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Clin Med3: Womens Health > Menses/Abnormal Uterine Bleeding > Flashcards

Menses/Abnormal Uterine Bleeding Flashcards

1
Q

what is the normal range for cycle length

A

21-35 days

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2
Q

what is the average blood loss during menstrual cycle

A

30ml; normal variation spotting to 80ml

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3
Q

what is the first menstrual period

A

menarche

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4
Q

what is the hypothalamus’s effect on the menstrual cycle

A

GnRH is secreted in pulsatile manner beginning several days before onset of menstruation

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5
Q

what is the anterior pituitary’s effect on menstrual cycle

A

GnRH stimulates production and release, also in pulsatile fashion, of FSH and LH

production of FSH and LH down-regulates release of GnRH from hypothalamus

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6
Q

What days of menses is the follicular phase

A

days 6-14

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7
Q

what day of menses us ovulation

A

day 14

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8
Q

what days of menses is the luteal phase

A

day 15-28

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9
Q

What is amenorrhea

A

lack of menses/period

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10
Q

what is dysmenorrhea

A

pain with menses

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11
Q

what is primary amenorrhea

A

absence of menses by age 16 or age 14 without onset of puberty - usually anatomical or hormonal, genetic

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12
Q

what is secondary amenorrhea

A

absence of menses for 3 menstrual cycles or total of 6 months in women who have had normal menstruation

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13
Q

what are some causes of primary amenorrhea if normal secondary sexual characteristics

A

imperforate hymen
transverse vaginal septum
cervical or mullerian agenesis (absence of vagina and or uterus)

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14
Q

what are some causes of primary amenorrhea if incomplete development of secondary sexual characteristics

A

hypothalamus or pituitary tumor
hypothyroidism
premature ovarian failure
hyperprolactinemia

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15
Q

what are some of the causes of primary amenorrhea if secondary sexual characteristics are ABSENT

A

physiological delay of puberty (not common in girls)
gonadal agenesis or dysgenesis (Turners)
Ovarian resistance syndrome
GnRH-deficiency (rare)
hyperprolactinemia
CNS mass lesion

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16
Q

what is the most common cause of secondary amenorrhea

A

pregnancy

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17
Q

what are other causes of secondary amenorrhea

A

drug use
stress
significant weight changes
excessive exercise

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18
Q

what is menorrhagia

A

heavy, prolonged menstrual flow (>7 days or > 80mL)

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19
Q

what is metrorrhagia

A

uterine bleeding at irregulat intervals, esp. between expected mnestrual periods

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20
Q

what is menometrorrhagia

A

excessive uterine bleeding both at expected time of menses and at irregular intervals

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21
Q

what is mid-cycle spotting

A

spotting that occurs just before ovulation, usually due to decline in estrogen

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22
Q

what is considered AUB

A

any bleeding prior to menarche is abnormal
any post-menopausal bleeding is abnormal

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23
Q

what are concerns with bleeding prior to menarche

A

concern for malignancy, trauma, sexual abuse, urinary tract issues

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24
Q

what is the concern with bleeding post-menopausal

A

primary concern is malignancy

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25
Q

when is AUB most common

A

beginning and end of reproductive years

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26
Q

what is acute AUB

A

EMERGENCY
excessive bleeding requiring immediate intervention to prevent further blood loss

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27
Q

what is chronic AUB

A

menstrual bleeding irregularities for most of the previous 6 months

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28
Q

What is the treatment of acute AUB

A

volume replacement with bleeding cessation
stabilize hemodynamically (IV fluids, blood products)
hormonal control of bleeding
may consider, bladder cath inserted into uterus and inflated to tamponade bleeding

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29
Q

what is the primary concern with AUB

A

Endometrial cancer

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30
Q

what are the risk factors of endometrial cancer

A

obesity, nulliparity, DM, infertility/unopposed estrogen/chronic anovulatory cycles, ages >35yo, tamoxifen

31
Q

what has protective effects of endometrial cancer

A

OCPs

32
Q

what is the most common presenting symptom of endometrial cancer

A

AUB

33
Q

what is the treatment for endometrial cancer

A

total hysterectomy (TAH/TVH) and bilateral salpingo-oophorectomy
recurrence treated with high dose progestins or anti-estrogens

34
Q

what can be associated symptoms/systemic symptoms of AUB

A

weight loss, fever, chills
pain (pelvic)
vaginal discharge
bowel/bladder symptoms
anemia signs/symptoms

35
Q

what occurs with anovulatory cycle

A

corpus luteum dose not form
estrogen stimulates endometrium unopposed which continues to proliferate
endometrium outgrows blood supply and sloughs incompletely; bleeds irregularly and maybe profusely or for a long time

36
Q

what occurs with ovulatory AUB

A

progesterone secretion is prolonged
irregular shedding of endometrium results because estrogen levels remain low, near threshold for bleeding (as occurs during menses)

37
Q

what is the most common cause of anovulatory AUB

A

PCOS (polycystic ovarian syndrome)
endometriosis
anorexia

38
Q

what is the clinical presentation of ovulatory AUB

A

excessive bleeding during regular menstrual cycles
may have other symptoms of ovulation (premenstrual symptoms, breast tenderness, mid-cycle cramping.. etc)

39
Q

what is the clinical presentation of anovulatory AUB

A

occurs at unpredictable times and in unpredictable patterns
not accompanied by cyclic changes in basal body temp

