Abnormal Menstration Flashcards
Menorrhagia Vs Metrorrhagia
Menorrhagia = Heavy or prolonged bleeding Metrorrhagia = Intermenstrual bleeding, spotting, or breakthrough bleeding
Menstrual interval > 35 days
Oligomenorrhea
Crampy or spasmodic pain in lower abdomen that occurs only in ovulatory cycles without the presence infectious process or injury
Primary Dysmenorrhea
8 non pelvic sx of Dysmenorrhea
HA - N/V - bloating -back ache - diarrhea - syncope - breast tenderness
Next best step for pt with primary dysmenorrhea that is refractory to tx w/ NSAIDS
Pelvic exam
5 nonphamacologic tx for Primary Dysmenorrhea
Heat - Diet - Behavior modification - TENS - Exercise/yoga
16 yo girl presents bc she is missing approx. 2 days of school each month for cramping, and severe head aches that coincide with her menses. Primary Tx? Next best step if breakthrough sx or refractory?
Ibuprofen / Naproxen Sulfate (NSAIDS)
OCP - thins endometrium = less prostaglandin production
6 Causes of Secondary Dysmenorrhea
Endometriosis - Adenomyosis - IUD - Uterine Leiomyomata - Ovarian Cyst - Chronic pelvic disease
Cyclic dysmenorrhea that lasts longer and becomes more severe over time w/ pelvic pain that is worse w/ menses and ovulation
Endometriosis
PE findings for Endometriosis
Pelvic tenderness w/ uterine movement
Palpable nadules on exam
Fixed, tender, enlarged adnexa
Imaging, Dx study, and tx for Endometriosis?
US - Laparoscopy - Pain tx + surgery + Post op hormone supression
Treatment goal for Endometriosis?
Manage pelvic pain + prevent infertility
What is the most common tumor of the female pelvis and what type of cells are is it composed of?
Uterine Leiomyomata - smooth muscle cells of the myometrium
7 factors that increase risk for Leiomyomata
Early menarche - Meat consumption - family hx - Beer - hx of uterine infxn - Vit D def - Obesity
8 factors that decrease risk for Leiomyomata
> 1 pregnancy, OCP, Progestin only injectable contraception, smoking, green veg + fruit, Vit A, Menopause, Exercise
What tool can be used to verify luteal timing of PMS sx?
Cope calendar
what is the difference between primary and secondary amenorrhea?
1 - No menses by age 15 w/ normal growth and development or > 2 yr after completing sexual maturation
2 - No menses for at least 3-6 months after having at least 1 menses
Stress, athletics, and obesity cause what type of amenorrhea?
Functional hypothalamic amenorrhea
Most common reason for primary amenorrhea?
Turner syndrome - XO
1st step in every case of 2ndary amenorrhea
Hcg! pregnancy is #1 cause
Scarring of endometrial lining due to previous infxn or surgery, known to cause amenorrhea? How do you dx?
Asherman’s syndrome
Pelvic US + Progestin challenge
TX for Asherman’s syndrome?
Hysteroscope lysis of adhesions + estrogen tx to regrow endometrium
What is PALM - COEIN used for?
All the causes of Abnormal Uterine Bleeding:
Polyp - Adenomyosis - Leimyoma - Malignancy
Coagulopathy - Ovulatory - Endometrial - Iatrogenic - Not classified
Abnormal uterine bleeding in post menopausal women
CANCER!!! (10% will have endometrial cancer)
What does a thickened endometrial stripe on US signify? best next step?
Endometrial Hyperplasia + Cancer
Endometrial biopsy
What is indicated if endometrial bx comes back hyperplasia w/o atypia? W/ atypia?
1) Dialation and Curettage - > Progestin tx
2) Hysterectomy
A 54-year-old woman presents with chest and neck flushing. She states this began 6 months ago. The “warm feeling”, as she describes it, is becoming more frequent, and seems to occur mainly in the evening. She denies any recent infections. There are no dermatologic lesions seen on physical examination. Her final menstrual period was 14 months ago. These symptoms are most likely due to a decline in what hormone?
Estradiol
A 29-year-old woman presents with cyclic pelvic pain that has been increasing over the last 7 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. What is the most likely diagnosis?
Endometriosis
What is the most frequent cystic structure found in the ovary?
Follicular cyst
A 23-year-old woman presents with pain in in the suprapubic area and right lower quadrant of her abdomen that began 4 hours ago. She denies vagina discharge and vaginal bleeding. Her vital signs are BP 115/65, HR 60, RR 12, and T98.1°F. Her last menses was one week ago. Which of the following diagnostic tests should be obtained first?
Hcg pregnancy test for all women of childbearing age sigh pelvic pain
A 15-year-old girl presents for severe lower abdominal pain that occurs for the first two days of her menstrual cycle each month. She has associated nausea and diarrhea. She denies menorrhagia. She had a normal menarche at age 13 and is not sexually active. Abdominal and pelvic exams are normal. Which of the following is the initial best step in management?
Recommend ibuprofen starting one day before menses
A 42-year-old woman presents for evaluation of irregular menses, associated with episodes of excessive daytime sweating and palpitations. She has not had a hysterectomy or oophorectomy. She is currently sexually active, although intercourse has been more uncomfortable lately. Which of the following disorders would you consider in this patient’s differential diagnosis?
Hyperthyroidism
