Flashcards in Amenorrhea (Intrauterine Adhesions) Deck (17)
Intrauterine adhesions a.k.a.?
Absence of menses for 6+ months in a woman with previous menses
Intrauterine adhesions? Form when?
When scar tissue forms and obliterates the endometrial cavity
Urine curettage following a pregnancy
Radiopaque dye injected into the endometrial cavity via transcervical catheter to evaluate endometrial cavity and fallopian tubes
Direct visualization of the endometrial cavity with an endoscope
Assessing the depth and direction of the cervical and uterine cavity with a thin blunt probe
Necessary to form intrauterine adhesions?
Endometrial trauma (especially basalis layer)
Adhesions consist of? Adhesions with poor prognosis?
Avascular fibrous tissue OR in active endometrium/myometrium
Myometrial adhesions are usually vascular and carry poor prognosis
Typically found after radiation or tuberculosis endometritis? Prognosis?
Atrophic and sclerotic endometrium without adhesions; poor prognosis
Risk factors for intrauterine scar formation?
1. Postpartum curettage 2-4 weeks after delivery
2. Hypoestrogenic states (breast-feeding or hypogonadotrophic hypogonadism)
When to suspect intrauterine adhesions (findings)?
1. Secondary amenorrhea with negative pregnancy test and no progestin-induced withdrawal bleeding
Gold standard – hysteroscopy
Also good – Hysterosalpingogram
Treatment for intrauterine adhesions?
1. Operative hysteroscopy
2. IUD or pediatric foley catheter to prevent reformation
3. Conjugated estrogens and progesterone
Patient with amenorrhea. A biphasic basal body temperature suggests?
Normal functioning of the HPG axis
Patient with secondary amenorrhea. Elevated FSH suggests? At risk for?
Premature ovarian failure; osteoporosis
Hormonal status with intrauterine adhesions?
Patient with amenorrhea but cramping pain every month - suggested diagnosis?
Cervical stenosis (not intrauterine adhesions)