20- Menstruation And Puberty

Question 1

What is the different value of normal menstrual bleeding?

Answer 1

Interval: 24-35 days ( mean of 28 days)
Duration: 2-7 days(mean:5 days)
Volume<80 mL (mean 35 mL)

Question 2

What is menorrhagia?

Answer 2

Prolonged excessive bleeding

Question 3

What is metrorrhagia?

Answer 3

Frequent irregular or intermenstrual bleeding

Question 4

What is menometrorrhagia?

Answer 4

Combination of menorrhagia and metrorrhagia

Question 5

What is hypomenorrhea?polymenorrhea?oligomenorrhea? Amenorrhea?

Answer 5

Hypomenorrhea- very little flow<10 mL
Polymenorrhea- cycles with interval equal or less than 21 days
Oligomenorrhea- cycles with interval>35 days
Amenorrhea- >3_6 months without menses but not pregnant and or not due to menopause

Question 6

What are the 2 portions of the menstrual cycle?

Answer 6

Proliferative phase in the endometrium corresponds to the follicular phase in the ovary
Secretory phase in the endometrium corresponds with the luteal phase in the ovary
Luteal phase is more consistent and lasts 14 days

Question 7

What are the characteristics of the menstrual cycle?

Answer 7

Day 1- first day of bleeding
In a 28 day cycle ovulation occurs at day 14
FSH in the early phase drives growth of follicles
FSH decreases in response to negative inhibitory effect of estradiol
Massive amount of estradiol causes a surge in LH causing ovulation
If no pregnancy corpus luteum degenerates

Question 8

What are the causes of heavy menstrual bleeding?

Answer 8

Abnormal uterine bleeding
Thyroid disorders
Endometrial hyperplasia/carcinoma

Question 9

What is the mechanism of anovulatory bleeding?

Answer 9

Progesterone withdrawal signals endometrium to shed
Women who do not ovulate do not have progesterone withdrawal because no corpus luteum formed
Bleeding is due to unopposed estrogen

Question 10

How to evaluate abnormal uterine bleeding?

Answer 10

History consistent with ovulatory cycles
Timed endometrial biopsy
LH surge kits detect LH surge in urine which follows LH surge in serum but occurs before ovulation
Day 21 serum progesterone level

Question 11

What is the therapies for abnormal uterine bleeding?

Answer 11

Medical- oral contraceptives, cycle progestin, high dose NSAIDs
Surgical- endometrial ablation, hysteroscopic, hysterectomy

Question 12

What are the sequences of sexual maturation in girls?

Answer 12

Breast budding (10-11)
Sexual hair growth (10.5-11.5)
Growth spurt (11-12)
Menarche (11.5-13)
Adult breast development (12.5-15)
Adult sexual hair

Question 13

What to do in case of ambiguous genitalia ?

Answer 13

Do not assign gender
Wait for karyotype
Explain parent that sexual maturation has not completed