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Women's Health - GYN > Abnormal Menstruation > Flashcards

Abnormal Menstruation Flashcards

1
Q

Two most common causes of secondary dysmenorrhea?

A

endometriosis

uterine fibroids

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2
Q

dysmenorrhea =

A

painful menses; aka menstrual cramps

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3
Q

Menorrhagia =

A

heavy or prolonged menses bleeding

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4
Q

Metrorrhagia =

A

Intermenstrual bleeding, spotting or breakthrough bleeding

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5
Q

Polymenorrhea =

A

Menstrual interval < 21 days

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6
Q

Oligomenorrhea =

A

Menstrual interval > 35 days

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7
Q

Primary dysmenorrhea onset and pathophysiology?

A

adolescence, usually starts 2 yrs after menarche but may be immediate

uterine “angina” caused by prostaglandins

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8
Q

Lab tests that are mandatory if sexually active teen

A

Chlamydia and GC

HIV and RPR (VDRL)

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9
Q

Treatment of primary dysmenorrhea

A

Heat, diet/supplements, behavior modification, TENS, exercise

NSAIDS (ibuprofen, Naproxen sulfate)

Oral contraceptives if no relief from aggressive NSAID tx

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10
Q

Dosing of ibuprofen or Naproxen (Aleve) for menstrual cramps?

A

Ibuprofen: 400-600 mg q 4-6 hours or 800 mg q 8 hours to a max dose of 2400 mg/day with food

Naproxen (Aleve): 500 mg to start, then 250 -500 q 8-12 hours

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11
Q

How do oral contraceptives help with primary dysmenorrhea?

A

they thin endometrium which results in less prostaglandin production

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12
Q

secondary dysmenorrhea =

A

painful abd cramping with menses WITH pelvic pathology

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13
Q

What is endometriosis?

A

Endometrial tissue growing outside of endometrial cavity and uterus, most commonly in pelvis

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14
Q

PE findings of endometriosis

A
  • Pelvic tenderness with uterine movement
  • Palpable nodules on exam
  • Fixed, tender, enlarged adnexa (appendages)
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15
Q

Best diagnostic imaging for endometriosis

A

Laparoscopy

  • may miss with U/S
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16
Q

Endometriosis treatment

A

Goal: manage pelvic pain and prevent infertility

  1. NSAIDs and/or OC’s
  2. Refer to gynecology for surgery vs hormonal interventions
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17
Q

Benign tumors in smooth muscle cells of myometrium. Most common tumor of the female pelvis.

A

Uterine Leiomyomata (fibroids)

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18
Q

Epidemiology of Uterine Leiomyomata (or fibroids)

A

More common in African Americans

Occurs in 30-40s

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19
Q

Labs to determine cause of secondary dysmenorrhea

A 
Pregnancy testing
STI testing
CBC
UA
Pelvic U/S
Laproscopy
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20
Q

What increases risk of uterine fibroids?

A 
Early menarche
Meat consumption
Family history
Beer
History of uterine infection
Vitamin D deficiency
Obesity (>30% body fat)
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21
Q

When is there decreased risk for fibroids?

A

menopause
> 1 pregnancy
use of OC’s

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22
Q

Therapy for uterine fibroids

A
  • Watchful waiting
  • Prophylactic myomectomy (prevents infertility, more complicated) vs. hysterectomy
  • Oral contraceptive pills
  • Lupron (GnRH analog)
23
Q

Best contraceptive for young girl who is not sexually active but has primary dysmenorrhea?

A

transdermal patch

24
Q

When do symptoms of PMS occur in cycle?

A

luteal phase; 7-10 days before onset of menses

symptoms resolve soon after flow begins and are absent during follicular phase

25
Q

Way for patient to help you diagnosis and monitor her PMS?

A

COPE calendar

26
Q

Nutritional modification to relieve PMS

A

Limit salt, refined sugar, caffeine, alcohol, fat
Increase complex carbohydrates and fiber

Vit B or calcium supplements

Evening Primrose Oil

27
Q

PMS + one affective symptom (anger, irritability, internal tension). Dx’d by DSM-IV criteria

A

Premenstrual dysphoric disorder

28
Q

Premenstrual dysphoric disorder treatment

A
  • OCP with 4 pill-free interval (Yaz)
  • SSRIs
  • Tranquilizers during luteal phase if very severe (Xanax or Ativan)
29
Q

When is woman at risk for increased PMS symptoms?

