Menstrual Disorders Flashcards
prolonged or excessive bleeding at regular intervals
Menorrhagia
irregular, frequent uterine bleeding of varying amounts but not excessive
Metrorrhagia
prolonged or excessive bleeding at irregular intervals
Menometrorrhagia
regular bleeding at intervals of less than 21 days
Polymenorrhea
bleeding at intervals greater than every 35 days
Oligomenorrhea
no uterine bleeding for at least 6 months
Amenorrhea
uterine bleeding between regular cycle
Intermenstrual
In a patient with abnormal uterine bleeding, what are some indications for an endometrial biopsy?
Post-menopausal any age
Age > 45
Obesity
Diabetes (increased risk of endometrial Ca)
Breakthrough bleeding on HT after 6-9 months
Infertility (if anovulatory)
Family history of endometrial or colon cancer
the absence of menstruation
Amenorrhea
What is the most common cause of amenorrhea?
pregnancy
Which type of amenorrhea is described below?
young woman who has never menstruated by 13 without secondary
development or by age 15 with secondary development; lack of menstruation within 2 years of the onset of breast development
Primary Amenorrhea
Which type of amenorrhea is described below?
woman who has not menstruated for 3-6 months (or for three
typical menstrual cycles in oliogomenorrhea patients) with previously normal menstration; or absence of menstruation for 12 months in a woman with a previous history of oligomenorrhea
Secondary Amenorrhea
List some causes of amenorrhea
Pregnancy – most common cause
Gonadal dysgenesis – 50%
Hypothalmic-pituitary dysfunction
Ovarian dysfunction
Psychogenic
Imperforate hymen – 5%
Mullerian agenesis
Head injury
Chronic medical illness
Alteration of genital outflow tract – structural
Endometrial atrophy
Premature ovarian failure
What is the most common anomalies in secondary amenorrhea?
Ashman syndrome
What labs should be tested in amenorrhea?
Beta hCG
FSH
LH
Prolactin
TSH
What challenge can you use for testing amenorrhea?
Progesterone Challenge Test
Describe the Progesterone Challenge Test
Medroxyprogesterone acetate 10-14 days
Mimics ovarian function in the luteal phase
Results help to determine what type of amenorrhea is present
Describe the results of the progesterone challenge test? (Bleeding v non-bleeding)
Withdrawal bleeding = anovulary, oliogovulatory
No withdrawal bleeding = structural, hypoestrogenic (hypogonadism)
Painful menstruation, often sufficiently severe that it prevents a woman from performing normal functions
Dysmenorrhea
Which type of dysmenorrhea is described below?
Begins soon after menarche
Absence of pathologic findings
Caused by excessive prostaglandins: PGF2a and PGE2
Primary dysmenorrhea
Which type of dysmenorrhea is described below?
New onset in an older woman
Menstrual pain for which an organic cause exists
Often associated with endometriosis or uterine fibroids
Secondary dysmenorrhea
Definition: a group of physical, mood-related, and behavioral changes that occur in a regular, cyclic relationship to the luteal phase of the menstrual cycle
Recurrent physical and emotional symptoms, relieved with menstration
40% incidence (25-40 year olds)
Premenstrual Syndrome
When does the premenstrual syndrome begin in relation to a person’s menses?
Occurs 7-14 days before the onset of menses
When does the premenstrual syndrome stop in relation to a person’s menses?
the symptoms are resolved within 4 days of the onset of menses
“middle pain” – German translation
Occurs during ovulation – the midpoint between menstrual periods (about two weeks before a period may pain)
Also referred to as painful ovulation (Twinge of pain = ovulation)
Mittelschmerz
