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Women's Health - GYN > Abnormal Menstruation > Flashcards

Abnormal Menstruation Flashcards

1
Q

Two most common causes of secondary dysmenorrhea?

A

endometriosis

uterine fibroids

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2
Q

dysmenorrhea =

A

painful menses; aka menstrual cramps

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3
Q

Menorrhagia =

A

heavy or prolonged menses bleeding

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4
Q

Metrorrhagia =

A

Intermenstrual bleeding, spotting or breakthrough bleeding

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5
Q

Polymenorrhea =

A

Menstrual interval < 21 days

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6
Q

Oligomenorrhea =

A

Menstrual interval > 35 days

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7
Q

Primary dysmenorrhea onset and pathophysiology?

A

adolescence, usually starts 2 yrs after menarche but may be immediate

uterine “angina” caused by prostaglandins

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8
Q

Lab tests that are mandatory if sexually active teen

A

Chlamydia and GC

HIV and RPR (VDRL)

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9
Q

Treatment of primary dysmenorrhea

A

Heat, diet/supplements, behavior modification, TENS, exercise

NSAIDS (ibuprofen, Naproxen sulfate)

Oral contraceptives if no relief from aggressive NSAID tx

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10
Q

Dosing of ibuprofen or Naproxen (Aleve) for menstrual cramps?

A

Ibuprofen: 400-600 mg q 4-6 hours or 800 mg q 8 hours to a max dose of 2400 mg/day with food

Naproxen (Aleve): 500 mg to start, then 250 -500 q 8-12 hours

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11
Q

How do oral contraceptives help with primary dysmenorrhea?

A

they thin endometrium which results in less prostaglandin production

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12
Q

secondary dysmenorrhea =

A

painful abd cramping with menses WITH pelvic pathology

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13
Q

What is endometriosis?

A

Endometrial tissue growing outside of endometrial cavity and uterus, most commonly in pelvis

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14
Q

PE findings of endometriosis

A
  • Pelvic tenderness with uterine movement
  • Palpable nodules on exam
  • Fixed, tender, enlarged adnexa (appendages)
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15
Q

Best diagnostic imaging for endometriosis

A

Laparoscopy

  • may miss with U/S
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16
Q

Endometriosis treatment

A

Goal: manage pelvic pain and prevent infertility

  1. NSAIDs and/or OC’s
  2. Refer to gynecology for surgery vs hormonal interventions
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17
Q

Benign tumors in smooth muscle cells of myometrium. Most common tumor of the female pelvis.

A

Uterine Leiomyomata (fibroids)

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18
Q

Epidemiology of Uterine Leiomyomata (or fibroids)

A

More common in African Americans

Occurs in 30-40s

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19
Q

Labs to determine cause of secondary dysmenorrhea

A 
Pregnancy testing
STI testing
CBC
UA
Pelvic U/S
Laproscopy
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20
Q

What increases risk of uterine fibroids?

A 
Early menarche
Meat consumption
Family history
Beer
History of uterine infection
Vitamin D deficiency
Obesity (>30% body fat)
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21
Q

When is there decreased risk for fibroids?

A

menopause
> 1 pregnancy
use of OC’s

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22
Q

Therapy for uterine fibroids

A
  • Watchful waiting
  • Prophylactic myomectomy (prevents infertility, more complicated) vs. hysterectomy
  • Oral contraceptive pills
  • Lupron (GnRH analog)
23
Q

Best contraceptive for young girl who is not sexually active but has primary dysmenorrhea?

A

transdermal patch

24
Q

When do symptoms of PMS occur in cycle?