A

perimenopausal

30
Q

Define primary amenorrhea

A
  • No menses by age 15 with normal development

- No menses after 2 yrs of completing sexual maturation

31
Q

pathophysiology of primary amenorrhea

A

dysfunction at hypothalamus or pituitary; usually functional (emotional stress, athletics, weight)

dysfunction at ovaries; Turner Syndrome (XO)

dysfunction at uterus or vagina; menses can’t occur d/t anatomic abnormality

32
Q

Most common of all primary amenorrhea? What are signs?

A

Turner Syndrome

short stature, webbed neck, short 4th metacarpal, nail dysplasia, high-arched palate, wide-space nipples (broad square chest), hypertension, renal abnormalities

33
Q

causes of secondary amenorrhea

A 
PREGNANCY!!!
hypothalamic dysfunction
hypothyroidism
pituitary tumor, hyperprolactinemia
Polycystic ovary syndrome
Ovarian failure = menopause
Asherman's Syndrome
34
Q

Definition of secondary amenorrhea

A

absence of menses for 3-6 months after having at least 1 menses

35
Q

What can cause hypothalamic dysfunction in women?

A

female athlete triad
emotional stress and illness
idiopathic

36
Q

What is Asherman’s Syndrome? How is it eval’d and treated?

A

Secondary amenorrhea due to scarring of endometrial lining from previous infection or surgery

Eval with Pelvic U/S, and Progestin challenge

TX: Hysteroscope lysis of adhesions; estrogen therapy to regrow endometrium

37
Q

First thing to do to eval for secondary amenorrhea

A

Pregnancy test

38
Q

PALM-COEIN classification system for causes of abnormal uterine bleeding

A 
P = polyps
A = adenomyosis
L = Leiomyomas (fibroids)
M = malignancy and hyperplasia
C = coagulopathy
O = ovulatory dysfunction
E = endometritis
I = iatrogenic
N = not yet classified
39
Q

Any bleeding in _______ women is abnormal. Concern?

A

post-menapausal

endometrial cancer

40
Q

Most common etiology of endometrial hyperplasia and cancer

A

chronic unopposed estrogen stimulation

exogenous - estrogen therapy w/o progestin
endogenous - chronic anovulation

41
Q

Risk factors for endometrial cancer

A 
Increasing age (peak 50-60s)
Unopposed estrogen therapy
Late menopause
Obesity
Polycystic ovary
DM
Tamoxifen therapy (used post breast cancer)
FHX of cancer (BRCA 1,2)
42
Q

Diagnosis of endometrial hyperplasia and cancer

A

Pelvic U/S with thickened endometrial stripe
Then endometrial biopsy
D&C to further eval biopsy results

43
Q

When should woman undergo eval for endometrial cancer?

A
  • over 40 with abnormal uterine bleed
  • under 40 with abnormal uterine bleed + risk factors
  • Failure to respond to treatment for bleed
  • Presence of atypical glandular cells on cervical cytology
  • Presence of endometrial cells in woman > 40
44
Q

What is D&C?

A

= Dilation and Curettage

brief surgical procedure in which cervix is dilated and a special instrument is used to scrape the uterine lining

45
Q

Endometrial Hyperplasia & Cancer treatment?

A

endometrial hyperplasia without atypia -> Progestin

endometrial hyperplasia with atypia -> Hysterectomy

endometrial cancer diagnosed on endometrial biopsy -> Referral to gynecologic oncologist

46
Q

When should coagulopathy causes of uterine bleeding be suspected?

A

Heavy or prolonged menses at menarche
Family history of coagulopathy
Signs such as easy bruising, prolonged bleeding from mucosal surfaces
Taking meds that increase bleeding tendency - warfarin

47
Q

Causes of ovarian dysfunction-related uterine bleeding?

A 
Puberty	
Perimenopause
Obesity 
Polycystic ovary syndrome	
Cigarette Smoking
48
Q

Iatrogenic causes of uterine bleeding

A

copper releasing IUD

hormonal contraceptive

49
Q

Treatment of uterine bleeding in younger sexually active female

A

think infection -> antibiotics

Endometrial ablation is effective treatment

50
Q

Treatment of uterine bleeding in postmenopausal women

A

CANCER UNLESS PROVEN OTHERWISE

Treat benign lesions as found, but if bleeding recurs or persists, work up aggressively

51
Q

Causes of cervical bleeding?

A

Cervical cancer
Cervicitis
Polyps

52
Q

When is D&C done for uterine bleeds?

A

if endometrial biopsy shows endometrial hyperplasia WITHOUT atypia

  • need treatment if biopsy with atypia
53
Q

What serum level suggests ovarian failure?

A

high FSH

  • ovaries release less estrogen, so pituitary increases FSH to increase estrogen

Women's Health - GYN (12 decks)

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