40
Q

what are diagnostics/work up test for AUB

A

signs of pallor, endocrine disorders, coagulopathies, abdominal exam, pelvic exam (visual, speculum, bimanual)

41
Q

what needs to be considered with AUB

A

pregnancy
iatrogenic (meds/herbals)
systemic disorders (thyroid, hematologic, hepatic, HPA-axis)
Genital tract pathology

42
Q

when is TVUS used for AUB workup

A

risk factors for endometrial cancer
age >35
bleeding that continues despite use of empiric hormone therapy
pelvic organs that cannot be examined adequately during PE
clinical evidence that suggests abnormalities in ovaries or uterus

43
Q

What is uterine Leiomyoma

A

fibroids
benign tumor that originates from smooth muscle layer and surrounding connective tissue of the uterus

44
Q

what do women with fibroids have an increased risk for

A

endometrial cancer

45
Q

what can be the clinical manifestations of uterine leiomyomas

A

often asymptomatic
-depends on number, size and location
heave/prolonged bleeding
pelvic pain or pressure
reproductive dysfunction

46
Q

what is the diagnostic imagine of choice for uterine leiomyomas

A

TVUS

47
Q

what is the treatment for fibroids

A

depends on pre vs post menopausal or if women desire fertility
observation
hormonal therapies
hysterectomy - only real ‘cure’

48
Q

what is adenomyosis

A

extension of endometrial glands into uterine musculature

49
Q

what is the classic patient presentation of adenomyosis

A

middle age, parous, severe dysmenorrhea and menorrhagia. diffusely enlarged globular uterus

50
Q

what is the definitive therapy for adenomyosis

A

hysterectomy

51
Q

how is adenomyosis diagnosed

A

r/o pregnancy
US
endometrial biopsy (r/o endometrial cancer)
MRI - most accurate imaging tool

52
Q

what are signs and symptoms of endometriosis

A

dysmenorrhea, dyspareunia, spotting, pelvic pain
infertility common

53
Q

what are the diagnostic tests for endometriosis

A

TVUS, laparoscopy, and biopsy of lesions

54
Q

what is the treatment for endometriosis

A

NSAIDs and OCP - first line
GnRH agnoists
Danazol: suppress LH and FSH
surgery

55
Q

what is DUB

A

(dysfunctional uterine bleeding)
absence of organic disease or anatomic lesion
usually a problem with the hypothalamic-pituitary-ovarian hormonal axis

56
Q

what is the most common cause of DUB

A

ovulation failure shortly after menarche or during perimenopause

57
Q

what is the treatment of endometrial hyperplasia in postmenopausal women

A

D&C with strong consideration for hysterectomy

58
Q

what is the treatment of endometrial hyperplasia in premenopausal women

A

medroxyprogesterone acetate or levonorgesterel-releasing IUD
treat for 3-6 months and repeat endometrial sampling

59
Q

what is the treatment for AUB

A

hormone therapy : OCP, progestogen, IUD

60
Q

what is the mechanism of hormone therapy for the treatment of AUB

A

suppresses endometrial development
re-establishes predictable bleeding patterns
decreases menstrual flow

61
Q

what are the benefits of OCP with AUB

A

decrease menstrual blood loss by 40-50%
decrease breast tenderness and dysmenorrhea
decreased risk of uterine and ovarian cancer

62
Q

what is the benefit of using Clomiphene

A

if pregnancy desired and bleeding not heavy, can induce ovulation

63
Q

what are non-hormonal treatments of AUB

A

NSAIDs: reduces bleeding, relieves dysmenorrhea
Tranexamic acid : inhibits plasminogen activator, reduces blood loss

64
Q

what is the most common cause of AUB

A

ovulatory dysfunction

65
Q

what are the tests for treatable causes of bleeding

A

pregnancy test
CBC and ferritin
hormone levels
TVUS or hysteroscopy and endometrial sampling

66
Q

what is dysmenorrhea

A

painful menses that interferes with normal activities

67
Q

what is secondary dysmenorrhea

A

painful menses due to pelvic pathology
incidence increases iwth age

68
Q

what are common causes of new onset/episodic dysmenorrhea

A

ruptured corpus luteum or ovarian cyst
ectopic pregnancy
PID
ovarian torsion
spontaneous abortion

69
Q

what are causes of chronic secondary dysmeorrhea

A

endometriosis
adenomyosis
leiomyoma (fibroids)

70
Q

what is PMS

A

wide range of physical or emotional symptoms usually occurring 5-11 days before monthly menstrual cycle (during luteal phase)

71
Q

what are PMS symptoms

A

HA
swelling of ankles, feet and hands
bachache
abd cramps/heaviness
moodiness, sadness
abdominal fullness/gaseous
breast tenderness
weight gain
irritability, hostility or aggressive behavior

72
Q

what is treatment for PMS

A

exercise and diet change
nutritional supplements: Vit B6, calcium, magnesium
NSAIDs
OCPs

73
Q

What is PMDD

A

(premenstrual dysphoric disorder)
condition marked by sadness, inability of function normally at work or in personal relationships, irritability and anger but which occurs only in the premenstrual period and then abates with the onset of menses or shortly after

74
Q

what is the treatment of PMDD

A

balanced diet
adequate rest
regular exercises 3-5 times per week
SSRI therapy
nutritional supplements

Clin Med3: Womens Health (13 decks)

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