Abnormal Uterine Bleeding, Amenorrhea etc - fothergill Flashcards
What is wrong with a women telling you how much she is bleeding?
there is poor correlation bw a women’s perception of blood loss and the actual amount lost
What is menorrhagia?
prolonged ( > 7 days) or excessive bleeding
what is metrorrhagia?
bleeding at irregular but frequent intervals
What is polymenorrhea?
regular bleeding at < 21 day intervals
What is oligomenorrhea?
cycle length of greater than 35 days
What is amenorrhea?
absence of menses for > 6 months
What initiates ovulation?
estradiol via and LH surge
What does the corpus luteum do?
1) secretes progesterone
2) influences the secretory phase of the endometrium
What is the most important thing to always rule out when someone presents with AUB?
PREGNANCY!!!
What are the most common causes of bleeding in young pre pubertal girls?
1) foreign body
2) trauma/abuse
3) sarcoma botryoides - cancer
4) pregnancy
What kinda of disorders are usually diagnosed in young women who have AUB during or after the onset of puberty?
blood dyscrasia - Von Wildebrands disease
What is dysmenorrhea?
1) painful menses
2) not a diagnosis - a symptom
What causes most of the pain symptoms in dysmenorrhea?
prostaglandin effects cause N/V and diarrhea
What is primary dysmenorrhea?
1) cyclic menstrual pain without an identifiable associated pathology
2) typically beings shortly after menarche
3) diagnosis of exclusion
what is secondary dysmenorrhea?
1) cyclic and associated with identifiable pathology such as endometriosis, leiomyoma, PID, adenomyosis
2) outlet obstruction in younger patients
3) more common in older patients
4) more commonly associated with additional GYN complaints (AUB, dysparenuia, infertility)
What are some of the first things we should think of when a patient complains of amenorrhea?
1) pregnancy
2) inherited disorder
3) PCOS
4) morbid obesity
5) thyroid disease
What is asherman’s syndrome
1) scar tissue in the uterus usually due to a miscarriage and DNC
2) presents with amenorrhea
What are some inherited anatomic problems causing amenorrhea?
1) mullerian agenesis
2) vaginal septum
3) imperforate hymen
4) androgen insensitivity syndrome
How does obesity cause amenorrhea?
1) peripheral fat tissue produces estrogen
2) turns off P-H-Ovarian axis
What is the problem in hypergonadotropic hypogonadism?
1) something wrong downstream - with ovaries
2) pre mature ovarian failure
What are some causes of premature ovarian failure?
1) Turners syndrome
2) autoimmune
3) iatrogenic (chemo)
4) idiopathic
What is the main problem in hypogonadotropic hypogonadism?
The pituitary or hypothalamus
What are disorders of the hypothalamus causing hypogonadotropic hypogonadism?
1) kallman’s syndrome
2) functional disorders (stress, eating disorder, exercise)
3) tumor radiation
What are disorders of the pituitary causing hypogonadotropic hypogonadism?
1) tumors (prolactinoma)
2) trauma/radiation
3) sheehan’s syndrome
What are the steps for a workup of AUB?
1) H&P and menstrual calendar
2) pap smear, endometrial biopsy
3) vaginal probe ultrasound*
4) CBC, lab work
5) saline infusion sonohysterography (SIS)
What are the steps in a work-up for dysmenorrhea?
1) H&P and menstrual calendar
2) exam - rule out anatomic abnormalities
3) vaginal ultrasound
4) screen for pelvic infection
5) emperic therapy warranted in many cases
When should iron be used as a treatment?
1) anemic patients
2) heavy menses
Does mirena IUD suppress ovulation?
No
What are estrogens + progestins (OCs) used for?
1) ovulatory AUB
2) anovulatory uterine bleeding
3) dysmenorrhea
4) excessive bleeding
What medical therapy do you use if contraception is desired with AUB?
1) combination OCs
2) progestin IUDs
What medical therapy do you use if fertility is desired with AUB?
1) NSAIDs
2) tranexamic acid (rarely used in US)
What is a good second line treatment for AUB?
GnRH agonists
What is the medical therapy for anovulatory AUB or amenorrhea?
1) underlying cause of anovulation should be identified and treated
2) cyclic progestins and combination OCs
3) mirena IUD
What is the medical therapy for dysmenorrhea?
1) rule out anatomic cause
2) NSAIDs
3) combination OCs
4) DMPA
What is the treatment for PMS?
1) lifestyle modification!!!
2) SSRI
3) OCs
