Complications of Menstruation & Abnormal Uterine Bleeding CH 38

Question 1

premenstrual syndrome, what is it

Answer 1

cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life and that appear with consistent and predictable relationship to menses. psychoneuroendocrine disorder

Question 2

premenstrual syndrome symptoms

Answer 2

Mood (irritability, mood swings, depression, anxiety), physical (bloating, breast tenderness [mastodynia], insomnia, fatigue, hot flashes, appetite changes) and cognitive (confusion, and poor concentration)

Question 3

symptoms of premenstrual dysphoric disorder

Answer 3

headache, breast tenderness, pelvic pain, bloating, premenstrual tension along with irritability, dysphoria, and mood liability that disrupt daily functioning

Question 4

pathogenesis of premenstrual syndrome

Answer 4

estrogen/progesterone imbalance, excess aldosterone, hypoglycemia, hyperprolactinemia, serotonin dysfunction, decreased GABA levels and psychogenic factors along with trigger of physiologic ovarian function

Question 5

diagnosis of premenstrual syndrome

Answer 5

patient medical history. need at least 1 affective symptom and somatic symptom during the 5 days prior to menses in each of the 3 prior menstrual cycles. symptoms should be relieved within 4 days of onset of menses. must also repeat for next 2 cycles after prospective reading

Question 6

premenstrual syndrome differential diagnosis

Answer 6

r/o neoplasm (for breast pain), r/o psych illness

Question 7

premenstrual syndrome tx

Answer 7

diet changes (limit caffeine, alcohol, tobacco, chocolate sodium), stress management, pharmacological ( calcium carbonate, magnesium, vitamin b6, vitamin, and nsaids, hormonal interventions, GnRH

Question 8

dysmenorrhea

Answer 8

painful menstruation that prevents normal activity and requires medication, one of the most common gyn complaints.

Question 9

membranous dysmenorrhea

Answer 9

rare, causes intense cramping due to passage of a cast of endometrium through an undilated cervix

Question 10

dysmenorrhea pathogenesis

Answer 10

abnormal and increased prostanoid and possibly eicosanoid secretion that induces uterine contractions, that reduce blood floow, leading to uterine hypoxia. increased leukotriene also a factor

Question 11

dysmenorrhea clinical findings

Answer 11

subjective pain, starts in adolescence, nausea, vomiting, diarrhea and headache may accompany. , generalized pelvic tenderness. use US to rule out pelvic abnormalities

Question 12

dysmenorrhea differential diagnosis

Answer 12

adenomyosis, secondary dysmenorrhea, endometriosis (pain begins 1 to 2 weeks before menses)

Question 13

main dysmenorrhea tx

Answer 13

NSAIDs, tylenol, heat; more severe pain may need codeine or stronger analgesics; antiprostaglandins

Question 14

antiprostaglandins

Answer 14

treat dysmenorrhea, help by reducing prostaglandin. should start 1 to days before expected pain

Question 15

COX 2 inhibitors

Answer 15

treat dysmenorrhea, same effectiveness as naproxen, has adverse effects

Question 16

oral contraceptives for dysmenorrhea

Answer 16

cyclic administration of oral contraceptive in lowest dosage but increased estrogen, helps prevent pain with those who don’t get relief with regular means. tx for 6 to 12 months then pain usually stays away

Question 17

surgical tx of dysmenorrhea

Answer 17

cervical dilation doesn’t help, may need hysterectomy without removal of ovaries

Question 18

abnormal uterine bleeding means and causes

Answer 18

abnormal menstrual bleeding and bleeding due to other causes, like pregnancy (always consider complication of pregnancy), systemic dz, and cancer

Question 19

menorrhagia (hypermenorrhea) meaning

Answer 19

heavy (gushing or open faucet) or prolonged menstrual flow, may pass clots

Question 20

causes of menorrhagia

Answer 20

submucous myomas, complication of pregnancy, adenomyosis, IUD, endometrial hyperplasia, malignant tumor, dysfunctional bleeding

Question 21

Hypomenorrhea (crytomenorrhea) meaning

Answer 21

unusually light menstrual flow, sometimes only spotting

Question 22

causes of hypomenorrhea

Answer 22

obstruction (hymenal or cervical stenosis), uterine synechiae (asherman’s syndrome) can be diagnosed by hysterogram or hysteroscopy, oral contraceptive use

Question 23

metrorrhagia (intermenstrual bleeding) meaning

Answer 23

bleeding that occurs between menstrual periods

Question 24

causes of metrorrhagia

Answer 24

ovulatory bleeding, endometrial polyps, endometrial and cervical CA, exogenous estrogen administration

