LaBarre- Amenorrhea and Dysfunctional Uterine Bleeding Flashcards
Normal flow
2-7 days
cycle length
24-35 days
MC causes amenorrhea
pregnancy
lactation
menopause
no spontaneous uterine bleeding by age 14 and absence of 2 sex characteristics OR by age 16 w/ normal development
primary ammenorrhea
absence of mentrual bleeding for 6 mos in a woman w/ prior regular menses for 12 mos
secondary amenorrhea
*40% d/t ovaries
Compartment I blockages that cause amenorrhea
imperforate hymen
Ashermans
Mulleraian anomalies (absent uterus/tubes)
Testicular feminization
Ashermans
destruction of endometrium and scarring prevents bleedingn (D&C, ablation, severe infecdtion)
Compartment II ovarian disorders that cause amenorrhea
- Turners
- MOsaicism
- gonadal agenesis
- Premature ovarian failure
- 17 alpha hydroxylase def
Follicles undergo apoptosis leading to HIGH FSH and LOW estrogen
Turners 46 XO
Stress related amenorrhea
stress> increased cortisol> decreases FSH/LH
First thing to check for in a F w/ amenorrhea…
rule out pregnancy w/ hCG
Amenorrhea w/ high TSH
hypothyroid
NO normal withdrawl bleed after progesterone
end organ problem
prolonged >7d or excessive bleeding
menorrhagia
irregular and more frequent intervals of bledding
metrorrhagia
prolonged/variable amts of bleeding occuring irregularly and more frequently than normal
Menometrorrhagia
menses at interval GREATER than 35 d
oliomenorrhea
menses at interval LESS than 21 days
polymenorrhea
bleeding between regular periods
intermenstrual bleeding
Midcycle spotting
1 day prior to ovulation from decline in estrogen
bleeding in a woman at least 1 year after cessation of cycles
postmenopausal bleeding
lack of bleeding 6 mos or longer
amenorrhea
Abnormal bleeding in pregnancy
- 1/4 woman have bleeding in 1st trimester
- ectopic pregnancy
- miscarriage
- placenta previa
- gestational trophoblastic disease, molar pregnancy
Uterine fibroids
float alongside the lining and causes the lining to become unstable and build up leading to shedding at irregular times
Teens who have heavy periods
evaluate for bleeding disorder if they have heavy bleeding and no other issues
MC condition that affects ovulation
PCOS
MC medications that affect ovulation
antiepleptics (valproic acid)
antipsychotics
Disturbance of normal HPO axis that leas to a progesterone def, estrogen dominant state
Anovulatory bleeding
NO ovulation leaving estrogen high and lining becomes unstable and sheds
When do adolescents need evaluation?
consistently >3 mos between cycles
irregular cycles > 3 years
When do adult women need evaulation?
suspected anovulatory cycles
PCOS and increased risk for endometrial cancer w/ HI estrogen
When do perimenopausal women need evaluation?
increased volume/duration of bleeding
More often than every 21 days
positcoital bleeding> infection/polyps
intermenstrual spotting in a perimenopausal woman
endometrial cancer
Hair growth/acne could be signs of
PCOS> check androgen levels and see if there are other signs of verilization
Evaluation for perimenopausal woman with a lot of bleeding?
endometrial biopsy
RF for endometrial cancer?
obesity nuliparity previous tamoxifen therapy unopposed estrogen therapy diabetes 50-70
Obese 17 y/o w/ 2-3 years of untreated anovulatory bleeding
endometrial biopsy
Endometrial biopsies have a high sensitivity for detecting…
carcinoma
*lower for atypical hyperplasia
Endometrial ultrasound have high sensitivity for detecitng…
endometrial cancer (thick lining)
Treatment for acute, heavy bleeding woman that’s hemodynamically unstable
- high dose IV estrogen
- IV fluids
- blood products
- consider D and C> progress to surgery and take out lining to stop bleeding
Treatment for acute, heavy bleeding woman that’s hemodynamically stable
- OCPS (heavy dose 1 pill twice daily for 7 days then withdrawal bleed)
- NSAIDS
- GnRH agonist
What can decrease the heaviness of a cycle?
NSAIDS (give on first day of menses x 5 days
