chp 39- amenorrhea and aub Flashcards
Define primary amenorrhea
no menstruation by age 13 w/out 2ndary sex characteristics or by age 15 with secondary sex characteristics
Define secondary amenorrhea
no menstruation for 3-6 months or for duration of 3 typical menstraul cycles for pt with oligomenorrhea
Define oligomenorrhea
reduction of frequency of menses with cycle lengths of greater than 40 days but less than 6 months
Define hypomenorrhea
reduction in the number of days or the amount of menstrual flow
Define polymenorrhea
frequent menstrual bleeding (21 days or less)
Define menorrhagia
prolonged or excessive uterine bleeding that occurs at regular intervals (the loss of 80mL or more of blood that lasts for more than 7 days)
Define metrorrhagia
irregular menstrual bleeding or bleeding between periods
Define menometrorrhagia
frequent menstrual bleeding that is excessive and irregular in amount and duration
What are causes of H-P amenorrhea?
functional- weight loss, excessive exercise, obesity
drug induced- marijuana, psychoactive drugs
neoplastic- prolactin secreting pituitary adenoma, hypothalamic hamartoma
Psychogenic- chronic anxiety, pseudocyesis, anorexia
other- head injury, chronic medical illness
What is the definitive method to identify hypothalamic-pituitary dysfunction?
measure FSH, LH, and prolactin levels in the blood. FSH and LH are in low range and prolactin is normal/elevated in pituitary adenomas
What are causes of ovarian failure?
Chromosomal- Turners, X chromosome long arm deletion (46, XX q5)
Other- Savage syndrome (gonadotropin resistant ovary syndrome), premature natural menopause, AI ovarian failure (blizzard syndrome)
As the ovaries cease functioning in ovarian failure, blood concentrations of FSH and LH _____ as women show signs of estrogen deficiency.
increase
What is Asherman Syndrome?
scarring of the uterine cavity, most frequent anatomic cause of secondary amenorrhea. Often occurs after D and C.
How is Asherman syndrome treated?
surgical lysis of adhesions, estrogen therapy postoperatively to stimulate endometrial regeneration. Balloon or intrauterine device may be placed to keep walls separated
What is the progesterone challenge test?
A commonly used first step to determine whether or not a patient has adequate estrogen, a competent endometrium, and a patent outflow tract. 10-14 days course of oral medroxyprogesterone acetate or micronized progesterone is expected to induce progesterone withdrawal bleeding w/in 1 week of completion. Bleeding= estrogen effect on endometrium is established so pt is presumed to be anovulatory or oligo-anovulatory. No bleeding= hypoestrogenic or anatomic cause.
How can hypothyroidism cause hyperprolactinemia?
A low TSH–> high TRH–> prolactin secretion
How can ovulation be induced in pt with PCOS desiring pregnancy?
clomiphene citrate
How can ovulation be induced in pt with hypogonadotropic hypogonadism desiring pregnancy?
pulsatile GnRH or human menopausal gonadotropins
Irregular bleeding that is unrelated to anatomic lesions of the uterus is referred to as_____.
Anovulatory uterine bleeding
In who anovulatory uterine bleeding most likely?
PCOS, exogenous obesity, adrenal hyperplasia
Women with H-P amenorrhea are in a state of _______
estrogen deficiency- inadequate endometrium for uterine bleeding to occur
Describe estrogen in women with oligo-ovulation and anovulation with AUB. How does this cause irregular bleeding?
constant, non-cyclic blood estrogen concentrations that stimulate growth and development of endometrium. Pts have amenorrhea at first due to estrogen levels but the endometrium outgrows its supplies and sloughs off.
Chronic stimulation of endometrium from low levels of estrogen causes ______. Chronic stimulation with high levels of estrogen causes _____.
infrequent and light; frequent and heavy
What is a luteal phase defect?
ovulation occurs but corpus luteum is not fully developed to secrete adequate quantities of progesterone to support the endometrium for 13-14 days and can not support a pregnancy.
What is the cause of midcycle spotting?
sudden drop in estrogen level that occurs at this time of the cycle
Structural causes of AUB
polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
Nonstructural causes of AUB
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic
Because AUB results from chronic unopposed estrogenic stimulation of the endometrium, these women are at increased risk for ____
endometrial cancer
What is the best treatment for intrauterine scarring?
D and C
What is most likely seen on a biopsy on a pt with hx of irregular vaginal bleeding and oligomenorrhea for 1 year?
endometrial hyperplasia
