GYN: Menstruation 15%

Question 1

(PPP 392)

what is primary amenorrhea?

Answer 1

Primary amenorrhea is the failure of menses to occur by age 15 years (some sources say 16 years) in the presence of secondary sex characteristics
~ or ~

age 13 years in the absence of secondary sex characteristics

Question 2

(PPP 392)

what lab tests are done for suspected primary amenorrhea?

Answer 2

“most importantly”: hCG & FSH

also usually measured: TSH & prolactin

Question 3

(PPP 392)

what is secondary amenorrhea?

Answer 3

absence of menses for > 3 months in a patient with previously normal menstruation

Question 4

(PPP 392)

what is the most common cause of secondary amenorrhea?

Answer 4

pregnancy

Question 5

(PPP 392)

what are four non-pregnancy reasons for amenorrhea?

Answer 5

hypothalamus dysfunction
pituitary dysfunction
ovarian dysfunction
uterine dysfunction

Question 6

(SmartyPance)

define polymenorrhea

Answer 6

menses that occur more frequently

(menses < 21 days apart)

Question 7

(SmartyPance)

define hemorrhagic or hypermenorrhea

Answer 7

menses that involve more bloodloss (>7 days or >80mL) during menses

Question 8

(SmartyPance)

define menorrhagia

Answer 8

prolonged/heavy bleeding; regular intervals

>7 days or >80mL

Question 9

(SmartyPance)

define metorrhagia

Answer 9

uterine bleeding that occurs frequently and irregularly between menses

Question 10

(SmartyPance)

define menometorrhagia

Answer 10

more blood loss during menses and frequent and irregular bleeding b/w menses

Question 11

(SmartyPance)

define oligomenorrhea

Answer 11

long intervals >35 days

Question 12

(SmartyPance)

what is dysfunctional uterine bleeding?

Answer 12

diagnosis of exclusion

excessive uterine bleeding and prolonged menses that is NOT CAUSED BY pregnancy or miscarriage

look for underlying endocrine disorder

Question 13

(SmartyPance)
AUB in the absence of an anatomic lesion
caused by a problem with the
hypothalamic-pituitary-ovarian axis

Answer 13

dysfunctional uterine bleeding

Question 14

(PPP 390)
workup for AUB/DUB may include:

*PPP 390 says “abnormal uterine bleeding” is the term now, “formerly dysfunctional uterine bleeding”

Answer 14

beta-hCG to r/o pregnancy
hgb
hct

Question 15

(SmartyPance)

what are five things we do to exclude other possible diagnoses for dysfunctional uterine bleeding?

Answer 15

urinary beta-hCG levels - r/o pregnancy

labs: CBC, iron studies, PT, PTT, TSH, progesterone, prolactin, FSH, LFTs

PROGESTIN TRIAL - if bleeding stops, anovulatory cycles confirmed

ovulation journal, pap smear

pelvic u/s, endometrial biopsy, HSG, hysteroscopy

Question 16

(SmartyPance)

what is treatment for dysfunctional uterine bleeding?

Answer 16

oral contraceptives and NSAIDs

Question 17

(SmartyPance)

what’s the difference b/w primary and secondary dysmenorrhea?

Answer 17

primary = no organic cause

secondary = pathologic cause

Question 18

(PPP 390)

When should endometrial biopsy be done to r/o endometrial carcinoma in cases of AUB/DUB?

Answer 18

all women > 35 yrs with 
obesity
HTN
DM
and all pts w/ postmenopausal bleeding

Question 19

(PPP 390)

what four things can be done for chronic management of AUB? what is the definitive management?

Answer 19

first line - estrogen-progestin contraceptive pills

progesterone if estrogen is contraindicated

levonorgestrel-releasing IUD

NSAIDs (if pt is unable or unwilling to be treated w/ hormone therapy)

definitive = hysterectomy
(if pt doesn’t want hysterectomy, try ENDOMETRIAL ABLATION)

Question 20

(PPP 390)

90% of AUB cases are due to what cause?

Answer 20

they are anovulatory cases - the ovaries produce estrogen but no ovulation which = no corpus luteum formation

Question 21

(RR)
mobile, globular, boggy uterus
heavy menstrual bleeding and dysmenorrhea

Answer 21

adenomyosis

(levonorgestrel-releasing intrauterine device is the recommended pharm tx

depot gonadotropin-releasing hormone analogs or aromatase inhibitors may also be used)