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| If implantation does not occur, the corpus luteum involutes and _____ is withdrawn | progesterone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