Menstrual Abnormalities Flashcards
MCC metrorrhagia
Cervical polyps
Endometrial polyps
Normal menses Frequency Duration Volume Regularity
21-35d
4-7d
30-80ml
Monthly
AUB classification
Organic - systemic and reproductive
Dysfunctional - non/ovulatory
Endometrial biopsy indications
> 35 yo obesity hpn DM
Post menopausal women
Occurs in reproductive tears Due to local endometrial factors Simultaneous orderly tissue breakdown Spiral arteriolar constriction Midcycle rise in body temp Secretory changes
Ovulatory
Occurs in peri and postmenopause Continued estrogen w/o progesterone Unstable spontaneous haphazard breakdown Absence of vasoconstriction and BBT rise Proliferative changes
Anovulatory
Tx for hemodynamically unstable bleeding
IV estrogen
GnRH agonist and D&C
DOC for anovulatory bleeding
Progestins
Chronic ovulatory bleeding with contraception
OCP and levonorgestrol IUD +/- NSAISs and tranexamic acid
Chronic ovulatory bleeding with fertility
NSAIDs and tranexamic acid
Chronic anovulatory bleeding
With contraception
With fertility
OCP
Cyclic progestin therapy from D14-25
Used prior to surgery
Danazol androgenic steroid
Leuprolide GnRH agonist
Surgical for DUB
D&C
Endometrial ablation
Hysterectomy
Prostaglandin F2a mediated uterine ischemia
Primary dysmenorrhea
NSAIDs and OCP
MCC secondary dysmenorrhea
Endometriosis and adenomyosis
Primary amenorrhea
14 w/o sec sexual characteristics
16 w/ sec sexual characteristics
Secondary amenorrhea
3 months regular menses
6 months irregular menses
Absent breast
Absent uterus
17,20 desmolase deficiency
17 a hydroxylase deficiency
Agonadism
Absent breast
Present uterus
Hypogonadotropic hypogonadism Dec GnRH FSH LH due to HP axis Dec estrogen Hypothalamic failure Pituitary failure
Hypergonadotropic hypogonadism
Inc GnRH FSH LH due to lack of response of ovaries to LH and FSH
No estrogen
Gonadal failure
Absent breast
Present uterus
FSH LH<5
CNS imaging: mass
CNS tumor
Pituitary failure
Hypo hypo
Absent breast Present uterus FSH LH<5 CNS imaging: none ANOSMIA
Kallman’s syndrome: gonadotropin deficiency
Hypothalamic failure
Hypo hypo
GnRH therapy
Absent breast
Present uterus
FSH <40
Karyotyping 45XO
Turner’s syndrome streaky ovaries
Hyper hypo
Estrogen therapy
Absent breast Present uterus FSH <40 Karyotyping 46XX MOSAICISM
Premature Ovarian Failure <40 yo
Hyper hypo
Absent breast Present uterus FSH <40 Karyotyping 46XX RECEPTOR DEFECT
Savage syndrome
Hyper hypo
Present breast
Normal utz of uterus
Outflow tract abnormality
Bulging purplish red membranes
Hematocolpos
Pelvic and abdominal pain
Imperforate hymen
Cruciate incision
Failure of Mullerian duct to fuse with urogenital sinus
Hematocolpos
Pelvic and abdominal pain
Transvaginal septum
Surgical correction
Short vaginal pouch
Vaginal agenesis
Neovagina
Present breasts
Absent or abn uterus on utz
46XX
Short vaginal pouch
Mullerian agenesis or Mayer Rokitansjy Kuster Hauser Syndrome
Neovagina
Present breasts
Absent or abn uterus on utz
46XY
N testosterone
Androgen Insensitivity
Present breast
Present uterus
MCC
Hyperprolactinemia
Prolactinoma
Stein Leventhal triad
Hirsutism
Amenorrhea
Obesity
MC antecedent factor of Asherman’s syndrome
Endometrial curettage
Withdrawal bleeding within 7 days
Progesterone challenge
Anovulatory
No withdrawal nleeding on progesterone challenge test
Positive EPCT
Negative EPCT
No estrogen
low FSH HP failure
high FSH ovarian failure
Mechanical causes
