Duke PA Amenorrhea, Dysmenorrhea, and Abnormal Uterine Bleeding
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| menstrual pain associated with ovulatory cycles in the absence of pathological findings | primary dysmenorrhea
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| primary dysmenorrhea usually begins within __ years after menarche and may become more severe with time | 2-5
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| dysmenorrhea affects __% of women at sometime | 50-75
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| characteristics of dysmenorrhea pain | low, midline, wave-like, cramping pelvic pain often radiating to the back or inner thighs
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| menstrual pain for which an organic cause exists | secondary dysmenorrhea
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| possible causes of secondary dysmenorrhea | endometriosis, pelvic inflammatory disease, submucous myoma, IUD use, cervical stenosis with obstruction, or blind uterine horn (rare)
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| polycystic ovary syndrome is a common cause of chronic __ | anovulation
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| __% of patients with polycystic ovary syndrome have amenorrhea | 50
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| __% of patients with polycystic ovary syndrome have abnormal bleeding | 30
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| __% of patients with polycystic ovary syndrome have normal menstruation | 20
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| aberrant growth of endometrium outside the uterus, particularly in the dependant parts of the pelvis and in the ovaries | endometriosis
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| the most common cause of secondary dysmenorrhea | endometriosis
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| what is the most widely accepted cause of endometriosis | retrograde menstruation
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| characteristics of endometriosis | pelvic pain, which may be associated with infertility, dyspareunia, or rectal pain with bleeding.
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| with endometriosis the pain generally occurs __ days before menses and worsens until flow slackens | 2-7
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| with increasing duration of endometriosis pain may become __ | continuous
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| most women with endometriosis have a __ pelvic exam | normal
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| pelvic exam in a woman with endometriosis may reveal __ | tender nodules in the cul-de-sac or rectovaginal septum, uterine retroversion with decreased uterine mobility, cervical motion tenderness, or an adnexal mass or tenderness
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| the clinical diagnosis of endometriosis is presumptive and is usually confirmed by __ | laparoscopy
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| average age of menarche in the US | 12.7
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| menarche usually occurs between the ages of __ years | 11-15
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| the failure of menarche to appear is called __ | primary amenorrhea
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| evaluation is commenced if at age __ neither menarche nor breast development has occured or if height is in the lowest 3%, or at age __ if menarche has not occured | 14, 16
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| causes of primary amenorrhea | hypothalamic pituitary causes, hyperanderogenism, ovarian causes, pseudohermaphroditism, uterine causes, and pregnancy
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| the initial endocrine evaluation of a patient with amenorrhea should include serum determination of | FSH, LH, PRL, testosterone, TSH, FT4, and hCG
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| absence of menses for 3 consecutive months in women who have passed menarche | secondary amenorrhea
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| the terminal episode of naturally occurring menses | menopause
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| a retrospective diagnosis, usually made after 6 months of amenorrhea | menopause
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| causes of secondary amenorrhea | pregnancy, hypothalamic-pituitary causes, hyperandrogenism, uterine causes, premaure ovarian failure, and menopause
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| __ is the most common cause for secondary amenorrhea in pre-menopausal women | pregnancy
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| the period of natural physiologic decline in ovarian function, generally occuring over about 10 years | climacteric
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| normal age range for menopause in the US is __ | 48-55
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| average age of menopause in the US | 51.5
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| amenorrhea, nausea and breast engorgement are typical signs of __ | early pregnancy
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| amenorrhea, headache/visual field abnormalities are seen with | ptiuitary or hypothalamic tumors
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| common sign of hyperprolactinemia | galactorrhea
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| hirsuitism or virilization may be a sign of | hyperandrogenism
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| weakness, psychiactric changes, hypertension, central obesity, hirsuitism, thin skin, ecchymoses may indicate __ | alcoholism or cushings syndrome
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| weight loss, diarrhea, or skin darkening may indicate | adrenal insufficiency
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| psychological symptoms of climacteric may include | depression and irritability
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| acute symptoms of estrogen deficiency | depression, irritability, fatigue, insomnia, headache, diminished libido, rheumatologic symptoms, vasomotor instability (hot flashes)
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| hot flashes with drenching sweat may be more severe when | at night
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| vasomotor instability (hot flashes) occur in __% of women in climacteric | 80
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| an elevated hCG overwhelmingly indicates __ | pregnancy
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| __ produced by the follicle stimulates the endometrium to grow in height during the proliferative phase | estradiol
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| the follicle becomes a corpus luteum and has a life span of __ days | 10
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| upon formation the corpus luteum begins to produce __ | progesterone
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| when the corpus luteum produces progesterone endometrial growth __ and the sroma becomes compact and rich in glycogen | stops
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| if implantation does not occur, the __ involutes and progesterone is withdrawn | corpus luteum
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| what happens when progesterone is withdrawn | immediate shrinkage of the height of the endometrium, the spiral arteries rhythmically constrict and relax decreasing blood flow, the spongiosum peels away from the basalis layer
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| what is the normal menstrual cycle length | 28 + or - 7 days
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| what is the duration of menses | 4 + or - 2 days
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| what is the duration of the follicular phase | 7-12 days
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| what is the duration of teh luteal phase | 14 + or - days
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| menstrual cycle <21 day intervals | polymenorrhea
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| irregular menses | metrorrhagia
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| irregular heavy bleeding | menometrorrhagia
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| menstrual cycle >35 day intervals | oligomenorrhea
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| DD of abnormal uterine bleeding | complications of pregnancy, trauma, cancer, benign pelvic pathology, systemic disease, iatrogenic
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| uterus with a fibroid that reaches the level of the umbilicus is described as __ weeks | 20
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| vaginal ultrasounds are best done with the bladder __ | empty
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| Endometriosis within the muscle of the uterus= | adenomyosis (thickened uterine wall, can be mistaken for fibroids)
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| Endometriosis: 10-fold risk increase if: | 1st-degree relative has it
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| if menorrhagia at menarche or adolescence, think: | coagulopathy
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