Menstrual Disorders

Question 1

prolonged or excessive bleeding at regular intervals

Answer 1

Menorrhagia

Question 2

irregular, frequent uterine bleeding of varying amounts but not excessive

Answer 2

Metrorrhagia

Question 3

prolonged or excessive bleeding at irregular intervals

Answer 3

Menometrorrhagia

Question 4

regular bleeding at intervals of less than 21 days

Answer 4

Polymenorrhea

Question 5

bleeding at intervals greater than every 35 days

Answer 5

Oligomenorrhea

Question 6

no uterine bleeding for at least 6 months

Answer 6

Amenorrhea

Question 7

uterine bleeding between regular cycle

Answer 7

Intermenstrual

Question 8

In a patient with abnormal uterine bleeding, what are some indications for an endometrial biopsy?

Answer 8

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

Question 9

the absence of menstruation

Answer 9

Amenorrhea

Question 10

What is the most common cause of amenorrhea?

Answer 10

pregnancy

Question 11

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

Answer 11

Primary Amenorrhea

Question 12

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

Answer 12

Secondary Amenorrhea

Question 13

List some causes of amenorrhea

Answer 13

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

Question 14

What is the most common anomalies in secondary amenorrhea?

Answer 14

Ashman syndrome

Question 15

What labs should be tested in amenorrhea?

Answer 15

Beta hCG
FSH
LH
Prolactin
TSH

Question 16

What challenge can you use for testing amenorrhea?

Answer 16

Progesterone Challenge Test

Question 17

Describe the Progesterone Challenge Test

Answer 17

Medroxyprogesterone acetate 10-14 days

Mimics ovarian function in the luteal phase

Results help to determine what type of amenorrhea is present

Question 18

Describe the results of the progesterone challenge test? (Bleeding v non-bleeding)

Answer 18

Withdrawal bleeding = anovulary, oliogovulatory

No withdrawal bleeding = structural, hypoestrogenic (hypogonadism)

Question 19

Painful menstruation, often sufficiently severe that it prevents a woman from performing normal functions

Answer 19

Dysmenorrhea

Question 20

Which type of dysmenorrhea is described below?

Begins soon after menarche

Absence of pathologic findings

Caused by excessive prostaglandins: PGF2a and PGE2

Answer 20

Primary dysmenorrhea

Question 21

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

Answer 21

Secondary dysmenorrhea

Question 22

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)

Answer 22

Premenstrual Syndrome

Question 23

When does the premenstrual syndrome begin in relation to a person’s menses?

Answer 23

Occurs 7-14 days before the onset of menses

Question 24

When does the premenstrual syndrome stop in relation to a person’s menses?

Answer 24

the symptoms are resolved within 4 days of the onset of menses

Question 25

“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)

Answer 25

Mittelschmerz