Abnormalities of the Menstrual cycle Flashcards
when is dysmenorrhea usually dx’d?
late teens b/c it is ass’d w/ovulation, and first cycles are anovulatory
what is pathophysio’c process behind dysmenorrhea?
elevated prostaglandins
how is dysmenorrhea pain diff from endometriosis pain?
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.
tx for dysmenorrhea?
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
causes of secondary dysmenorrhea?
cervical stenosis endometriosis adenomyosis fibroids pelvic adhesions
tx of cervical stenosis
surgical dilation laminaria tents (usually need multiple tx's) pg'y with vag delivery is usually permanent cure
PMS sx’s:
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
tx of PMS:
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
what is DUB?
dysfunctional uterine bleeding - heavy and/or irregular bleeding that cannot be attributed to another cause
what is metrorrhagia
bleeding between menses
what is menometrorrhagia
excessive or prolonged bleeding at irregular intervals
oligomenorrhea vs. polymenorrhea
oligo = irregular cycles. More than 35d apart. poly = regular cycles. < 21d apart
what is ave blood loss during a normal cycle?
30-50mL
common causes of menometrorrhagia & metrorrhagia?
cervical polyps or cancer
endometrial polyps or cancer
what is usual cause of polymenorrhea?
anovulation
w/u of abn’l bleeding?
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
pathophys of DUB?
anovulatory cycles => no CL => no PG withdrawal. So continuous ES => prolif of endometrium => outgrows its bs => sloughs off
conditions that involve anovulatory cycles:
adolescence perimenopause lactation pg'y hypothyroidism hyperPrl hyperandrogenism premature ovarian failure
tx of DUB:
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
what is most common cause of postmenopausal bleeding?
atrophy (endometrial or vaginal)
nonGYN causes of postmenopausal bleeding:
hemorrhoids anal fissures rectal prolapse lower GI tumors urethral caruncles
what is most common cause of postmenopausal uterine bleeding?
use of exogenous hrms
w/u of postmenopausal bleeding:
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
how big should endometrial stripe be in a postmenopausal woman?
< 3-5mm
tx of postmenopausal bleeding:
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)
