LaBarre- Amenorrhea and Dysfunctional Uterine Bleeding

Question 1

Normal flow

Answer 1

2-7 days

Question 2

cycle length

Answer 2

24-35 days

Question 3

MC causes amenorrhea

Answer 3

pregnancy
lactation
menopause

Question 4

no spontaneous uterine bleeding by age 14 and absence of 2 sex characteristics OR by age 16 w/ normal development

Answer 4

primary ammenorrhea

Question 5

absence of mentrual bleeding for 6 mos in a woman w/ prior regular menses for 12 mos

Answer 5

secondary amenorrhea

*40% d/t ovaries

Question 6

Compartment I blockages that cause amenorrhea

Answer 6

imperforate hymen
Ashermans
Mulleraian anomalies (absent uterus/tubes)
Testicular feminization

Question 7

Ashermans

Answer 7

destruction of endometrium and scarring prevents bleedingn (D&C, ablation, severe infecdtion)

Question 8

Compartment II ovarian disorders that cause amenorrhea

Answer 8

1. Turners
2. MOsaicism
3. gonadal agenesis
4. Premature ovarian failure
5. 17 alpha hydroxylase def

Question 9

Follicles undergo apoptosis leading to HIGH FSH and LOW estrogen

Answer 9

Turners 46 XO

Question 10

Stress related amenorrhea

Answer 10

stress> increased cortisol> decreases FSH/LH

Question 11

First thing to check for in a F w/ amenorrhea…

Answer 11

rule out pregnancy w/ hCG

Question 12

Amenorrhea w/ high TSH

Answer 12

hypothyroid

Question 13

NO normal withdrawl bleed after progesterone

Answer 13

end organ problem

Question 14

prolonged >7d or excessive bleeding

Answer 14

menorrhagia

Question 15

irregular and more frequent intervals of bledding

Answer 15

metrorrhagia

Question 16

prolonged/variable amts of bleeding occuring irregularly and more frequently than normal

Answer 16

Menometrorrhagia

Question 17

menses at interval GREATER than 35 d

Answer 17

oliomenorrhea

Question 18

menses at interval LESS than 21 days

Answer 18

polymenorrhea

Question 19

bleeding between regular periods

Answer 19

intermenstrual bleeding

Question 20

Midcycle spotting

Answer 20

1 day prior to ovulation from decline in estrogen

Question 21

bleeding in a woman at least 1 year after cessation of cycles

Answer 21

postmenopausal bleeding

Question 22

lack of bleeding 6 mos or longer

Answer 22

amenorrhea

Question 23

Abnormal bleeding in pregnancy

Answer 23

1. 1/4 woman have bleeding in 1st trimester
2. ectopic pregnancy
3. miscarriage
4. placenta previa
5. gestational trophoblastic disease, molar pregnancy

Question 24

Uterine fibroids

Answer 24

float alongside the lining and causes the lining to become unstable and build up leading to shedding at irregular times

Question 25

Teens who have heavy periods

Answer 25

evaluate for bleeding disorder if they have heavy bleeding and no other issues

Question 26

MC condition that affects ovulation

Answer 26

PCOS

Question 27

MC medications that affect ovulation

Answer 27

antiepleptics (valproic acid) | antipsychotics

Question 28

Disturbance of normal HPO axis that leas to a progesterone def, estrogen dominant state

Answer 28

Anovulatory bleeding NO ovulation leaving estrogen high and lining becomes unstable and sheds

Question 29

When do adolescents need evaluation?

Answer 29

consistently >3 mos between cycles | irregular cycles > 3 years

Question 30

When do adult women need evaulation?

Answer 30

suspected anovulatory cycles | PCOS and increased risk for endometrial cancer w/ HI estrogen

Question 31

When do perimenopausal women need evaluation?

Answer 31

increased volume/duration of bleeding More often than every 21 days positcoital bleeding> infection/polyps

Question 32

intermenstrual spotting in a perimenopausal woman

Answer 32

endometrial cancer

Question 33

Hair growth/acne could be signs of

Answer 33

PCOS> check androgen levels and see if there are other signs of verilization

Question 34

Evaluation for perimenopausal woman with a lot of bleeding?

Answer 34

endometrial biopsy

Question 35

RF for endometrial cancer?

Answer 35

``` obesity nuliparity previous tamoxifen therapy unopposed estrogen therapy diabetes 50-70 ```

Question 36

Obese 17 y/o w/ 2-3 years of untreated anovulatory bleeding

Answer 36

endometrial biopsy

Question 37

Endometrial biopsies have a high sensitivity for detecting...

Answer 37

carcinoma *lower for atypical hyperplasia

Question 38

Endometrial ultrasound have high sensitivity for detecitng...

Answer 38

endometrial cancer (thick lining)

Question 39

Treatment for acute, heavy bleeding woman that's hemodynamically unstable

Answer 39

1. high dose IV estrogen 2. IV fluids 3. blood products 4. consider D and C> progress to surgery and take out lining to stop bleeding

Question 40

Treatment for acute, heavy bleeding woman that's hemodynamically stable

Answer 40

1. OCPS (heavy dose 1 pill twice daily for 7 days then withdrawal bleed) 2. NSAIDS 3. GnRH agonist

Question 41

What can decrease the heaviness of a cycle?

Answer 41

NSAIDS (give on first day of menses x 5 days