Abnormalities of the Menstrual Cycle

Question 1

No menses by age 14 y in the absence of secondary sexual characteristics

OR

No menses by age 16 y in the presence of
secondary sexual characteristics

Answer 1

Primary Amenorrhea

Question 2

No menses for 6 or more consecutive months

Answer 2

Secondary Amenorrhea

Question 3

1st line treatment for Premenstrual Dysphoric Disorder (PMDD)

Answer 3

SELECTIVE SEROTONIC REUPTAKE INHIBITORS (SSRI)

Fluoxetine
Citalopram
Paraxetine
Sertraline

Question 4

Normal Menstrual Cycle

Answer 4

CYCLE LENGTH: 28 +/- 7 days

DURATION OF FLOW: 3-5 days

MENSTRUAL BLOOD LOSS: 30-50 mL

Question 5

PALM COIEN System of AUB

Answer 5

PALM - Structural Causes
Polyps
Adenomyosis
Leiomyomas
Malignancy and Hyperplasia

COEIN - Nonstructural Causes
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified

Question 6

Localized overgrowths of endometrial tissue with glands, stroma and blood vessels, covered with epithelium

POSSIBLE CAUSE: estrogen stimulation

Answer 6

Endometrial Polyp

Diagnosis: TVS, Hysteroscopy

Management: Operative Hysteroscopy

Question 7

3 Components of Endometrial Polyp

Answer 7

endometrial glands
endometrial stroma
central vascular channels

Question 8

Presence of endometrial glands and stroma in the uterine myometrium

profound dysmenorrhea

Answer 8

Adenomyosis

Diagnosis: Histologic diagnosis, TVS, MRI

Management: Operative Hysteroscopy

Question 9

Somatic mutation in a single progenitor cell which affects cytokines that affect cell growth which may be affected by ESTROGEN and PROGESTERONE

Mechanisms by which fibroids cause abnormal bleeding are varied and depend on size, location and number

Answer 9

Leiomyoma

Question 10

Thickens endometrial tissue

MC presenting symptom of endometrial cancer

Answer 10

Malignancy or Hyperplasia

RISK FACTOR: increased circulating levels of estrogen

Question 11

Present in menorrhagia occurred at the time of the first menstrual period

AUB seen in: von Willebrand disease, Prothrombin deficiency, Hemophilias A and B, Chronic anticoagulation therapy, May-Thurner syndrome

Answer 11

Coagulopathy

Question 12

Secondary to alterations in neuroendocrine function

oligomenorrhea, intermenstrual bleeding or heavy menstrual bleeding

Answer 12

Ovulatory Dysfunction

PCOS< Hypothyroidism, Prolactinemia, Obesity, Mental Stress, Extreme exercise

Question 13

Excessive uterine production of prostacyclin a vasodilatory prostaglandin that opposes platelet adhesion and may also interfere with uterine contractility

Answer 13

Primary Endometrial Disorder

Question 14

Due to medications such as:

SERMs
GnRH analog
Risperidone and other antipsychotics

Answer 14

Iatrogenic

Question 15

First line diagnostic tool for AUB

Answer 15

Ultrasound

Question 16

Accurate evaluation tool for intracavitary lesions

Answer 16

Saline Infusion Sonography (SIS)

Question 17

Endometrial biopsy is recommended for:

Answer 17

Postmenopausal woman with bleeding or premenopausal with heavy/irregular vaginal bleeding

Postmenopausal women with endometrial cells on pap smear

Premenopausal women with atypical glandular cells on pap smear

Breast cancer patients on Tamoxifen who complain of abnormal vaginal bleeding

Women who are still “menstruating” after 52 years of age

Question 18

Diagnostic and therapeutic for immediate management of severe bleeding

Answer 18

Dilatation and Curettage