Question 25

polymenorrhea meaning

Answer 25

periods that occur frequently

Question 26

polymenorrhea causes

Answer 26

anovulation, shortened luteal phase

Question 27

menometrorrhagia meaning

Answer 27

bleeding at irregular intervals

Question 28

menometrorrhagia causes

Answer 28

malignant tumors, complication of pregnancy, ovulatory bleeding, endometrial polyps, endometrial and cervical CA, exogenous estrogen administration

Question 29

oligomenorrhea meaning

Answer 29

menstrual periods that occur more than 35 days apart (if more than 6 months diagnose with amenorrhea),

Question 30

causes of oligomenorrhea

Answer 30

anovulation, excessive weight loss, estrogen secreting tumors

Question 31

contact bleeding (postcoital bleeding)

Answer 31

spotting or bleeding unrelated to menstruation that occurs during or after sexual intercourse

Question 32

causes of contact bleeding

Answer 32

cervical CA, cervical polyps, cervical eversion, cervical/vaginal infection, atrophic vaginitis. colposcopy and/or biopsy may be needed for diagnosis

Question 33

blood test to eval uterine bleeding

Answer 33

CBC, assay of beta subunit of hCG, TSH; used to rule out systemic disease, trophoblastic dz, and pregnancy

Question 34

physical exam findings for myoma

Answer 34

abdominal masses, enlarged irregular uterus

Question 35

physical exam findings for adenomyosis and endometrial CA

Answer 35

symmetrically enlarged uterus

Question 36

decidual reaction of cervix

Answer 36

during pregnancy, velvety, friable erythematous lesion on ectocervix

Question 37

reason for cytologic exam

Answer 37

diagnose asymptomatic intraepithelial lesions of cervix, presence of endometrial cells could mean endometrial CA, tubal and ovarian CA can be suspected with smear

Question 38

sonohysterography

Answer 38

modification of pelvic US, performed following injection of saline by thin catheter into uterus. used to evaluate endometrial cavity for polyps, fibroids and other abnormalities

Question 39

Transvagainal US vs transabdominal US

Answer 39

transvaginal US done with empty bladder and enables greater look at pelvic organs. transabdominal US done with full bladder to enable wider and less discriminative exam of pelvis

Question 40

endometrial biopsy

Answer 40

done with Novak suction curette, Duncan curette, Kevorkian curette, or Piprllr. No cervical dilation needed. Small areas are sampled. If source of bleeding cannot be found, pt may need hysteroscopy or D&C

Question 41

disadvantage of D&C

Answer 41

blind procedure, accuracy is not good

Question 42

tx for menorrhagia

Answer 42

antifibrinolytic therapy, prostaglandin synthetase inhibitor, long acting intramuscular progestin (Depo Provera) administraion (can result in erratic bleeding or even amenorrhea), IUD

Question 43

nongynecologic reasons for abnormal bleeding

Answer 43

rectal and urological disorders, myxedema (amenorrhea), less severe hypothyroidism (abnormal uterine bleeding), liver disease, blood dyscraias, coagulation abnormalities. extreme weight loss, pts receiving anticoagulants or adrenal steroids

Question 44

overall tx of dysfunctional uterine bleeding

Answer 44

for adolescents and young women: rule out pathologic causes then give oral estrogens followed by medroxyprogesterone; for premenopaual women take careful consideration of pathologic causes and eval with endometrial biopsy or hysteroscopy

Question 45

surgical measures for dysfunctional uterine bleeding

Answer 45

if bleeding causes pt to be symptomatically anemic and alters lifestyle, D&C, IUD, or endometrial ablation may be needed. hysterectomy is last choice

Question 46

postmenopausal bleeding meaning

Answer 46

bleeding that occurs after 12 months of amenorrhea in middle aged woman.

Question 47

causes of postmenopausal bleeding

Answer 47

may be non gynecological, atrophic/proliferative endometrium, use of exogenous hormones

Question 48

clinical findings of vaginal atrophy

Answer 48

bleeding from lower reproductive tract, thin tissue with ecchymosis. tears may (rarely) require suturing

Question 49

clinical findings of vulvar dystrophies

Answer 49

white area and cracking of skin of vulva, immature epithelial cells with or without inflammation on cytologic study.

Question 50

differentiating tumors of reproductive tract

Answer 50

uterine sampling must be done and tissue should be obtained. endocervical curettage should be done with endometrial sampling. if no diagnosis can be made, pt may need D&C. may be helpful to use pelvic US and hysteroscopy to locate and diagnose tumors