Dobbs - Uterine Disorders Flashcards by Alice Richards

regular interval btw menses, excessive flow and duration

menorrhagia

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decreased flow during normal duration of regular menses

hypomenorrhea

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metorrhagia

irregular interval of menses, excessive flow and duration

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shortened interval btw menses < 9-21 days

polymenorrhea

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irregular or excessive bleeding during menses and btw menses

menomotorrhagia

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lengthened interval btw menses > 35 day intervals

oligomenorrhea

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procedure to remove tissue from inside the uterus

dilation and curettage (D&C)

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D&C is used to dx and treat (2)

heavy bleeding

clear uterine lining after miscarriage/abortion

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pain associated w. menses

1-2 days of mild discomfort-severe pain everyday of menses

dysmenorrhea

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sx associated w. dysmenorrhea (3)

n.v

fatigue

diarrhea

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what causes dysmenorrhea

prostaglandin overactivity

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tx for dysmenorrhea (4)

NSAIDs

heat

avoid nicotine, etoh, caffeine

reduce frequency of menses

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persistent dysmenorrhea → r.o (3)

leiomyomas

endometriosis

ovarian cysts

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common benign uterine tumor

round, firm, often multiple; composed of smooth m/CT

leiomyoma (same-same uterine fibroid)

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fibroids depend on

estrogen

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fibroids are classified by

location

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uterine fibroids may be asymptomatic; name 4 sx if not

bleeding → MC

pressure or fullness in pelvis

menorrhagia, metorrhagia, intermenstrual bleeding, dysmenorrhea

anemia w. heavy bleeding

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during bimanual exam, you feel firm, enlarged, irregular uterine mass; what do you think

uterine fibroid

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mc dx for uterine fibroid

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other dx options for fibroids (4)

saline hysteroscopy

hysterosalpingography

laparascopy → large fibroids

MRI/CT

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tx for asymptomatic fibroids

obs

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tx for symptomatic fibroids (3)

myomectomy or D&C

uterine arterial embolization or endometrial ablation

hysterectomy

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pharm for uterine fibroids

GnRH agonists (Lupron)

transexamic acid → non hormonal; eases heavy periods

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s.e of Lupron

medical menopause → sweats, mood disturbance, sleep disturbance, feel awful

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major consideration pre uterine arterial embolization/endometrial ablation

no desire for future fertility

condition where endometrial tissue is found outside of endometrial cavity

endometriosis

4 locations for endometriosis

ovaries uterosacral ligament GI tract lungs/brain → uncommon

definitive dx for endometriosis

have to visualize it (surgically/histologically)

when you see pt w. infertility, think

endometriosis

infertility in endometriosis is related to

adhesions

chocolate cysts on ovaries

endometriosis insertions filled w. blood

rf for endometriosis (5)

family hx early menarche long duration of menstrual flow heavy bleeding during menses shorter menstrual cycles

decreased risk for endometriosis (3)

4 or more hr exercise/week higher parity longer duration of lactation

US for endometriosis is used to

r. o other conditions * only way to dx endometriosis is to see it surgically*

3 d's of endometriosis

dysmenorrhea dyspareunia dyschezia **also infertility!!!**

what is dyschezia

pain during defecation

tender nodules in posterior vagainal fornix pain w. uterine motion tender adnexal masses

clinical findings for endometriosis

repetitive, but probs will be a questions on exam: dx for endometriosis

direct visualization of implants during laparoscopy or laparotomy PLUS tissue bx

tx fo endometriosis

obs NSAIDs surgery

pharm for endometriosis

OCP IUD progresterone therapy (Depo Provera, Mirena) danazol GnRH (Lupron)

endometrial tissue from uterus exists w.in and grows into the muscular wall of the uterus

adenomyosis

symmetrically enlarged uterus

adenomyosis

sx of adenomyosis if not asymptomatic

severe dysmenorrhea abd pressure/bloating heavy bleeding

what do you think when you see: middle aged woman, severe dysmenorrhea, hx of childbearing, symmetrically enlarged uterus, menorrhagia

adenomyosis

definitive dx for adenomyosis

**hysterectomy** *also pelvic US, MRI*

tx for adenomyosis

NSAIDs hormones hysterectomy

2 types of pelvic organ prolapse

anterior vaginal wall posterior vaginal wall

types of anterior pelvic organ prolapse

cystocele cystourethrocele

types of posterior pelvic organ prolapse

rectocele enterocele

mc type of pelvic organ prolapse

cystourethrocele

rf for uterine prolapse

post pregnancy/labor vaginal delivery post menopause increased intra-abd pressure smoking

sx of uterine prolapse are worse after \_\_ and relieved by \_\_

prolonged sitting lying down

sx of uterine prolapse

vaginal fullness urinary sx lower abd pain low back pain “falling out sensation”

management of uterine prolapse requires

gyn referral!

non surgical management of uterine prolapse

wt reduction smoking cessation pelvic m exercises vaginal pessary

abnormal menstrual bleeding and bleeding dt other causes (pregnancy, systemic dz, cancer)

abnormal uterine bleeding (AUB)

mc cause of AUB

pregnancy

exclusion of all possible pathologic causes of AUB establishes dx of

dysfunctional uterine bleeding (DUB)

AUB includes (5)

bleeding btw periods bleeding after intercourse spotting any time after menstrual cycle bleeding heavier or for more days than normal bleeding after menopause

causes of AUB (many!!)

PCOS pregnancy miscarriage ectopic pregnancy adenomyosis birth control hormones STIs fibroids clotting d.o polyps endometrial hyperplasia cancer

4 structural causes of AUB

**PALM** **p**olyp **a**denomyosis **l**eiomyoma **m**alignancy/hyperplasia

5 nonstructural causes of AUB

**coine** **c**oagulopathy **o**varian dysfxn **i**atrogenic **n**ot yet classified **e**ndometrial process

evaluation of AUB depends on

age → hormonal flow ex have they had first period? vs menopause

2 exams that is especially important for evaluation of AUB

rectovaginal → palpate uterus cytological → pap smear

mc cause of AUB

iatrogenic

gold standard eval tool for AUB

**hysteroscopy** → direct visualization of endometrium

other important imaging for AUB (2)

pelvic US endometrial bx

tx to try for AUB

progesterone OCP surgical

bleeding that occurs after 12 months of amenorrhea in a middle-aged woman

postmenopausal bleeding

2 lab values highly suggestive of menopause

FSH \> 30 miUL/mL estradiol \< 20

mc cause of postmenopausal bleeding

use of exogenous hormones

mc gyn cancer

endometrial

mc type of endometrial ca

adenocarcinoma

rf for endometrial ca

increasing age obesity nulliparity/infertility late menopause early menarche DM unopposed estrogen genetic predisposition prior pelvic xrt

cardinal sx of endometrial ca

abnormal uterine bleeding

other sx of endometrial ca

abnormal vaginal d.c intermittent spotting lower abd cramps/pain

dx for endometrial ca

incidental on pap pelvic US D&C endometrial bx

tx for endometrial ca

gyn referral! total hysterectomy w. salpingo-oophrectomy xrt chemo

basis of tx and staging for endometrial ca

total hysterectomy w. combined oophrectomy