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DU PA GYN Bleeding
Duke PA Amenorrhea, Dysmenorrhea, and Abnormal Uterine Bleeding
| Question | Answer |
|---|---|
| menstrual pain associated with ovulatory cycles in the absence of pathological findings | primary dysmenorrhea |
| primary dysmenorrhea usually begins within __ years after menarche and may become more severe with time | 2-5 |
| dysmenorrhea affects __% of women at sometime | 50-75 |
| characteristics of dysmenorrhea pain | low, midline, wave-like, cramping pelvic pain often radiating to the back or inner thighs |
| menstrual pain for which an organic cause exists | secondary dysmenorrhea |
| possible causes of secondary dysmenorrhea | endometriosis, pelvic inflammatory disease, submucous myoma, IUD use, cervical stenosis with obstruction, or blind uterine horn (rare) |
| polycystic ovary syndrome is a common cause of chronic __ | anovulation |
| __% of patients with polycystic ovary syndrome have amenorrhea | 50 |
| __% of patients with polycystic ovary syndrome have abnormal bleeding | 30 |
| __% of patients with polycystic ovary syndrome have normal menstruation | 20 |
| aberrant growth of endometrium outside the uterus, particularly in the dependant parts of the pelvis and in the ovaries | endometriosis |
| the most common cause of secondary dysmenorrhea | endometriosis |
| what is the most widely accepted cause of endometriosis | retrograde menstruation |
| characteristics of endometriosis | pelvic pain, which may be associated with infertility, dyspareunia, or rectal pain with bleeding. |
| with endometriosis the pain generally occurs __ days before menses and worsens until flow slackens | 2-7 |
| with increasing duration of endometriosis pain may become __ | continuous |
| most women with endometriosis have a __ pelvic exam | normal |
| 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 |
| the clinical diagnosis of endometriosis is presumptive and is usually confirmed by __ | laparoscopy |
| average age of menarche in the US | 12.7 |
| menarche usually occurs between the ages of __ years | 11-15 |
| the failure of menarche to appear is called __ | primary amenorrhea |
| 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 |
| causes of primary amenorrhea | hypothalamic pituitary causes, hyperanderogenism, ovarian causes, pseudohermaphroditism, uterine causes, and pregnancy |
| the initial endocrine evaluation of a patient with amenorrhea should include serum determination of | FSH, LH, PRL, testosterone, TSH, FT4, and hCG |
| absence of menses for 3 consecutive months in women who have passed menarche | secondary amenorrhea |
| the terminal episode of naturally occurring menses | menopause |
| a retrospective diagnosis, usually made after 6 months of amenorrhea | menopause |
| causes of secondary amenorrhea | pregnancy, hypothalamic-pituitary causes, hyperandrogenism, uterine causes, premaure ovarian failure, and menopause |
| __ is the most common cause for secondary amenorrhea in pre-menopausal women | pregnancy |
| the period of natural physiologic decline in ovarian function, generally occuring over about 10 years | climacteric |
| normal age range for menopause in the US is __ | 48-55 |
| average age of menopause in the US | 51.5 |
| amenorrhea, nausea and breast engorgement are typical signs of __ | early pregnancy |
| amenorrhea, headache/visual field abnormalities are seen with | ptiuitary or hypothalamic tumors |
| common sign of hyperprolactinemia | galactorrhea |
| hirsuitism or virilization may be a sign of | hyperandrogenism |
| weakness, psychiactric changes, hypertension, central obesity, hirsuitism, thin skin, ecchymoses may indicate __ | alcoholism or cushings syndrome |
| weight loss, diarrhea, or skin darkening may indicate | adrenal insufficiency |
| psychological symptoms of climacteric may include | depression and irritability |
| acute symptoms of estrogen deficiency | depression, irritability, fatigue, insomnia, headache, diminished libido, rheumatologic symptoms, vasomotor instability (hot flashes) |
| hot flashes with drenching sweat may be more severe when | at night |
| vasomotor instability (hot flashes) occur in __% of women in climacteric | 80 |
| an elevated hCG overwhelmingly indicates __ | pregnancy |
| __ produced by the follicle stimulates the endometrium to grow in height during the proliferative phase | estradiol |
| the follicle becomes a corpus luteum and has a life span of __ days | 10 |
| upon formation the corpus luteum begins to produce __ | progesterone |
| when the corpus luteum produces progesterone endometrial growth __ and the sroma becomes compact and rich in glycogen | stops |
| if implantation does not occur, the __ involutes and progesterone is withdrawn | corpus luteum |
| 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 |
| what is the normal menstrual cycle length | 28 + or - 7 days |
| what is the duration of menses | 4 + or - 2 days |
| what is the duration of the follicular phase | 7-12 days |
| what is the duration of teh luteal phase | 14 + or - days |
| menstrual cycle <21 day intervals | polymenorrhea |
| irregular menses | metrorrhagia |
| irregular heavy bleeding | menometrorrhagia |
| menstrual cycle >35 day intervals | oligomenorrhea |
| DD of abnormal uterine bleeding | complications of pregnancy, trauma, cancer, benign pelvic pathology, systemic disease, iatrogenic |
| uterus with a fibroid that reaches the level of the umbilicus is described as __ weeks | 20 |
| vaginal ultrasounds are best done with the bladder __ | empty |
| Endometriosis within the muscle of the uterus= | adenomyosis (thickened uterine wall, can be mistaken for fibroids) |
| Endometriosis: 10-fold risk increase if: | 1st-degree relative has it |
| if menorrhagia at menarche or adolescence, think: | coagulopathy |
Created by:
bwyche
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