Wk3 Dysfunctional uterine bleeding and anovulation Flashcards
day 0-8 of normal menstrual cycle
menses
day 8-14 of normal menstrual cycle
proliferative phase (uterus)
follicular phase (ovaries)
day 14-end of normal menstrual cycle
secretory phase (uterus)
luteal phase (ovary)
Summary of cycle on
slide 8
no spontaneous uterine bleeding by age 15 with normal sexual characteristics
primary amenorrhea
absence of menstrual bleeding for > 3 months in women with previously normal menses
secondary amenorrhea
Typical cause of primary amenorrhea:
genetic or anatomic abnormality
**slide 13
Two main sites of origin of secondary amenorrhea:
hypothalamus
ovary
Slides for DDx of amenorrhea:
16-19
BIG thing to rule out first in amenorrhea:
pregnancy!!!!
Progesterone withdrawal?
10 mg for 10 days
any bleeding 2-7 days after = positive test
What does a negative progestinal challenge mean:
end organ problem
what does a positive progestinal challenge mean:
anovulation
**check FSH/LH – high = ovarian failure
low = hypothalamic
Official nomenclature for abnormal uterine bleeding:
PALM-COEIN system;
Abnormal uterine bleeding + descriptive term (heavy/intermenstrual) + palm coein
What does PALM COEIN stand for?
Polyp Adenomyosis Leiomyoma Malignancy *other Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified
What is not part of PALM COEIN?
pregnancy
alternating between missed/heavy menses
disturbance of normal hypothalamic pituitary axis
progesterone deficient/estrogen dominant
more common in extremes of reproductive years
ovulatory dysfunction
most common condition affecting ovulation
PCOS
No ovulation and therefore no corpus luteum increases risk for:
endometrial hyperplasia and cancer
**prolonged estrogen state (no progesterone)
Rotterdam criteria for PCOS dx:
must have at least two of:
- irregular menstruation
- signs of hyperandrogenism
- 1 ovary w/12 or more follicles 2-9 mm and increased ovarian volume on US
