Reproductive

Question 1

40 year old woman presents with menstrual pain and heavy menstrual bleeding. On exam she has a uniformly enlarged uterus. What is the most likely Dx?

Answer 1

Adenomyosis

Question 2

Describe the devleopmental defect that causes an imperforate hymen. How does it present?

Answer 2

Imperforate hymen is due to failure of the central portion of the fibrous CT on the vagina to degenerate.

It presents with primary amenorrhea and cyclic (monthly) pain due to endometrial shedding not having an outlet. This may pool in the pouch of Douglas (hematocolpos) and be palpable on a DRE. Patients will have normal secondary sex characteristics.

Question 3

What is Asherman syndrome?

Answer 3

Scarring on the endometrium that prevents normal buildup and shedding of the endometrial lining -> secondary amenorrhea.

Usually due to trauma from surgery or recurrent bacterial infection.