Genital Tract Bleeding & Menstrual Disorders

Question 1

Abnormal bleeding noted in the genital area is often attributed to what source?

Answer 1

Uterine source, but may arise from any anatomic site in the lower & upper genital tract or a nongynecologic organ

Question 2

What is estrogen responsible for?

Answer 2

Proliferation and growth of the functional layer of the endometrium

Question 3

What is progesterone responsible for?

Answer 3

It induces the endometrium to secrete glycogen, mucous and other substances which ready the endometrium for implantation

Question 4

What happens to the endometrium when estrogen and progesterone levels drop?

Answer 4

The endometrium undergoes involution

Question 5

What two substances cause vasoconstriction of the spiral arteries in the endometrial lining resulting in apoptosis and sloughing?

Answer 5

Endothelin and thromboxin

Question 6

Chronic menstrual blood loss in what amount can lead to iron deficiency anemia?

Answer 6

> 80 ml per cycle

Question 7

What is the term for pain during ovulation?

Answer 7

Mittelschmertz

Question 8

What is the term for any bleeding that does not conform to the frequency, duration, or amount of bleeding that a woman considers normal?

Answer 8

Abnormal uterine bleeding (AUB)

Question 9

What helps to determine the most likely cause and likelihood of serious pathology with AUB?

Answer 9

Life phase

Question 10

What are possible differentials for AUB?

Answer 10

1) Pregnancy
2) Systemic disease
3) Trauma
4) Malignant neoplasm
5) Benign lesions
6) Infection
7) Medications
8) Hormonal imbalances

Question 11

What is the term for an abnormally high amount of menses?

Answer 11

Hypermenorrhea

Question 12

What is the term for an abnormally low amount of menses?

Answer 12

Hypomenorrhea

Question 13

What is the term for periodic uterine blood loss >80 ml/cycle that occurs in the absence of structural uterine abnormalities?

Answer 13

Dysfunctional uterine bleeding (DUB)

Question 14

What are the two types of DUB?

Answer 14

Anovulatory and ovulatory

Question 15

What is the underlying cause of anovulatory DUB?

Answer 15

Hormonal disturbance (no progesterone to balance estrogen)

Question 16

What is the underlying cause of ovulatory DUB?

Answer 16

Prostaglandin disturbance (vasodilation of spiral arteries)

Question 17

What disorders cause anovulation?

Answer 17

1) Thyroid disease (hypo or hyper)
2) Hyperprolactinemia
3) Obesity
4) Primary ovarian failure (genetic - Turner’s)
5) Secondary ovarian failure (drugs, radiation)

Question 18

What are some lab tests for AUB?

Answer 18

If 13-18: screen for blood dyscrasias and get CBC with platelet count
If 19-50: TSH, FSH, CBC with platelet count, serum prolactin

Question 19

What are some indications for biopsy?

Answer 19

1) Age
2) PCOS
3) Liver disease
4) Diabetes
5) Obesity
6) Tamoxifen
7) FHX colon CA
8) Past DX of endometrial hyperplasia

Question 20

The risk of endometrial cancer increases with what?

Answer 20

Age

Question 21

What is used for medical management of ovulatory DUB?

Answer 21

NSAIDS

Question 22

What is used for medical management of anovulatory DUB?

Answer 22

Oral contraceptives, progestins, GnRH agonists, Danazol, ablation or hysterestomy

Question 23

What is the term for the absence of menarche by age 16 in the presence of normal growth and secondary sex characteristics?

Answer 23

Primary amenorrhea

Question 24

What is the term for the absence of menses for 3 consecutive months in women who were previously menstruating?

Answer 24

Secondary amenorrhea

Question 25

What is the term for painful menstruation?

Answer 25

Dysmenorrhea

Question 26

What are the two types of dysmenorrhea?

Answer 26

Primary (normal pelvic anatomy) and secondary (genital tract pathology)

Question 27

What is the medical treatment for primary dysmenorrhea?

Answer 27

NSAIDS

Question 28

What is the medical treatment for secondary dysmenorrhea?

Answer 28

Hormonal contraceptives, GnRH agonists, Danazol, surgical interventions