Menstrual Disorders

Question 1

What are the classifications of amenorrhea?

Answer 1

Primary- normal secondary sexual characteristics and no period by the age of 16 OR no secondary sexual characteristics and no period by the age of 14

Secondary- no period in 3 months

Question 2

What are several unique causes of amenorrhea?

Answer 2

Genetic abnormalities- androgen insensitivity syndrome, turner’s syndrome

Anatomic abnormalities- agenesis, vaginal septum

Question 3

What are the major causes of amenorrhea?

Answer 3

PREGNANCY
Hypothyroidism
Hypothalamic-pituitary dysfunction
Hyperprolactemia
Premature ovarian failure

Question 4

What goes into an evaluation for amenorrhea?

Answer 4

Physical examination- rule out anatomic abnormality
Karyotype- identify genetic abnormality
HCG- exclude pregnancy
TSH- exclude hypothyroidism
Prolactin- assess for pituitary microadenoma
FSH- assess for premature ovarian failure
Progesterone withdrawal- assess for hypoestrogen state

Question 5

What is a progesterone withdrawal test?

Answer 5

Progesterone in oil (100mg) or medroxyprogesterone acetate (10mg daily x 5 days)
Withdrawal should occur withing 7-14 days

Question 6

What do the results of a progesterone withdrawal test mean?

Answer 6

Withdrawal- Dx= hypothalamic-pituitary dysfunction. Treat with OCs or Clomiphene citrate, bromocriptine
No withdrawal (low FSH)- Dx= hypothalamic pituitary failure, Treat with HRT or gonadotropins
No withdrawal (high FSH)- Dx= premature ovarian failure, Treat with HRT or donor eggs

Question 7

What are the classifications of dysmenorrhea?

Answer 7

Primary- due to excessive release of prostaglandin from a secretory endometrium
Secondary- due to an anatomic abnormality

Question 8

What are possible causes of secondary dysmenorrhea?

Answer 8

Uterine myoma
Uterine malformation
Endometrial polyp
Endometriosis
IUD

Question 9

What goes into the evaluation of dysmenorrhea?

Answer 9

Pelvic US or HSG- assess for myoma, polyp or malformation

Laparoscpoy- assess for endometiosis

Question 10

What is the treatment for dysmenorrhea?

Answer 10

Medical: NSAIDS or Oral contraceptives
Surgical: Myomectomy, Polypectomy, Hysterectomy, Ablation of endometriosis

Question 11

Definition of Menorrhagia

Answer 11

excessive menstrual blood loss

Question 12

Definition of Menometrorrhagia

Answer 12

excessive blood loss during and between menses

Question 13

What are the principal causes of abnormal uterine bleeding?

Answer 13

Anovulatory (dysfunctional) bleeding
Endometrial hyperplasia or cancer
Myoma
Endometrial polyp
Chronic endometritis
Bleeding disorder (Von Willebrand's Disease o rThrombocytopenia)
Thyroid Disease

Question 14

What goes into an evaluation of abnormal uterine bleeding?

Answer 14

Platelet count- assess for thrombocytopenia
Platelet function assay- assess for platelet dysfunction
TSH- assess for thyroid disease
Hemoglobin/hematocrit- assess for anemia

Question 15

What are the two tests of greatest value in assessment of a patient with abnormal uterine bleeding?

Answer 15

Pelvic US/hysterectomy- assess for myoma or endometrial polyp
Endometrial biopsy- assess for chronic inflammation, hyperplasia, cancer

Question 16

Treatment for anovulatory bleeding?

Answer 16

Progestin or OCs

Question 17

Treatment for Hyperplasia/cancer

Answer 17

progestin/hysterectomy

Question 18

Treatment for a polyp

Answer 18

hysterectomy - polypectomy

Question 19

Treatment for myoma

Answer 19

myomectomy or hysterectomy

Question 20

Treatment for thyroid disease

Answer 20

Correct thyroid dysfunction

Question 21

Treatment for a bleeding disorder

Answer 21

Correct coagulation abnormality

Question 22

What are additional treatments for abnormal uterine bleeding?

Answer 22

endometrial ablation
progesterone-containing IUD
Hysterectomy

Question 23

What do you have to rule out 1st when assessing an abnormal uterine bleed?

Answer 23

CANCER