chp 39- amenorrhea and aub

Question 1

Define primary amenorrhea

Answer 1

no menstruation by age 13 w/out 2ndary sex characteristics or by age 15 with secondary sex characteristics

Question 2

Define secondary amenorrhea

Answer 2

no menstruation for 3-6 months or for duration of 3 typical menstraul cycles for pt with oligomenorrhea

Question 3

Define oligomenorrhea

Answer 3

reduction of frequency of menses with cycle lengths of greater than 40 days but less than 6 months

Question 4

Define hypomenorrhea

Answer 4

reduction in the number of days or the amount of menstrual flow

Question 5

Define polymenorrhea

Answer 5

frequent menstrual bleeding (21 days or less)

Question 6

Define menorrhagia

Answer 6

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)

Question 7

Define metrorrhagia

Answer 7

irregular menstrual bleeding or bleeding between periods

Question 8

Define menometrorrhagia

Answer 8

frequent menstrual bleeding that is excessive and irregular in amount and duration

Question 9

What are causes of H-P amenorrhea?

Answer 9

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

Question 10

What is the definitive method to identify hypothalamic-pituitary dysfunction?

Answer 10

measure FSH, LH, and prolactin levels in the blood. FSH and LH are in low range and prolactin is normal/elevated in pituitary adenomas

Question 11

What are causes of ovarian failure?

Answer 11

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)

Question 12

As the ovaries cease functioning in ovarian failure, blood concentrations of FSH and LH _____ as women show signs of estrogen deficiency.

Answer 12

increase

Question 13

What is Asherman Syndrome?

Answer 13

scarring of the uterine cavity, most frequent anatomic cause of secondary amenorrhea. Often occurs after D and C.

Question 14

How is Asherman syndrome treated?

Answer 14

surgical lysis of adhesions, estrogen therapy postoperatively to stimulate endometrial regeneration. Balloon or intrauterine device may be placed to keep walls separated

Question 15

What is the progesterone challenge test?

Answer 15

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.

Question 16

How can hypothyroidism cause hyperprolactinemia?

Answer 16

A low TSH–> high TRH–> prolactin secretion

Question 17

How can ovulation be induced in pt with PCOS desiring pregnancy?

Answer 17

clomiphene citrate

Question 18

How can ovulation be induced in pt with hypogonadotropic hypogonadism desiring pregnancy?

Answer 18

pulsatile GnRH or human menopausal gonadotropins

Question 19

Irregular bleeding that is unrelated to anatomic lesions of the uterus is referred to as_____.

Answer 19

Anovulatory uterine bleeding

Question 20

In who anovulatory uterine bleeding most likely?

Answer 20

PCOS, exogenous obesity, adrenal hyperplasia

Question 21

Women with H-P amenorrhea are in a state of _______

Answer 21

estrogen deficiency- inadequate endometrium for uterine bleeding to occur

Question 22

Describe estrogen in women with oligo-ovulation and anovulation with AUB. How does this cause irregular bleeding?

Answer 22

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.

Question 23

Chronic stimulation of endometrium from low levels of estrogen causes ______. Chronic stimulation with high levels of estrogen causes _____.

Answer 23

infrequent and light; frequent and heavy

Question 24

What is a luteal phase defect?

Answer 24

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.

Question 25

What is the cause of midcycle spotting?

Answer 25

sudden drop in estrogen level that occurs at this time of the cycle

Question 26

Structural causes of AUB

Answer 26

polyp, adenomyosis, leiomyoma, malignancy and hyperplasia

Question 27

Nonstructural causes of AUB

Answer 27

coagulopathy, ovulatory dysfunction, endometrial, iatrogenic

Question 28

Because AUB results from chronic unopposed estrogenic stimulation of the endometrium, these women are at increased risk for ____

Answer 28

endometrial cancer

Question 29

What is the best treatment for intrauterine scarring?

Answer 29

D and C

Question 30

What is most likely seen on a biopsy on a pt with hx of irregular vaginal bleeding and oligomenorrhea for 1 year?

Answer 30

endometrial hyperplasia