menstrual Flashcards
cyclic bleeding occurs every how many days
- 21-35 days
- cycle day #1 (first day of bleeding) through cycle day #1 of next cycle
life cycle of corpeus luteum is
always 14 days
What is primary amenorrhea
- lack of onset of menses by age 15 (with normal growth and secondary sex characteristics)
- lack of onset of menses by age 13 with lack of normal secondary sex characteristics
lack of menses for 6 months after irregular or 3 months of regular menses
secondary amenorrhea
what should be checked on every patient who presents with amenorrhea
urine or serum HCG for pregnancy
What is DDX in a female patient who presents with primary amenorrhea and the patient is found to be genotypically male (XY)
-
5α-Reductase deficiency
- is an enzyme that converts testosterone to 5α-dihydrotestosterone (DHT) in peripheral tissues
-
Androgen insensitivity syndrome
- resistant to male hormones (called androgens).
What is DDX in a female patient who presents with primary amenorrhea and you suspect defect of urogenital sinus development
- vaginal agenesis
- transverse vaginal septum
- imperforate hymen
asherman’s syndrome etiologies
- iatrogenic or infectious damage to endometrium
- causes
- aggressive surgical curetting
- infectious disease (ex. TB)
- h/o multiple cesarean sections
- endometrial ablation
asherman’s syndrome can present as primary or secondary amenorrhea
can present as either primary or secondary amenorrhea
What are some causes of hypothalamic dysfunction -> GnRH deficiency
- genetic
- weight loss resulting in <10% body fat
- extreme exercise
- nutritional deficiencies
- extreme stress
role of prolactin in amenorrhea
- prolactin inhibits GnRH resulting in low gonadotropins and low gonadal hormones
if persistent hyperprolactinemia, review patient h/o of
- pregnancy or breastfeeding
- medications
- excessive breast stimulation
What are some symptoms of prolactinoma
- hyperprolactinemia
- galactorrhea
- HA
- visual disturbances
What is sheehan syndrome associated with? What is the result?
- associated with significant hemorrhage during childburth with resulting hypotension and decreased blood flow to pituitary causing ischemic damage
- results in low gonadotropins (FSH, LH) as well as other pituitary hormones -> secondary amenorrhea
what condition should you consider in a women who goes through menopause before age of 40 yo with a h/o chemotherapy, radiation, or systemic illness
primary ovarian insufficiency (premature ovarian failure)
Dysfunction in what organ can lead to annovulatory cycles
thyroid
what lab tests should be ordered for patient presenting with amenorrhea
- HCG
- CBC
- TSH
- LH, FSH, estradiol
- Prolactin
- Total testosterone
What is prolonged or excessive, but regular bleeding
Menorrhagia
what is irregular and frequent bleeding
Metrorrhagia
what is intermenstrual bleeding
bleeding between otherwise regular cycles
What is excessive irregular bleeding
menometrorrhagia
- a combination of metrorrhagia and menorrhagia
what is polymenorrhea
regular cycles shorter than 21 days
List the causes of abnormal uterine bleeding
PALM-COEIN
- Polyps
- Adenomyosis
- Leiomyoma
- Malignancy and hyperplasia
- Coagulation problems
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet classified
Workup for patients with abnormal uterine bleeding under age 15 yo
- CBC, coags
