Amenorrhea & DUB Flashcards
What is the definition of AUB?
Abnormal Uterine Bleeding
- bleeding o/side of norm physiologic menstruation
- includes both DUB [absence of organic dz] and structural bleeding
- 15-20% of menstruating women
What is normal for menses?
duration
amount
cycle length
other
- duration: 2-7 days
- amt: <80 ml [2.5 oz]
- length: 24-35 days
other:
- Change pad/tampon >3 hours
- Use fewer than 21 pads/tampons per cycle
- Seldom need to change pad/tampon overnight
- Clots less than 1 inch in diameter
on what days of the menstrual cycle does the following fall on?
menses
proliferative phase/follicular
secretory phase/luteal
ovulation
menses: day 0-8
proliferative phase/follicular: day 8-14
- E>P
secretory phase/luteal: 14-28
- ovulation triggers P prodxn
ovulation: on day 14, or 14 days before menses start
after the LH surge, what happens?
ovulation w/in 48 hrs
Define the following terms:
menorrhagia
metrorrhagia
menometrorrhagia
oligomenorrhea
polymenorrhea
¢Menorrhagia –Normal intervals, but prolonged (>7d) or excessive (>80 ml/cycle)
¢Metrorrhagia –irregular and more frequent intervals, amount is variable
¢Menometrorrhagia –prolonged or variable amounts occurring irregularly and more frequently than normal
¢Oligomenorrhea-menses at interval greater than 35 days
¢Polymenorrhea- menses at interval less than 21 days
define:
intermenstrual bleeding
midcycle spotting
postmenopausal bleeding
amenorrhea
¢Intermenstrual bleeding –bleeding between regular periods
¢Midcycle spotting –just prior to ovulation, from declining estrogen
¢Postmenopausal bleeding-bleeding in a woman at least 1 year after cessation of cycles
¢Amenorrhea –Lack of bleeding for 6 months or longer
1’ vs 2’ amenorrhea
¢Primary amenorrhea: no spontaneous uterine bleeding by age 14 in the absence of secondary sexual characteristics –OR- by age 16 with otherwise normal development [prevalence is 0.3%]
¢Secondary amenorrhea: the absence of menstrual bleeding for six months in a woman with prior regular menses or for 12 months in a woman with previous oligomenorrhea
- Ovary – 40%, Hypothalamus – 35 %, Pituitary – 19 %, Uterus – 5 %, Other – 1%
- prevalence is 1.3%, higher in certain subgroups such as competitive atheletes.
What are compartment I causes of amenorrhea?
DO’s of o/Q tract
- Imperforate hymen
- Ashermans Syndrome–destruction of endometrium. Scarring preventing bleeding – due to D&C, ablation, severe infection–> scraped too far down and taken away stratum basalis
- Mullerian Anomolies-absent uterus, no vaginal orifice
- Testicular Feminization (Androgen Insensitivity) -46 XY – resistent to testosterone- fail to develop normal male features, but testes still present and secreting mullarian inhibiting substance
What are compartment II causes of amenorrhea?
DO’s of ovary
¢Turners Syndrome 46XO –follicles undergo apoptosis –resulting in high FSH, low estrogen
- Mosaicism
¢Gonadal agenesis/dysgenesis
¢Resistant ovary syndrome (rare)
¢Prematureovarian failure ** (before age 40)** **menopause)
¢Radiation/chemotherapy
17 alpha-hydroxylase deficiency
what are compartment III causes of amenorrhea?
DOs of anterior pituitary
- Pituitary Adenoma –(hyperprolactinemia) –prolactin inhibits GnRH (so decrease LH/FSH)
- Empty Sella Syndrome –(elevated prolactin)
- Sheehans Syndrome –-necrosis of pituitary –post partum or trauma
- Hypopituitarism
- Hypothyroid– increase TSH suppresses GnRH
- Infiltrative (Sarcoidosis/hemochromostosis)
- (medications) –opiates and phenothiazines can increase prolactin
what are compartment IV causes of amenorrhea?
DO’s of CNS or hypothalamus
¢Tumors
¢Craniopharyngioma, harmartoma
¢Stress – Increases cortisol- decreases FSH/LH
¢Hypothalamic amenorrhea- High corticotropin –releasing hormone –inhibits GnRH
Eating disorder, weight loss (or gain), exercise
Kallmanns Syndrome –congenital GnRH deficiency
Disease-JRA,syphillis, TB
Psychosocial stress
What should be part of your evaluationof amenorrhea?
HISTORY
- menstrual Hx, reproductive hx, gneral medical Hx, famHx, social Hx
PE: complete
- anatomy, genital development, BMI, hair distribution, galactorrhea etc
LABS
- hCG to rule out preg, PRL, FSH, LH [if hypoGonad sx’s do test., 17hydro, & DHEA]
- P w/drawal bleed
- CT/MRI
What is necessary to Tx amenorrhea?
need a clear Dx!!!
Hypothyroid– thyroid replacement
Ovarian Failure– estrogen replacement
Pituitary Tumor–medication or surgery
Hypothalamic Amenorrhea–change lifestyle, cyclical hormones
what are some major causes of abnormal bleeding?
- pregnancy: ectopic, miscarriage, placenta previa, moles
- medications: steroid, thyroid, H’s, anticoagulatns, SSRIs, herbs
- benign genital tract path: myoma, endoM, polyp, PID, infxn, trauma
- malignant GTP: carcinoma
- systemic dz: ovulatory or anovulatory
- iatrogenic: IUD, implant
What is the condition that is MC to affect ovulation?
PCOS!!!
about 6% of women
