Abnormal Menstruation Flashcards
What is a cause of primary dysmenorrhea?
prostaglandin abnormalities (overproduced)
What are some common causes of secondary dysmenorrhea
endometriosis & uterine fibroids, infxn, or IUD
How is abnl menstruation defined:
interval: less than 21 days or more than 45
Flow: more than 8-10 days or less than 2
define menorrhagia
heavy or prolonged bleeding
define metrorrhagia
intermensrual bleeding, spotting, or breakthrough bleeding
A pt comes in complaining of cyclic dysmenorrhea that lasts longer and becomes more severe over time, pelvic pain, worse w/ menses & ovulation
Endometriosis
What PE findings will help support ur suspicion of endometriosis?
Cervical motion tenderness, palpable nodules, fixed/tender/enlarged adnexa
How do u work up a pt suspected of endometriosis?
U can U/S
Diagnostic is laparoscopy
How do u tx a pt with endometriosis?
Mild pain-NSAID’s or OCP
& if no relief refer to GYN for surgery or hormone interventions
Who is at risk for uterine leiomyomata aka Fibroids
African American women in 30-40’s
List the 7 RF’s for fibroids aka uterine leiomyomata
early menarche, meat consumption, family hx, beer, history of uterine infxn, vit. d deficiency, obesity
List the 9 factors that decrease ur risk for fibroids
> 1 pregnancy, OCP’s, smoking, green veggies/fruits, dietary vit. A, progestin only injectable, menopause, exercise
what are the sx of increased uterine bleeding, pelvic pressure/pain, and in some infertility
fibroids
what is the PE findings going to be for fibroids
enlarged, irregular, mobile uterus
Which labs would u be likely to order for fibroid w/u
TSH, CBC, pap smear
Also, transvaginal U/S
how do we manage fibroids aka uterine leiomyomata
observe
prophylactic myomectomy vs. hysterectomy depending on age & if they want to remain fertile… OCPs and Lupron
What is the COPE calendar used for?
following sx of PMS for a month to assess dx & tx
If someone is having worse sx than PMS such as anger, irritability, internal tension what dx would u consider
premenstrual dysphoric d/o
what are some causes of primary amenhorrea? how is it defined?
None by age 15 or by time sexual maturation.. causes-stress, athletics, wt, turner syndrome
what is the #1 cause of 2ndary amenorrhea
pregnancy
what are some other causes of secondary amenorrhea
hypothalamic dysfxn; female athlete triad, thyroid dz, pituitary dz, polycystic ovarian syndrome, asherman’s syndrome
How do u define Asherman’s syndrome? How would u evaluate it…
scarring of endometrial lining due to previous infxn or surgery… pelvic U/S, progestin challenge
How would a normal uterus respond to the progestin challenge?
If they are amenorrhic, they will have their period if everything is intact
how do we tx asherman’s syndrome
hysteroscope lysis or estrogen therapy
