OB/GYN Flashcards
Menometrorrhagia
heavy bleeding at normal intervals
Metrorrhagia:
bleeding between cycles
Menometrorrhagia
irregular intervals with excessive bleeding
Polymenorrhea
frequent cycles <21 days
Tx of DUB
NSAIDs, hormonal (oral contraceptive pills [OCPs], intrauterine device [IUD]),
ablation/surgery if persistent
Definition of Primary Amenorrhea
the absence of menarche by age 15 yo with normal 2° sexual characteristics or by age 13 yo without
Workup for Primary Amenorrhea
pregnancy test, prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH)
Dx the cause of primary amenorrhea as an outflow obstruction
Breast present, uterus present, w/ either transverse vaginal, or imperforate hymen
Dx the cause of primary amenorrhea as ovarian causes
Breast absent, Uterus present w/ Increased FSH, and LH
Dx the cause of primary amenorrhea as hypothalamus pituitary failure
Breast absent, uterus present, decreased FSH, and LH (ex athletes, anorexia)
Definition of 2º Amenorrhea
cessation of menses of 6 mo with previous normal cycles
etiologies of 2º Amenorrhea
1) Pregnancy (MC)
2) hypothalamus dysfxn
3) Pituitary Dysfxn
4) Ovarian disorders
5) Uterine disorders
Workup for secondary amenorrhea
1) beta hcg
2) FSH, LH
3) Prolactin
4) estrogen
5) TSH
6) U/S
dx hypothalamic dysfxn in 2º amenorrhea
1) normal or low fsh and lh
2) low estradiol
3) normal prolactin
management of 2º amenorrhea if caused by hypothalamic dysfxn
clomiphene, lifestyle changes, CBT
dx of 2º amenorrhea caused by pituitary dysfxn
1) dec FSH, LH
2) inc prolactin
dx of 2º amenorrhea caused by ovarian disorders
1) inc FSH, LH
2) dec estradiol
3) perform a progesterone challenge- if w/d bleeding then it is an ovarian abnormality. no w/d bleeding perform a prog/estrogen challenge. if bleeding then ovarian abnormality. no bleeding in both tests suggests a uterine abnormality.
what is the cause of primary dysmenorrhea
inc prostaglandins
clinical manifestations of dysmenorrhea
pain right before or with the onset of menses
management of primary dysmenorrhea
1) NSAIDs 1st line
2) OCP
3) if meds all fail laproscopy
def of PMS
Cyclic cluster of physical & emotional changes
• Must occur 2 weeks prior to menstruation & must have 7 symptom free days at
beginning of cycle
• Must occur for 2 consecutive cycles to be diagnosed
sx of PMS
physical (bloating, headache, breast pain, bowel changes), emotional
(irritability, depression), behavioral (poor concentration, food cravings)
tx of PMDD
SSRIs
def of PMDD
severe PMS with functional impairment
