Abnormal Uterine Bleeding, Amenorrhea etc - fothergill

Question 1

What is wrong with a women telling you how much she is bleeding?

Answer 1

there is poor correlation bw a women’s perception of blood loss and the actual amount lost

Question 2

What is menorrhagia?

Answer 2

prolonged ( > 7 days) or excessive bleeding

Question 3

what is metrorrhagia?

Answer 3

bleeding at irregular but frequent intervals

Question 4

What is polymenorrhea?

Answer 4

regular bleeding at < 21 day intervals

Question 5

What is oligomenorrhea?

Answer 5

cycle length of greater than 35 days

Question 6

What is amenorrhea?

Answer 6

absence of menses for > 6 months

Question 7

What initiates ovulation?

Answer 7

estradiol via and LH surge

Question 8

What does the corpus luteum do?

Answer 8

1) secretes progesterone

2) influences the secretory phase of the endometrium

Question 9

What is the most important thing to always rule out when someone presents with AUB?

Answer 9

PREGNANCY!!!

Question 10

What are the most common causes of bleeding in young pre pubertal girls?

Answer 10

1) foreign body
2) trauma/abuse
3) sarcoma botryoides - cancer
4) pregnancy

Question 11

What kinda of disorders are usually diagnosed in young women who have AUB during or after the onset of puberty?

Answer 11

blood dyscrasia - Von Wildebrands disease

Question 12

What is dysmenorrhea?

Answer 12

1) painful menses

2) not a diagnosis - a symptom

Question 13

What causes most of the pain symptoms in dysmenorrhea?

Answer 13

prostaglandin effects cause N/V and diarrhea

Question 14

What is primary dysmenorrhea?

Answer 14

1) cyclic menstrual pain without an identifiable associated pathology
2) typically beings shortly after menarche
3) diagnosis of exclusion

Question 15

what is secondary dysmenorrhea?

Answer 15

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)

Question 16

What are some of the first things we should think of when a patient complains of amenorrhea?

Answer 16

1) pregnancy
2) inherited disorder
3) PCOS
4) morbid obesity
5) thyroid disease

Question 17

What is asherman’s syndrome

Answer 17

1) scar tissue in the uterus usually due to a miscarriage and DNC
2) presents with amenorrhea

Question 18

What are some inherited anatomic problems causing amenorrhea?

Answer 18

1) mullerian agenesis
2) vaginal septum
3) imperforate hymen
4) androgen insensitivity syndrome

Question 19

How does obesity cause amenorrhea?

Answer 19

1) peripheral fat tissue produces estrogen

2) turns off P-H-Ovarian axis

Question 20

What is the problem in hypergonadotropic hypogonadism?

Answer 20

1) something wrong downstream - with ovaries

2) pre mature ovarian failure

Question 21

What are some causes of premature ovarian failure?

Answer 21

1) Turners syndrome
2) autoimmune
3) iatrogenic (chemo)
4) idiopathic

Question 22

What is the main problem in hypogonadotropic hypogonadism?

Answer 22

The pituitary or hypothalamus

Question 23

What are disorders of the hypothalamus causing hypogonadotropic hypogonadism?

Answer 23

1) kallman’s syndrome
2) functional disorders (stress, eating disorder, exercise)
3) tumor radiation

Question 24

What are disorders of the pituitary causing hypogonadotropic hypogonadism?

Answer 24

1) tumors (prolactinoma)
2) trauma/radiation
3) sheehan’s syndrome

Question 25

What are the steps for a workup of AUB?

Answer 25

1) H&P and menstrual calendar
2) pap smear, endometrial biopsy
3) vaginal probe ultrasound*
4) CBC, lab work
5) saline infusion sonohysterography (SIS)

Question 26

What are the steps in a work-up for dysmenorrhea?

Answer 26

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

Question 27

When should iron be used as a treatment?

Answer 27

1) anemic patients

2) heavy menses

Question 28

Does mirena IUD suppress ovulation?

Answer 28

No

Question 29

What are estrogens + progestins (OCs) used for?

Answer 29

1) ovulatory AUB
2) anovulatory uterine bleeding
3) dysmenorrhea
4) excessive bleeding

Question 30

What medical therapy do you use if contraception is desired with AUB?

Answer 30

1) combination OCs

2) progestin IUDs

Question 31

What medical therapy do you use if fertility is desired with AUB?

Answer 31

1) NSAIDs

2) tranexamic acid (rarely used in US)

Question 32

What is a good second line treatment for AUB?

Answer 32

GnRH agonists

Question 33

What is the medical therapy for anovulatory AUB or amenorrhea?

Answer 33

1) underlying cause of anovulation should be identified and treated
2) cyclic progestins and combination OCs
3) mirena IUD

Question 34

What is the medical therapy for dysmenorrhea?

Answer 34

1) rule out anatomic cause
2) NSAIDs
3) combination OCs
4) DMPA

Question 35

What is the treatment for PMS?

Answer 35

1) lifestyle modification!!!
2) SSRI
3) OCs