A

luteal phase; 7-10 days before onset of menses

symptoms resolve soon after flow begins and are absent during follicular phase

25
Way for patient to help you diagnosis and monitor her PMS?
COPE calendar
26
Nutritional modification to relieve PMS
Limit salt, refined sugar, caffeine, alcohol, fat Increase complex carbohydrates and fiber Vit B or calcium supplements Evening Primrose Oil
27
PMS + one affective symptom (anger, irritability, internal tension). Dx'd by DSM-IV criteria
Premenstrual dysphoric disorder
28
Premenstrual dysphoric disorder treatment
- OCP with 4 pill-free interval (Yaz) - SSRIs - Tranquilizers during luteal phase if very severe (Xanax or Ativan)
29
When is woman at risk for increased PMS symptoms?
perimenopausal
30
Define primary amenorrhea
- No menses by age 15 with normal development | - No menses after 2 yrs of completing sexual maturation
31
pathophysiology of primary amenorrhea
dysfunction at hypothalamus or pituitary; usually functional (emotional stress, athletics, weight) dysfunction at ovaries; Turner Syndrome (XO) dysfunction at uterus or vagina; menses can't occur d/t anatomic abnormality
32
Most common of all primary amenorrhea? What are signs?
Turner Syndrome short stature, webbed neck, short 4th metacarpal, nail dysplasia, high-arched palate, wide-space nipples (broad square chest), hypertension, renal abnormalities
33
causes of secondary amenorrhea
``` PREGNANCY!!! hypothalamic dysfunction hypothyroidism pituitary tumor, hyperprolactinemia Polycystic ovary syndrome Ovarian failure = menopause Asherman's Syndrome ```
34
Definition of secondary amenorrhea
absence of menses for 3-6 months after having at least 1 menses
35
What can cause hypothalamic dysfunction in women?
female athlete triad emotional stress and illness idiopathic
36
What is Asherman's Syndrome? How is it eval'd and treated?
Secondary amenorrhea due to scarring of endometrial lining from previous infection or surgery Eval with Pelvic U/S, and Progestin challenge TX: Hysteroscope lysis of adhesions; estrogen therapy to regrow endometrium
37
First thing to do to eval for secondary amenorrhea
Pregnancy test
38
PALM-COEIN classification system for causes of abnormal uterine bleeding
``` P = polyps A = adenomyosis L = Leiomyomas (fibroids) M = malignancy and hyperplasia ``` ``` C = coagulopathy O = ovulatory dysfunction E = endometritis I = iatrogenic N = not yet classified ```
39
Any bleeding in _______ women is abnormal. Concern?
post-menapausal endometrial cancer
40
Most common etiology of endometrial hyperplasia and cancer
chronic unopposed estrogen stimulation exogenous - estrogen therapy w/o progestin endogenous - chronic anovulation
41
Risk factors for endometrial cancer
``` Increasing age (peak 50-60s) Unopposed estrogen therapy Late menopause Obesity Polycystic ovary DM Tamoxifen therapy (used post breast cancer) FHX of cancer (BRCA 1,2) ```
42
Diagnosis of endometrial hyperplasia and cancer
Pelvic U/S with thickened endometrial stripe Then endometrial biopsy D&C to further eval biopsy results
43
When should woman undergo eval for endometrial cancer?
- over 40 with abnormal uterine bleed - under 40 with abnormal uterine bleed + risk factors - Failure to respond to treatment for bleed - Presence of atypical glandular cells on cervical cytology - Presence of endometrial cells in woman > 40
44
What is D&C?
= Dilation and Curettage brief surgical procedure in which cervix is dilated and a special instrument is used to scrape the uterine lining
45
Endometrial Hyperplasia & Cancer treatment?
endometrial hyperplasia without atypia -> Progestin endometrial hyperplasia with atypia -> Hysterectomy endometrial cancer diagnosed on endometrial biopsy -> Referral to gynecologic oncologist
46
When should coagulopathy causes of uterine bleeding be suspected?
Heavy or prolonged menses at menarche Family history of coagulopathy Signs such as easy bruising, prolonged bleeding from mucosal surfaces Taking meds that increase bleeding tendency - warfarin
47
Causes of ovarian dysfunction-related uterine bleeding?
``` Puberty Perimenopause Obesity Polycystic ovary syndrome Cigarette Smoking ```
48
Iatrogenic causes of uterine bleeding
copper releasing IUD | hormonal contraceptive
49
Treatment of uterine bleeding in younger sexually active female
think infection -> antibiotics Endometrial ablation is effective treatment
50
Treatment of uterine bleeding in postmenopausal women
CANCER UNLESS PROVEN OTHERWISE Treat benign lesions as found, but if bleeding recurs or persists, work up aggressively
51
Causes of cervical bleeding?
Cervical cancer Cervicitis Polyps
52
When is D&C done for uterine bleeds?
if endometrial biopsy shows endometrial hyperplasia WITHOUT atypia * need treatment if biopsy with atypia
53
What serum level suggests ovarian failure?
high FSH * ovaries release less estrogen, so pituitary increases FSH to increase estrogen

Women's Health - GYN (12 decks)

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