Genital Tract Bleeding & Menstrual Disorders Flashcards
Abnormal bleeding noted in the genital area is often attributed to what source?
Uterine source, but may arise from any anatomic site in the lower & upper genital tract or a nongynecologic organ
What is estrogen responsible for?
Proliferation and growth of the functional layer of the endometrium
What is progesterone responsible for?
It induces the endometrium to secrete glycogen, mucous and other substances which ready the endometrium for implantation
What happens to the endometrium when estrogen and progesterone levels drop?
The endometrium undergoes involution
What two substances cause vasoconstriction of the spiral arteries in the endometrial lining resulting in apoptosis and sloughing?
Endothelin and thromboxin
Chronic menstrual blood loss in what amount can lead to iron deficiency anemia?
> 80 ml per cycle
What is the term for pain during ovulation?
Mittelschmertz
What is the term for any bleeding that does not conform to the frequency, duration, or amount of bleeding that a woman considers normal?
Abnormal uterine bleeding (AUB)
What helps to determine the most likely cause and likelihood of serious pathology with AUB?
Life phase
What are possible differentials for AUB?
1) Pregnancy
2) Systemic disease
3) Trauma
4) Malignant neoplasm
5) Benign lesions
6) Infection
7) Medications
8) Hormonal imbalances
What is the term for an abnormally high amount of menses?
Hypermenorrhea
What is the term for an abnormally low amount of menses?
Hypomenorrhea
What is the term for periodic uterine blood loss >80 ml/cycle that occurs in the absence of structural uterine abnormalities?
Dysfunctional uterine bleeding (DUB)
What are the two types of DUB?
Anovulatory and ovulatory
What is the underlying cause of anovulatory DUB?
Hormonal disturbance (no progesterone to balance estrogen)
What is the underlying cause of ovulatory DUB?
Prostaglandin disturbance (vasodilation of spiral arteries)
What disorders cause anovulation?
1) Thyroid disease (hypo or hyper)
2) Hyperprolactinemia
3) Obesity
4) Primary ovarian failure (genetic - Turner’s)
5) Secondary ovarian failure (drugs, radiation)
What are some lab tests for AUB?
If 13-18: screen for blood dyscrasias and get CBC with platelet count
If 19-50: TSH, FSH, CBC with platelet count, serum prolactin
What are some indications for biopsy?
1) Age
2) PCOS
3) Liver disease
4) Diabetes
5) Obesity
6) Tamoxifen
7) FHX colon CA
8) Past DX of endometrial hyperplasia
The risk of endometrial cancer increases with what?
Age
What is used for medical management of ovulatory DUB?
NSAIDS
What is used for medical management of anovulatory DUB?
Oral contraceptives, progestins, GnRH agonists, Danazol, ablation or hysterestomy
What is the term for the absence of menarche by age 16 in the presence of normal growth and secondary sex characteristics?
Primary amenorrhea
What is the term for the absence of menses for 3 consecutive months in women who were previously menstruating?
Secondary amenorrhea
