Abnormal Menstrual Cycles

Question 1

What 2 items define Primary Amenorrhea?

Answer 1

1. No menses by 15 WITH secondary sex characteristics
2. No menses by 13 WITHOUT secondary sex characteristics

Question 2

What 2 items define Primary Amenorrhea?

Answer 2

1. No menses by 15 WITH secondary sex characteristics
2. No menses by 13 WITHOUT secondary sex characteristics

Question 3

Describe Androgen Insensitivity Syndrome. Karyotype?

Answer 3

46XY
- Phenotypically FEMALE
- NO pubic hair
- Absent cervix, uterus, ovaries

Question 4

Describe Klinefelter Syndrome. Karyotype?

Answer 4

47XXY
- Phenotypically MALE + Female characteristics
- Long arms/legs and wide hips
- Larger breasts
- Lack of male pattern body hair
- Small testes

Question 5

Signs of Kallmann’s Syndrome?

Answer 5

Hypogonadotropic Hypogonadism + anosmia

Question 6

Besides Kallmann Syndrome, what else can lead to hypogonadism and delayed puberty?

Answer 6

Malnourished and excessive exercise

Question 7

What things can be done in the workup for Primary Amenorrhea?

Answer 7

US
FSH/LH and Estrogen levels
Karyotype Analysis

Question 8

What defines Secondary Amenorrhea?

Answer 8

NO menses for 6 months after previously having them

Question 9

What defines Secondary Amenorrhea?

Answer 9

NO menses for 6 months after previously having them

Question 10

What is the initial workup for Secondary Amenorrhea? (4)

Answer 10

UPT
FSH
TSH
Prolactin

Question 11

What defines Primary Dysmenorrhea?

Answer 11

Pain with Menses with NO pathologic cause

Question 12

What is a possible reason for Primary Dysmenorrhea?

Answer 12

Excess prostaglandins

Question 13

What are some treatment options for Primary Dysmenorrhea?

Answer 13

NSAIDs
OCPs
IUD
Topical heat

Question 14

What defines Secondary Dysmenorrhea?

Answer 14

Pain with Menses due to a specific organic cause

Question 15

What are examples of things that cause Secondary Dysmenorrhea?

Answer 15

Endometriosis
Adenomyosis
Fibroids
PID

Question 16

What is Endometriosis?

Answer 16

Endometrial glands/stroma outside of the uterus

Question 17

How is Endometriosis diagnosed?

Answer 17

Laparoscopy and direct visualization of lesions

Question 18

How may the lesions look with Endometriosis?

Answer 18

“Powder burned” – dark brown appearance
“Chocolate cyst” – Endometrioma on the ovary

Question 19

What are some common symptoms of Endometriosis?

Answer 19

Infertility
Pain with menses/sex
Pelvic pain

Question 20

What is Adenomyosis?

Answer 20

Endometrial tissue in the myometrium of the uterus

Question 21

How will Adenomyosis present?

Answer 21

Pain and heavy periods

Question 22

How will the uterus feel with Adenomyosis?

Answer 22

Symmetrically ENLARGED

Question 23

How do you diagnose Adenomyosis?

Answer 23

Tissue sample

Question 24

You can try symptomatic relief with Adenomyosis but what is the definitive treatment?

Answer 24

Hysterectomy

Question 25

What is the pneumonic for abnormal bleeding?

Answer 25

PALM - COEIN

Question 26

What are structural causes of abnormal uterine bleeding?

Answer 26

PALM - Polyps - Adenomyosis - Leiomyomas - Malignancy

Question 27

What are non-structural causes of abnormal uterine bleeding?

Answer 27

COEIN - Coagulopathy - Ovulatory dysfunction - Endometrial - Iatrogenic - Not yet classified

Question 28

What is the pneumonic for abnormal uterine bleeding and what it stands for?

Answer 28

PALM - COEIN Polyps Adenomyosis Leiomyomas Malignancy - Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified

Question 29

Painful and very heavy periods with a symmetrically enlarged uterus?

Answer 29

Adenomyosis

Question 30

Cyclic pelvic pain, pain with sex and menses and infertility is likely?

Answer 30

Endometriosis

Question 31

More than 35 days between periods

Answer 31

Oligomenorrhea

Question 32

Less than 21 days between periods

Answer 32

Polymenorrhea

Question 33

Heavy periods

Answer 33

Menorrhagia

Question 34

Intermenstrual bleeding

Answer 34

Metrorrhagia

Question 35

Heavy periods with intermenstrual bleeding

Answer 35

Menometrorrhagia