Abnormalities of the Menstrual cycle Flashcards

1
Q

when is dysmenorrhea usually dx’d?

A

late teens b/c it is ass’d w/ovulation, and first cycles are anovulatory

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2
Q

what is pathophysio’c process behind dysmenorrhea?

A

elevated prostaglandins

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3
Q

how is dysmenorrhea pain diff from endometriosis pain?

A

dysmenorrhea occurs on 1st or 2nd day of menses. Endometriosis pain begins 1-2 weeks prior, peaks right before, and is relieved with onset of menses.

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4
Q

tx for dysmenorrhea?

A
aspirin
ibuprofen
naproxen
take them 24-h prior to onset of expected menses, continue throughout
OCPs (2nd line)
heat, massage, acupuncture
TENS (Transcutaneous electrical n. stim)
exercise
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5
Q

causes of secondary dysmenorrhea?

A
cervical stenosis
endometriosis
adenomyosis
fibroids
pelvic adhesions
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6
Q

tx of cervical stenosis

A
surgical dilation
laminaria tents (usually need multiple tx's)
pg'y with vag delivery is usually permanent cure
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7
Q

PMS sx’s:

A
HA
weight gain
bloating
breast tenderness
mood changes
irritability
anx
fatigue
feeling out of control
occurring in the 2 weeks prior to emnses, and there is at least a 7-d sx-free interval in first half of menstrual cycle.
sx's must occur in at least 2 consecutive cycles
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8
Q

tx of PMS:

A
dietary modification (limit sodium, alcohol, caffeine, tobacco, chocolate.  Eat small, frequent meals)
stress mgt, beh'l therapy
exercise
NSAIDs
OCPs
leupron
diuretics for bloating
bromocriptine or danazol for breast pain
SSRIs, busprione, benzos for anx
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9
Q

what is DUB?

A

dysfunctional uterine bleeding - heavy and/or irregular bleeding that cannot be attributed to another cause

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10
Q

what is metrorrhagia

A

bleeding between menses

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11
Q

what is menometrorrhagia

A

excessive or prolonged bleeding at irregular intervals

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12
Q

oligomenorrhea vs. polymenorrhea

A
oligo = irregular cycles.  More than 35d apart.
poly = regular cycles.  < 21d apart
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13
Q

what is ave blood loss during a normal cycle?

A

30-50mL

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14
Q

common causes of menometrorrhagia & metrorrhagia?

A

cervical polyps or cancer

endometrial polyps or cancer

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15
Q

what is usual cause of polymenorrhea?

A

anovulation

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16
Q

w/u of abn’l bleeding?

A

history
physical - r/o rectal, urethral, vag, cervical causes of bleeding
Pap smear
labs: b-hCG, CBC, TSH, Prl, FSH if suspect premature ov failure or menopause.
if age 35 or older, do endometrial bx.
u/s to look for polyps & fibroids

17
Q

pathophys of DUB?

A

anovulatory cycles => no CL => no PG withdrawal. So continuous ES => prolif of endometrium => outgrows its bs => sloughs off

18
Q

conditions that involve anovulatory cycles:

A
adolescence
perimenopause
lactation
pg'y
hypothyroidism
hyperPrl
hyperandrogenism
premature ovarian failure
19
Q

tx of DUB:

A

NSAIDs if ovulatory
IV ES if anovulatory and acute hemorrhage (risk of VTE though); high-dose PO ES if HD stable
OCP taper (monophasic pill for TID 3d, then BID 2d, then daily for rest of pack)
cyclic progestins if ES is CI’d

D&C

endometrial ablation

hysterectomy

20
Q

what is most common cause of postmenopausal bleeding?

A

atrophy (endometrial or vaginal)

21
Q

nonGYN causes of postmenopausal bleeding:

A
hemorrhoids
anal fissures
rectal prolapse
lower GI tumors
urethral caruncles
22
Q

what is most common cause of postmenopausal uterine bleeding?

A

use of exogenous hrms

23
Q

w/u of postmenopausal bleeding:

A

H&P - do DRE, FOBT
labs - CBC, TSH, Prl, FSH, tumor markers if mass found on exam
endometrial bx
pelvic u/s or sonohysterogram or MRI

24
Q

how big should endometrial stripe be in a postmenopausal woman?

A

< 3-5mm

25
Q

tx of postmenopausal bleeding:

A
repair lacs
topical ES if atrophy is cause
systemic HRT
remove polyps
hysterectomy if endometrial ca or hyperplasia. (can also do cyclic progestins if hyperplasia)