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DU PA GYN Bleeding

Duke PA Amenorrhea, Dysmenorrhea, and Abnormal Uterine Bleeding

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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