Abnormalities of the Menstrual Cycle

Question 1

What is primary dysmenorrhea thought to be due to?

Answer 1

Increased levels of endometrial prostaglandin production

Question 2

How is primary dysmenorrhea diagnosed?

Answer 2

Absence of organic causes

Question 3

How is primary dysmenorrhea treated?

Answer 3

NSAIDs are first-line
COX-2 inhibitors (celebrex)
OCPs - cessation of ovulation, decrease in prostaglandin production

Surgery has very little use here

Question 4

How are pelvic adhesions diagnosed?

Answer 4

Not visible on MRI/US/CT

laparoscopy is diagnostic and treatment (occasionally requires laparotomy for safe treatment)

Question 5

Diagnosis of PMS

Answer 5

Symptoms occur 2 weeks prior to menstruation, at least a 7-day symptom free interval in first half of menstrual cycle

Question 6

What is the pathophysiology and treatment of PMS?

Answer 6

Thought to be due to interaction between serotonin and ovarian steroids levels

Treatment: SSRIs (Prozac), SNRI (Effexor and Xanax)
Yaz (new OCP with drospirenone)
Vitamin supplementation (Ca, D, B6, Mg)
Carb rich beverages

Question 7

What is PALM-COEIN

Answer 7

Pattern and etiology
Polyps
Adenomyosis
Leiomyomas
Malignancy/hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified

Question 8

What is menorrhagia?

Answer 8

Regular menstrual cycles that are long duration or heavy flow
>24 pads a day or >1 per hour

Question 9

What are the most common causes of menorrhagia?

Answer 9

Fibroids, adenomyosis, endometrial polyps

primary bleeding disorders (VWD, ITP, platelet dysfunction)

Question 10

What patients are hypomenorrhea seen in?

Answer 10

Athletes or anorexic patients

Patients on OCPs

Question 11

What is the most common cause of abnormal uterine bleeding?

Answer 11

anovulation - estrogen builds up and causes bleeding and abnormal times

Question 12

Any woman > 45 yo with abnormal uterine bleeding should get what?

Answer 12

Endometrial Bx to rule out cancer/hyperplasia

Question 13

How is dysfunctional uterine bleeding treated?

Answer 13

Acute hemorrhage = IV estrogen or PO (if stable)
NSAIDs
Menstrual regulation using OCPs
Hysterectomy is definitive treatment

Question 14

How is postmenopausal bleeding approached?

Answer 14

Any postmenopausal bleeding is abnormal
Usually due to endometrial or vaginal atrophy
Exogenous estrogen
cancer, polyps, hyperplasia