Abnormal Uterine Bleeding

Question 1

define dysmenorrhea

Answer 1

pain with menses, often associated with endometriosis

Question 2

define oligomenorrhea

Answer 2

> 35-day cycle (infrequent menstruation)

Question 3

define polymenorrhea

Answer 3

< 21-day cycle (frequent menstruation)

Question 4

define metrorrhagia

Answer 4

frequent or irregular menstruation

Question 5

define menorrhagia

Answer 5

heavy menstrual bleeding; > 80 mL blood loss or > 7 days of menses

Question 6

define menometrorrhagia

Answer 6

heavy, irregular menstruation

Question 7

dx: female 20-40 yo, heavy menstrual bleeding, urinary pressure/urgency, constipation, intermenstrual spotting, pain

Answer 7

leiomyoma (uterine fibroids)

Question 8

which uterine tumor regresses with menopause?

Answer 8

leiomyoma (uterine fibroids; estrogen sensitive)

Question 9

leiomyoma (uterine fibroids): _____ decreases risk and _____ increases risk

Answer 9

parity; obesity

Question 10

dx: uterine tumor, histology shows smooth muscle bundles with well-demarcated borders

Answer 10

leiomyoma (uterine fibroids)

Question 11

dx: uterine tumor, histology shows hyperplasia of basal layer of endometrium

Answer 11

adenomyosis

Question 12

dx: dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus

Answer 12

adenomyosis

Question 13

adenomyosis: pathogenesis

Answer 13

extension of endometrial tissue (glandular) into uterine myometrium

Question 14

pathogenesis of anovulation and abnormal uterine bleeding at extremes of reproductive age spectrum

Answer 14

result of chronic exposure of the endometrium to estrogen without the benefit of cyclic exposure to postovulatory progesterone –> endometrium becomes abnormally thickened and structurally incompetent –> asynchronous shedding of portions of the endometrium unaccompanied by vasoconstriction

Question 15

anovulation and abnormal uterine bleeding at extremes of reproductive age spectrum: overall risk of progression to endometrial cancer based upon _______

Answer 15

duration of unopposed estrogen exposure

Question 16

endometrial ______: often described as spotting, related to _______

Answer 16

atrophy; hypoestrogenism

Question 17

treatment for leiomyoma (uterine fibroids)

Answer 17

leuprolide (GnRH analog, continuous), oral contraceptive pills, surgery

Question 18

endometriosis: pathogenesis

Answer 18

non-neoplastic endometrial glands and stroma outside endometrial cavity

Question 19

dx: cyclic pelvic pain, bleeding, dysmenorrhea, infertility, normal sized uterus

Answer 19

endometriosis

Question 20

chocolate cyst of the ovary: pathogenesis

Answer 20

endometriosis that spread to the ovary

Question 21

treatment for endometriosis

Answer 21

NSAIDS, oral contraceptive pills, GnRH agonists, aromatase inhibitors (decrease inflammation and cause hormonal suppression to minimize stimulation of endometriosis tissue)

Question 22

dx: dysmenorrhea, dypareunia (painful intercourse), infertility

Answer 22

endometriosis

Question 23

how does obesity exacerbate anovulation caused by increased estrogen exposure unopposed by progesterone?

Answer 23

increased circulating estradiol

Question 24

23 yo G0 presents complaining of worsening dysmenorrhea and pelvic pain. she does not desire fertility at this time. what treatment option is INappropriate for her?

Answer 24

clomiphene citrate (because it induces ovulation)