Menstrual Disorders

Question 0

Polymenorrhea

Answer 0

cycle <21 days

Question 1

Oligomenorrhea

Answer 1

cycle >35 days

Question 2

Amenorrhea Definitions

Answer 2

Primary: no menarche by 16yo
or no menarche 4yrs after thelarche
Secondary: 3 missed cycles or >6mos

Question 3

Menorrhagia

Answer 3

> 7 days of bleeding or abnormally heavy bleeding

Question 4

Metorrhagia

Answer 4

irregular frequent bleeding

Question 5

Menometorrhagia

Answer 5

irregular prolonged bleeding

Question 6

Dysfunctional Uterine Bleeding (DUB) Etiology

Answer 6

Hormonal
Pregnancy
Local Pathology
Bleeding Diathesis

Question 7

DUB: Hormonal Causes

Answer 7

PCOS
Thyroid dysfunction
Hyperprolactinemia
Adrenal gland abnormalities
OCP

Question 8

DUB: Pregnancy-Related Causes

Answer 8

Threatened/spontaneous/elective abortion
Molar/ectopic pregnancy
Post-abortion endometritis
Placenta previa/abruption

Question 9

DUB: Local Pathology Causes

Answer 9

STI's
Retained foreign body
Laceration
Polyp
AV malformation
Dysplasia/malignancy

Question 10

DUB: Bleeding Diathesis Causes

Answer 10

ITP
von Willebrand dz
Abnormal platelet function d/t meds (NSAID’s) or illness (CKD)
Bone marrow suppression (chemo, leukemia)
Coagulopathy (inherited, liver dz, anti-coagulant meds)

Question 11

DUB Work-Up

Answer 11

βhcg
chlamydia/gonorrhea, trichomonas
cbc, tft's
INR, PTT, vWF
FSH, LH, prolactin
Androgens: t/f testosterone, androstenedione, 17-OH, DHEA-S
pelvic U/S

Question 12

Mild DUB Management

Answer 12

Hgb >12, no active bleeding
Prophylactic iron
Re-eval in 3mos

Question 13

Moderate DUB Management

Answer 13

Hgb 10-12 w/mod-heavy bleeding

OCP’s and iron

Question 14

Severe DUB Management

Answer 14

Hgb <7
     or orthostasis 
Inpt monitoring
Consider blood transfusion
IV conjugated estrogens
Add progestin ASAP
OCP, iron
D&C if uncontrollable bleeding

Question 15

PCOS

Answer 15

Risk Factors: premature adrnarche, maybe obesity, insulin resistance
Diagnosis: at least 2 of 3 criteria
--- polycystic ovaries
--- oligo or anovulation
--- sx of hyperandrogenism 
          hirsutism  
          severe acne
          clitoromegaly (>3mm)
          high testosterone