-coital, it may be an STD. Look for polyps on speculum exam (usually benign, but remove and send to pathology) |
| Older women with new bleeding may be | atrophic vaginitis. Frank red bleeding |
| Ulcerations in the vagina may be | herpes |
| Fibroids | if they affect your bleeding, would cause heavier bleeding. With a fibroid uterus, you would expect a larger uterus described as like a gestational uterus ( in weeks). May complain of needing to urinate constantly. Pelvic and rectal pressure. |
| Two types of IUDs | Copper for 10 years (makes period heavier), Progesterone for 5 years (makes period lighter) |
| Those at risk for uterine cancer | overweight, nulliparity, diabetic. (not risk factors: thin, mother, birth control) |
| Causes of abnormal uterine bleeding | always consider pregnancy first! |
| Hypothyroidism can cause | abnormal bleeding |
| Tamoxifen tx for breast cancer can increase risk for | endometrial cancer. |
| Ectopic Pregnancies | Emergency, people can die from this . |
| Amenorrhea, positive pregnancy test, rule out | ectopic. Relief of pain indicates rupture, only a short time before death |
| Cervicitis STDs | Chlamydia and Gonorrhea |
| Abnormal Uterine Bleeding Work up | H and P, Labs: CBC, HCG, Thyroid, Other hormones (?), cultures, Endometrial biopsy, US, hyperoscopy |
| Abdominal US requires | bladder to have 2 L of liquid in it. Not so in vaginal US, bladder better empty |
| SIS | Saline infused US. Infused into cavity |
| MRI test of choice in | adenomyosis |
| Evaluation of Endometrial Cavity | Transvaginal Ultrasound, Infusion sonography, Hysteroscopy |
| Hysteroscopic Endometrial Ablation | Rollerball/rollerbarrel, Loop resection, Hydrothermal ablation (HTA) |
| Non-hysteroscopic Endometrial Ablation | Therachoice (balloon), Her Option (cryo), Novasure (bipolar mesh), Microwave |
| Prevalence of Hysterectomy by age 60 in the US (from 1997 data) | 1 in 3 |
| Primary Amenorrhea | failure to menstruate by 16 in presence of secondary sexual characteristics or by age 14 in the absence of secondary sexual characteristics |
| Secondary Amenorrhea | Cessation of menstrual flow for a period of time equal to 3 cyclesAll causes of secondary amenorrhea can also present as primary amenorrhea |
| 50% of Primary amenorrhea is caused by | Chromosomal abnormalities causing gonadal dysgenesis |
| Pituitary Adenoma will do what to Prolactin levels? | Elevate them. Other signs: galactorrhea, amenorrhea, a change in peripheral vision |
| Amenorrhea Basic Evaluation | B-hCG, TSH, FSH, LH, Prolactin, Karyotype, MRI pituitary, Progestin Challenge |
| 1/3 of patients with secondary amenorrhea have | pituitary tumors |
| Premature Ovarian Failure | Ovarian failure before age 40. Tx to protect from decreased bone density, increased CV risk, Sleep loss, hot flashes, Libido |
Created by:
ltm12