Amenorrhea and Uterine Bleeding Flashcards Preview

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Flashcards in Amenorrhea and Uterine Bleeding Deck (28):
1

Abnormal Uterine Bleeding

bleeding outside normal physiologic menstruation
- includes both dysfunctional uterine bleeding and structural bleeding

2

Normal Menses

Duration - 2-7 days
Flow 3 hrs

3

Normal Cycle

Menses (day 0 to 8)
Proliferative (day 8-14) -> predominance of estrogen over progesterone --> building endometrium
Secretory/Luteal (day 14) -> begins after ovulation -> progesterone production, stabilize endometrium

4

Menorrhagia

normal intervals, but prolonged or excessive

5

Metrorrhagia

irregular and more frequent intervals but amount is variable

6

Menometrorrhage

prolonged and variable amounts

7

Oligomenorrhea

menses interval greater than 35 days

8

Polymenorrhea

menses interval less than 24 days

9

Intermenstrual bleeding

bleeding between regular periods

10

Midcycle spotting

just prior to ovulation from declining estrogen

11

Postmenopausal bleeding

bleeding in woman at least 1 year after cessation of cycles

12

Amenorrhea

lack of bleeding for 6 months or longer
- overall prevalence 3% - not due to pregnancy, lactation, or menopause

13

Primary amenorrhea

no spontaneous uterine bleeding by age 14 in absence of secondary sex characteristics

14

Secondary amenorrhea

absence of menstrual bleeding for 6 months in woman with prior menses

15

Compartment I

disorders of outflow tract
- imperforate hymen
- Ashermans Syndrome - destruction of endometrium (D&C, ablation, infection)
- Mullerian Anomolies - absent uterus, no vaginal orifice
- Testicular Feminization - 46 XY

16

Compartment II

disorders of ovary
- Turner Syndrome - 46 XO - follicles undergo apoptosis (higher FSH, lower estrogen)
- Mosaicism
- Gonadal agenesis
- 17 alpha-hydroxylase deficiency

17

Compartment III

disorders of Anterior Pituitary
- Adenoma (hyperprolactinemia)
- Empty Sella Syndrome
- Sheehans syndrome
- Hypopituitarism
- Hypothyroid
- Infiltrative (sarcoidosis/hemochromotosis)

18

Compartment IV

disorders of CNS or hypothalamus
- tumors
- craniopharyngioma
- stress -> increased cortisol -> decreased FSH/LH
- hypothalamic amenorrhea -> high corticotropin releasing hormone -> inhibits GnRH

19

Evaluation of Amenorrhea

Menstrual history -> age, previous patterns
Reproductive history -> BCPs, ob/gyn procedures, preg?
General Medical history -> meds, illnesses, drugs
Family History -> sisters, mom
Social history

20

Physical Exam

COMPLETE PHYSICAL
- androgen excess, estrogen deficiency or excess

21

Labs

RULE OUT PREGNANCY - hCG
Prolactin
FSH
TSH
hypogonadism? -> testosterone, 17-hydroxyprogesterone, DHEA

22

Treatment of Amenorrhea

NEED CLEAR DIAGNOSIS
- hypothyroid
- ovarian failure
- pituitary tumor
- hypothalamic amenorrhea

23

Causes of abnormal bleeding

Pregnancy
Medications
Benign Genital Tract Pathology
Malignant Genital Tract Pathology
Systemic diseases
Iatrogenic

24

Anovulatory Bleeding

more unpredictable
disturbance of normal HPO axis
progesterone deficient/estrogen dominant state
more common in extremes of reproductive years
no ovulation --> no corpus luteum --> endometrium instability leading to erratic bleeding

25

Risk for Endometrial Cancer

Obesity
Nuiparity
Previous tamoxifen
Unopposed estrogen therapy
Diabetes
Age

26

Endometrial Ultrasound

looking for cancers, thickening, masses
Sensitivity for cancer - 96%
Sensitivity for abnormality - 92%
- do toward end of bleeding cycle

27

Endometrial Biopsy

Looking for polyps, fibroids, lesions
High sensitivity for carcinoma
lower sensitivity for hyperplasia

28

Treatment

Goal of treatment is to control bleeding, prevent recurrence, and preserve fertility