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Endo/Repro > Amenorrhea and Uterine Bleeding > Flashcards

Amenorrhea and Uterine Bleeding Flashcards

1
Q

Abnormal Uterine Bleeding

A

bleeding outside normal physiologic menstruation

- includes both dysfunctional uterine bleeding and structural bleeding

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2
Q

Normal Menses

A

Duration - 2-7 days

Flow 3 hrs

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3
Q

Normal Cycle

A

Menses (day 0 to 8)
Proliferative (day 8-14) -> predominance of estrogen over progesterone –> building endometrium
Secretory/Luteal (day 14) -> begins after ovulation -> progesterone production, stabilize endometrium

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4
Q

Menorrhagia

A

normal intervals, but prolonged or excessive

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5
Q

Metrorrhagia

A

irregular and more frequent intervals but amount is variable

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6
Q

Menometrorrhage

A

prolonged and variable amounts

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7
Q

Oligomenorrhea

A

menses interval greater than 35 days

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8
Q

Polymenorrhea

A

menses interval less than 24 days

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9
Q

Intermenstrual bleeding

A

bleeding between regular periods

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10
Q

Midcycle spotting

A

just prior to ovulation from declining estrogen

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11
Q

Postmenopausal bleeding

A

bleeding in woman at least 1 year after cessation of cycles

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12
Q

Amenorrhea

A

lack of bleeding for 6 months or longer

- overall prevalence 3% - not due to pregnancy, lactation, or menopause

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13
Q

Primary amenorrhea

A

no spontaneous uterine bleeding by age 14 in absence of secondary sex characteristics

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14
Q

Secondary amenorrhea

A

absence of menstrual bleeding for 6 months in woman with prior menses

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15
Q

Compartment I

A

disorders of outflow tract

  • imperforate hymen
  • Ashermans Syndrome - destruction of endometrium (D&C, ablation, infection)
  • Mullerian Anomolies - absent uterus, no vaginal orifice
  • Testicular Feminization - 46 XY
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16
Q

Compartment II

A

disorders of ovary

  • Turner Syndrome - 46 XO - follicles undergo apoptosis (higher FSH, lower estrogen)
  • Mosaicism
  • Gonadal agenesis
  • 17 alpha-hydroxylase deficiency
17
Q

Compartment III

A

disorders of Anterior Pituitary

  • Adenoma (hyperprolactinemia)
  • Empty Sella Syndrome
  • Sheehans syndrome
  • Hypopituitarism
  • Hypothyroid
  • Infiltrative (sarcoidosis/hemochromotosis)
18
Q

Compartment IV

A

disorders of CNS or hypothalamus

  • tumors
  • craniopharyngioma
  • stress -> increased cortisol -> decreased FSH/LH
  • hypothalamic amenorrhea -> high corticotropin releasing hormone -> inhibits GnRH
19
Q

Evaluation of Amenorrhea

A

Menstrual history -> age, previous patterns
Reproductive history -> BCPs, ob/gyn procedures, preg?
General Medical history -> meds, illnesses, drugs
Family History -> sisters, mom
Social history

20
Q

Physical Exam

A

COMPLETE PHYSICAL

- androgen excess, estrogen deficiency or excess

21
Q

Labs

A 
RULE OUT PREGNANCY - hCG
Prolactin
FSH
TSH
hypogonadism? -> testosterone, 17-hydroxyprogesterone, DHEA
22
Q

Treatment of Amenorrhea

A

NEED CLEAR DIAGNOSIS

  • hypothyroid
  • ovarian failure
  • pituitary tumor
  • hypothalamic amenorrhea
23
Q

Causes of abnormal bleeding

A 
Pregnancy
Medications
Benign Genital Tract Pathology
Malignant Genital Tract Pathology
Systemic diseases
Iatrogenic
24
Q

Anovulatory Bleeding

A

more unpredictable
disturbance of normal HPO axis
progesterone deficient/estrogen dominant state
more common in extremes of reproductive years
no ovulation –> no corpus luteum –> endometrium instability leading to erratic bleeding

25
Q

Risk for Endometrial Cancer

A 
Obesity
Nuiparity
Previous tamoxifen
Unopposed estrogen therapy
Diabetes
Age
26
Q

Endometrial Ultrasound

A

looking for cancers, thickening, masses
Sensitivity for cancer - 96%
Sensitivity for abnormality - 92%
- do toward end of bleeding cycle

27
Q

Endometrial Biopsy

A

Looking for polyps, fibroids, lesions
High sensitivity for carcinoma
lower sensitivity for hyperplasia

28
Q

Treatment

A

Goal of treatment is to control bleeding, prevent recurrence, and preserve fertility

Endo/Repro (34 decks)

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