Lecture 6- Abnormal Bleeding Flashcards
Frequent menstrual bleeding (<21 days)
Polymenorrhea
Prolonged or excessive bleeding occuring at regular intervals (loss of 80mL or more lasting for more than 7 days).
Menorrhagia
Bleeding in between periods.
Metrorrhagia
Frequent bleeding that is excessive and irregular in amount and duration.
Menometrorrhagia
what is the most common cause of amenorrhea?
pregnancy
What levels should be measured with amenorrhea?
FSH, LH, prolactin level
What is primary amenorrhea?
No menstruation by age 13 w/out 2° sexual development or by age 15 with 2° sexual development.
What is secondary amenorrhea?
Absence of menstruation for 3 – 6 months in a previously normal menstruating woman or for three typical cycle lengths in a woman with oligomenorrhea.
What are some functional causes of amenorrhea?
Wt loss, excessive exercise, obesity, drug-induced, neoplastic, psychogenic, heat injury, chronic medical illness
When is ovarian failure considered premature?
Women under 40
What are the most common anomalies in primary amenorrhea?
Imperforate hypen
Absence of uterus or vagina
What is a syndrome that is from scarring of the uterine cavity due to D&C. Most frequent anatomic cause of secondary amenorrhea.
Asherman Syndrome (common in people with a number of abortions)
What is a common syndrome that causes anovulatory abnormal uterine bleeding?
PCOS
What are the two main types of abnormal uterine bleeding?
Anovulatory
Ovulatory
What causes anovulatory AUB?
Endometrium outgrows its blood supply and sloughs at irregular and unpredictable times. Bleeding can be light and infrequent or frequent and heavy (can alternate)
What causes ovulatory AUB?
Luteal phase defect.
Corpus luteum doesn’t develop fully.
There is insufficient progesterone secretion.
How long does the corpus luteum live?
14 days
What do you measure for ovulatory AUB?
Progesterone (often at day 21)
What tests do you do for AUB?
Pap smear vaginitis/ STI screening Endometrial biopsy Labs Pelvic ultrasound sonohysterogram
What are some risks associated with AUB?
Anemia, acute hemorrhage, endometrial hyperplasia/ CA
What is some treatment for AUB?
Minera IUD Prover 10 mg 10-14 days cyclic progesterone OCP high dose estrogen OCP 4x4, 3x3, 2x2, 1 PO q day
If people with AUB has no reponse to medical thearpy what can be done?
D&C
Ablation of uterine lining
Hysterectomy
What is excess of protaglandins leading to painful uterine muscle cramping.
Primary dysmenorrhea
what is painful uterine muscle cramping caused by clinically identifiable causes: extrauterine, tumors, intramural, intrauterine.
Secondary dysmenorrhea
What is the main difference b/w chronic pelvic pain and dysmenorrhea?
Chronic pelvic pain isn’t cyclical, where dysmenorrhea is
What are some common cause of secondary dysmneorrhea?
Endometriosis, adenomyosis, adhesions, PID, leiomyomata
When is secondary dysmenorrhea most common?
Later in life
What are common therapy for primary dysmenorrhea?
NSAIDS (prostaglandin inhibitors) Heat exercise psychotherapy reassurance oral contraceptives
What is used for cases of severe pain that don’t respond to conventional therapy. This disrupts the presacral nerves.
Presacral Neurectomy
How do you treat secondary dysmenorrhea?
Correct underlying condition when possible.
OCP can also be used
How long does pelvic pain need to have lastsed to be diagnosed as chronic pelvic pain?
Longer than a year
Is chronic pelvic pain just combined to the uterus?
No, can also involve diseases of reproductive, genitourinary, and GI tracts
What is a condition that can cause chronic pelvic pain and is a chronic inflammatory condition of the bladder?
Interstitial cystitis (ICS)
What is when there is the presence of endometrial glands and stroma in any extrauterine site
Endometriosis
What do you use for diagnosis of endometriosis?
Tissue biopsy
What are the three major theories of endometriosis?
- Retrograde menstruation
- Vascular and lymphatic dissemination
- Coelomic metaplasia
What should you think when you see “mulberry, brown lesions, “chocolate cysts”
Endometriosis
What is the triad of endometriosis?
Dysmenorrhea, dyspareunia, dyschezia
What are the two types of surgery for endometriosis?
Conservative
Extirpative (everything removed)
What is medical treatment for endometriosis?
NSAIDS, continuous OCP’s, Depo-Provera, Danazol, GnRH agonists (Depo-Lupron) with add-back therapy.
What are benign muscular tumors or the uterus. Highest prevalence in 5th decade?
Uterine Leiomyomas (fibroids)
What type women have a higher prevalence of uterine fibroids?
African-American women
What are the three most common types of leiomyomas?
Intramural
Subserosal
Submucosal
What is The presence of ectopic endometrial tissue within the myometrium. Causes irregular bleeding and pain. Only treatment is hysterectomy. Commonly found at time of hysterectomy.
Adenomyosis
