menstrual disorders

Question 1

what is the most common cause of unexplained uterine bleeding?
What are other commonc uases?

Answer 1

the most common cause in a nonpregnant woman is dysfunctional menstrual cycles
• Unexplained uterine bleeding can occur for many reasons eg abortion, pregnancy, neoplasms, and bleeding disorders

Question 2

when the basic pattern of bleeding is changed what is most likely the cause

Answer 2

• When the basic pattern of bleeding is changed its most often due to lack of ovulation & disturbances in pattern of hormone secretion.

Question 3

if the basic pattern is the undisturbed but there is superimposed bleeding what is the etiology?

Answer 3

If the basic pattern is undisturbed and there are superimposed bleeding episodes or spotting, the etiology is more likely to be related to organic lesions or hematologic disorders

Question 4

define amenorrhea and primary amenorrhea

Answer 4

• Amenorrhea is an absence of menstruation.
• Primary amenorrhea is failure to menstruate by 15yrs old or by 13yrs old if accompanied by absence of secondary sex characteristics.

Question 5

what is secondary amenorrhea

Answer 5

• Secondary amenorrhea is the cessation of menses for at least 6 months in a woman with established normal menstrual cycles.

Question 6

etiology of primary amenorrhea

brief exp of what each is will come later. might not be nec?

Answer 6

It is usually caused by gonadal dysgenesis
congenital mullerian agenesis,
testicular feminization,
or a hypothalamic-pituitary-axis disorder

Question 7

etiology of 2ary amenorrhea

Answer 7

Causes include: ovarian, pituitary or hypothalamic dysfunction;
intrauterine adhesions;
infections (eg syphilis, TB)
pituitary tumor;
anorexia nervosa;
or strenuous physical exercise (that alters fat-muscle ratio which is necessary for menses to occur)

Question 8

dx of amenorrhea

maybe doesnt need to be so detailed as he says briefly discuss

Answer 8

like that of dys fx uterine bleeding

history with emphasis on bleeding pattern and physical exam,
endocrine studies,
pregnancy test,
endometrium,
endometrial biopsy,
D;C with and without hysteroscopy, (Dilation and Curettage this means going in and getting sample)
progesterone withdrawal tests,
CT scan or MRI to exclude pituitary tumor

Question 9

tx of amenorrhea

Answer 9

• Treatment: address underlying cause and induce menses with cyclic progesterone or combined estrogen progesterone

Question 10

what is dysmenorrhea?

Answer 10

• Pain or discomfort with menstruation that is generally not serious but can cause some monthly disability for certain women

Question 11

what is a possible cause of dysmenorrhea?

Answer 11

• Dysmennorrhea is thought to be the result of excess prostaglandin production that causes painful contraction of the uterus and arteriolar vasospasm

Question 12

describe primary dysmenorhea

Answer 12

• Primary: menstrual pain that isn’t associated with a pathologic process or physical abnormality

Question 13

describe Tx of primary dysmenorrhea

Answer 13

Treatment is directed at controlling symptoms. Aspirin and acetaminophen relieve minor cramps but prostaglandin synthetase inhibitors (eg ibuprofen, naproxen) are best if contraception isn’t desired. Ovulation suppression and symptomatic relief can be achieved with oral contraceptive.

Question 14

describe secondary dysmenorrhea and summarize its Tx

Answer 14

• Secondary: menstrual pain caused by specific organc conditions eg endometriosis, uterine fibroids, adenomyosis, pelvic adhesions, IUDs or PID. Medical or surgical intervention may be necessary.

Question 15

what is menorrhagia

Answer 15

• Prolonged or excessive bleeding during regular menstrual flow

Question 16

etiology of menorrhagia

Answer 16

• In young women its usually related to endocrine disturbance
• Later in life it usually results from inflammatory disturbances, tumours of the uterus, or hormonal imbalance

Question 17

which form of bleeding is most serious?

what is it?

Answer 17

metrorrhagia . • Vaginal bleeding between regular menstrual periods.

Question 18

why is metrorrhagia significant

Answer 18

This is the most significant form of menstrual dysfunction as it may signal cancer, benign tumours of the uterus, or other gynaecologic problems and prompt evaluation is necessary

Question 19

not under outcomes from here on

which hormones could cause irreg periods

Answer 19

estrogen and progesterone (id also say FSH, LH and GnRH or maybe even androgens)

Question 20

how would estrogen deprivation affect a menstrual cycle?

Answer 20

estrogen deprivation causes retrogression of previously built-up endometrium and bleeding that often irreg in amount and duration

Question 21

why would a woman not have progesterone

Answer 21

from failure of any of dev ovarian follicles to mature to point of ovulation, with subseq formation of corpus luteum and prod and sec of progesterone

Question 22

how would a lack of progesterone affect a menstrual cycle

Answer 22

in its absence estrogen induces dec of much thicker endometrial layer with richer blood supply

Question 23

if a womanwa having anovulatory bleeding what type of symptoms would be expected/not expected

Answer 23

becuse vasocnstriction and myometrial contractions that normally accompany menstruation are caused by progesterone, anovulatory bleeding is not often crampy, flow is freq heavy (d/t buildup of estrogen i guess?)

Question 24

?? indicates not sure if nec.

et of primary amenorrhea what is gonadal dysgenesis

Answer 24

Gonadal dysgenesis is any congenital developmental disorder of the reproductive system characterized by a progressive loss of germ cells on the developing gonads of an embryo.

Question 25

?? et of primary amenorrhea what is mullerian dysgenesis

Answer 25

most common presentation of müllerian agenesis is congenital absence of the vagina, uterus, or both, which also is referred to as müllerian aplasia,

Question 26

??et of primary amenorrhea what is testicular feminization

Answer 26

Testicular feminization syndrome: Now more appropriately called the complete androgen insensitivity syndrome, this is a genetic disorder that makes XY fetuses insensitive (unresponsive) to androgens (male hormones). Instead, they are born looking externally like normal girls. Internally, there is a short blind-pouch vagina and no uterus, fallopian tubes or ovaries. There are testes in the abdomen or the inguinal canal.

Question 27

??how is hormonal control involved in menstruation? hypothalamus and pituitary what secretes what? what is the hormones fx?

Answer 27

GnRH from hypothalamus stim rel of FSH and LH by ant pituitary (these stim growth and dev of cells in ovaries as a means of stim production of sex hormones). LH acts more on corpus luteum and progestins. FSH on estrogen. Levels of these hormones–> neg feedback
ant pituitary also sec prolactin (stims lactation and imp for pregnancy)

Question 28

?? which hormones do ovaries produce? when do these peak? fx?

Answer 28

estrogens. peak before ovulation and in middle of luteal phase. fx=dev of 2ary sex char, dev of endometrial lining, promote growth of ovarian follicles, help w fertilization

progesterone=sec by corpus luteum after ovulation. Causes secretory phase of endometrium to prep for implantation. When this doesnt occur the sudden withdrawal of progesterone–>menstruation/shedding. the estrogen peaks then the progesterone peaks after

androgens…not r/t menstrual cycle r/t hair grownth and metb

Question 29

??et of primary amenorrhea hypothalamic-pituitary-axis disorder

Answer 29

I guess that any problem of neg feedback, maybe not enough GnRH, imbalance of LH and FSH, no prod of estrogen and progesterone for neg feedback, etc