Monday - Uterine Bleeding - LaBarre

Question 1

Normal flow

Answer 1

2-7 days
80 ml or less
- tampon can hold up to 30 mL

change tampon every 3 hours

Question 2

normal cycle in days:

Answer 2

24-35 days

Question 3

proliferative phase

follicular phase

Answer 3

day 8-14

estrogen more than progesterone - building endometrium

Question 4

secretory phase

luteal phase

Answer 4

day 14
begins when ovulation triggers progesterone production
LH transforming oocyte to corpus luteum

Question 5

Primary amenorrhea

Answer 5

never started by age of 15

Question 6

secondary amenorrhea

Answer 6

previously normal, no menstruation in 3 months. or 6 months if they are usually irregular

Question 7

causes of primary amenorhhea

Answer 7

turner’s
Mullarian agenesis
delayed puberty
PCOS

Question 8

causes of secondary amenorhhea

Answer 8

early onset - hyperandrogenism from PCOS

adult onset - Hypothalus, pituitary
- PCOS or ovarian insufficiency

Question 9

Things that can go wrong in the outflow tract that cause amenorrhea

Answer 9

imperforate hymen
mullarian agenesis
androgen insensitivity
asherman syndrome
 - scarring in uterus, usually from trauma

Question 10

Things that can go wrong in the ovary that cause amenorrhea

Answer 10

turner - 45XO - no oocytes
46XX - gonadal dysgenesis
46XY - gonadal dysgenesis

Question 11

androgen insensitivity karyotype
sex
labs

Answer 11

46xx - look female - rudimentary vagina and uterus = gonadal dysgenesis. resistance to testorsterone (increased testosterone, estrogen and LH)

Question 12

anterior pituitary causes of amenorrhea

Answer 12

pit adenoma - prolactinoma - inhibits GnRH –> decreases FSH and LH

Sheehan Syndrome - post partum necrosis

radiation

Hypothyroid –> increase TSH –> decreases GnRH

Question 13

hypothalamus causes of amenorrhea

Answer 13

GnRH deficiency - kallmann syndrome

tumors

Abnormal GnRH secretion

• eating disorders
• exercise
• stress (increases cortisol –> decrease FSH and LH)

Question 14

things to ask in history is amenorrhea

Answer 14

was it previously normal?
ob procedures
marijuana
family history
social history
 - runner, med student, nutritional

Question 15

Physical exam for amenorrhea

Answer 15

look for abnormal anatomy
BMI
hair distribution
gallactorrhea

Question 16

Labs for amenorrhea

Answer 16

hCG - rule out pregnancy
prolactin
FSH
TSH
MRI for pituitary
estrogen

Question 17

progesterone challenge

Answer 17

give progesterone. if the bleed within 2-7 days, they aren’t ovulating normally.