Abnormal Uterine Bleeding, Amenorrhea etc - fothergill Flashcards Preview

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Flashcards in Abnormal Uterine Bleeding, Amenorrhea etc - fothergill Deck (35):
1

What is wrong with a women telling you how much she is bleeding?

there is poor correlation bw a women's perception of blood loss and the actual amount lost

2

What is menorrhagia?

prolonged ( > 7 days) or excessive bleeding

3

what is metrorrhagia?

bleeding at irregular but frequent intervals

4

What is polymenorrhea?

regular bleeding at < 21 day intervals

5

What is oligomenorrhea?

cycle length of greater than 35 days

6

What is amenorrhea?

absence of menses for > 6 months

7

What initiates ovulation?

estradiol via and LH surge

8

What does the corpus luteum do?

1) secretes progesterone
2) influences the secretory phase of the endometrium

9

What is the most important thing to always rule out when someone presents with AUB?

PREGNANCY!!!

10

What are the most common causes of bleeding in young pre pubertal girls?

1) foreign body
2) trauma/abuse
3) sarcoma botryoides - cancer
4) pregnancy

11

What kinda of disorders are usually diagnosed in young women who have AUB during or after the onset of puberty?

blood dyscrasia - Von Wildebrands disease

12

What is dysmenorrhea?

1) painful menses
2) not a diagnosis - a symptom

13

What causes most of the pain symptoms in dysmenorrhea?

prostaglandin effects cause N/V and diarrhea

14

What is primary dysmenorrhea?

1) cyclic menstrual pain without an identifiable associated pathology
2) typically beings shortly after menarche
3) diagnosis of exclusion

15

what is secondary dysmenorrhea?

1) cyclic and associated with identifiable pathology such as endometriosis, leiomyoma, PID, adenomyosis
2) outlet obstruction in younger patients
3) more common in older patients
4) more commonly associated with additional GYN complaints (AUB, dysparenuia, infertility)

16

What are some of the first things we should think of when a patient complains of amenorrhea?

1) pregnancy
2) inherited disorder
3) PCOS
4) morbid obesity
5) thyroid disease

17

What is asherman's syndrome

1) scar tissue in the uterus usually due to a miscarriage and DNC
2) presents with amenorrhea

18

What are some inherited anatomic problems causing amenorrhea?

1) mullerian agenesis
2) vaginal septum
3) imperforate hymen
4) androgen insensitivity syndrome

19

How does obesity cause amenorrhea?

1) peripheral fat tissue produces estrogen
2) turns off P-H-Ovarian axis

20

What is the problem in hypergonadotropic hypogonadism?

1) something wrong downstream - with ovaries
2) pre mature ovarian failure

21

What are some causes of premature ovarian failure?

1) Turners syndrome
2) autoimmune
3) iatrogenic (chemo)
4) idiopathic

22

What is the main problem in hypogonadotropic hypogonadism?

The pituitary or hypothalamus

23

What are disorders of the hypothalamus causing hypogonadotropic hypogonadism?

1) kallman's syndrome
2) functional disorders (stress, eating disorder, exercise)
3) tumor radiation

24

What are disorders of the pituitary causing hypogonadotropic hypogonadism?

1) tumors (prolactinoma)
2) trauma/radiation
3) sheehan's syndrome

25

What are the steps for a workup of AUB?

1) H&P and menstrual calendar
2) pap smear, endometrial biopsy
3) vaginal probe ultrasound*
4) CBC, lab work
5) saline infusion sonohysterography (SIS)

26

What are the steps in a work-up for dysmenorrhea?

1) H&P and menstrual calendar
2) exam - rule out anatomic abnormalities
3) vaginal ultrasound
4) screen for pelvic infection
5) emperic therapy warranted in many cases

27

When should iron be used as a treatment?

1) anemic patients
2) heavy menses

28

Does mirena IUD suppress ovulation?

No

29

What are estrogens + progestins (OCs) used for?

1) ovulatory AUB
2) anovulatory uterine bleeding
3) dysmenorrhea
4) excessive bleeding

30

What medical therapy do you use if contraception is desired with AUB?

1) combination OCs
2) progestin IUDs

31

What medical therapy do you use if fertility is desired with AUB?

1) NSAIDs
2) tranexamic acid (rarely used in US)

32

What is a good second line treatment for AUB?

GnRH agonists

33

What is the medical therapy for anovulatory AUB or amenorrhea?

1) underlying cause of anovulation should be identified and treated
2) cyclic progestins and combination OCs
3) mirena IUD

34

What is the medical therapy for dysmenorrhea?

1) rule out anatomic cause
2) NSAIDs
3) combination OCs
4) DMPA

35

What is the treatment for PMS?

1) lifestyle modification!!!
2) SSRI
3) OCs