Gynecology
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| PMS course | 1-2 weeks before menses (during luteal phase) to 1-2 days post onset; symptom-free during follicular phase
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| DUB causes | usually increased anovulatory cycles; also PCOS, obesity, adrenal hyperplasia
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| endometriosis pathophysiology | endometrial glands & stroma outside endometrium, usually pelvis or on ovary (90%) or distant
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| Amenorrhea: pathophysiology (if low/normal FSH): | HPA tumor, Cushing, hypothyroid, high testosterone, uterine malformation.
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| Dysmenorrhea: tx | Heat, thiamine; vitamin E; NSAIDs, celebrex; OCPs. Laparoscopy if tx failure (to rule out causes of secondary dysmenorrhea)
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| Cervicitis: etiology | often CT/NG; or idiopathic
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| Amenorrhea: dx tests | LH, FSH, prolactin, testosterone, TSH, FT4, hCG, DHEA-S, estradiol
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| secondary dysmenorrhea etiology | endometriosis, adenomyosis, uterine leiomyomata, chronic PID. Onset usually after age 25
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| primary dysmenorrhea etiology | frequent/ prolonged uterine contractions mediated by prostaglandins -> decreased blood flow to myometrium -> ischemia (uterine "angina"). Onset 1-2 yrs post-menarche
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| Chronic pelvic pain sx | Intermittent, cyclical, dull, nonspecific, diffuse. Generally afebrile
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| Endometriosis sx | Dysmenorrhea; dyspaurenia; low back pain. Adhesive dz possible. Improved with suppression of ovulation
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| Osteitis pubis | Symphysis pain; Pelvic joint instability following childbirth
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| Vulvodynia | Vulvar pain; Painful urination; Dyspaurenia; Vaginal and Pelvic floor symptoms
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| Primary dysmenorrhea: onset within: | 1-2 years of menarche
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| Musculoskeletal pelvic pain includes: | Myofascial pain; Muscle spasm; Round ligament; Spinal nerve innervation
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| Painful bladder syndrome = | Dysuria; Negative UA; Urinary Frequency; Dyspareunia ; Dx of exclusion/ autoimmune component
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| Overweight, irregular menstrual cycles or amenorrhea, infertility, elevated blood sugar, hirsutism = | PCOS (Stein-Leventhal syndrome)
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| Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs | Mittelschmerz
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| Dysmenorrhea, dyspareunia, dyschezia. Uterus is fixed, retroflexed. Cyclic pelvic pain. May have palpable pelvic mass = | Endometriosis
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| Palpable pelvic mass (chocolate cyst) = | Endometriosis
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| primary amenorrhea = | absence of menses by 13 yo (in pt w/o secondary sexual characteristics) or by 15 yo (in pts having secondary sexual characteristics)
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| secondary amenorrhea = | cessation of menses after onset of menarche, lasting 3+ months
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| secondary amenorrhea: pt w/o secondary sex characteristics = | 2/2 gonad agenesis, pubertal delay, ovarian resistance syndrome, galactosemia, GnRH def, CNS mass lesion
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| secondary amenorrhea: pt w/ breast devt but no pubic hair = | androgen insensitivity
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| secondary amenorrhea: normal 2nd sex characteristics = | imperforate hymen, transverse vaginal septum, mullerian dysgenesis
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| secondary amenorrhea: incomplete 2nd sex characteristics = | HPA tumor, hypothyroid, hyperprolactinemia, premature ovar failure
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| secondary amenorrhea, not PG: | Asherman syndrome (uterine synechiae) or PCOS
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| primary dysmenorrhea = | painful menses 2/2 xs prostaglandin E2 secretion; onset near menarche, peaks in late teens
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| secondary dysmenorrhea = | 2/2 other condition (endometriosis, adenomyosis, fibroids); usu >25 yo
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| Ectopic PG sx | Missed menses/unusual menses; Lower abdominal/pelvic pain; Vaginal bleeding; Positive PG test
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| Ovarian cyst sx | Unilateral/diffuse; Sharp; Spontaneous resolution common; Uncommon on OCPs
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| Ovarian torsion sx | severe pain, down legs/back
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| average uterine length = 6-8 cm |
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| uterine (apical) prolapse grading | 0 (no descent) to 4 (thru hymen)
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| anterior vaginal wall prolapse includes: | cystocele or cystourethrocele
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| apical vaginal prolapse includes: | uretovaginal or vaginal vault prolapse
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| posterior vaginal prolapse includes: | enterocele or rectocele
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| Atrophic vaginitis often masquerades as: | Infection
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| atrophic vaginitis S/S | Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation; women w/o menses (decreased estrogen)
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| PCOS pathology | Abnormal gonadotropin secretion with excessive androgen production with pituitary suppression
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| Amenorrhea: pathophysiology (if high FSH): | Ovarian, Turner, autoimmune. High LH: pseudohermaphroditism
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| Menstrual cycle definitions | Normal: Q24-38 days. Oligo: interval >36 days. Polymenorrhea: interval <21 days
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| Primary amenorrhea causes | developmental/absence of repro organs, ovarian failure, hypogonadotrophic hypogonadism, androgen insensitivity, chronic anovulation
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| Secondary amenorrhea causes | CNS, pituitary/thyroid/adrenal/ovarian/uterine dysfn, strenuous exercise
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| endometritis sx/sx | usually post C-section or if membrane rupture >24 hours pre-delivery. sx/sx 2-3 days post partum; fever >101F, uterine tenderness
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