Lecture 6- Abnormal Bleeding

Question 1

Frequent menstrual bleeding (<21 days)

Answer 1

Polymenorrhea

Question 2

Prolonged or excessive bleeding occuring at regular intervals (loss of 80mL or more lasting for more than 7 days).

Answer 2

Menorrhagia

Question 3

Bleeding in between periods.

Answer 3

Metrorrhagia

Question 4

Frequent bleeding that is excessive and irregular in amount and duration.

Answer 4

Menometrorrhagia

Question 5

what is the most common cause of amenorrhea?

Answer 5

pregnancy

Question 6

What levels should be measured with amenorrhea?

Answer 6

FSH, LH, prolactin level

Question 7

What is primary amenorrhea?

Answer 7

No menstruation by age 13 w/out 2° sexual development or by age 15 with 2° sexual development.

Question 8

What is secondary amenorrhea?

Answer 8

Absence of menstruation for 3 – 6 months in a previously normal menstruating woman or for three typical cycle lengths in a woman with oligomenorrhea.

Question 9

What are some functional causes of amenorrhea?

Answer 9

Wt loss, excessive exercise, obesity, drug-induced, neoplastic, psychogenic, heat injury, chronic medical illness

Question 10

When is ovarian failure considered premature?

Answer 10

Women under 40

Question 11

What are the most common anomalies in primary amenorrhea?

Answer 11

Imperforate hypen

Absence of uterus or vagina

Question 12

What is a syndrome that is from scarring of the uterine cavity due to D&C. Most frequent anatomic cause of secondary amenorrhea.

Answer 12

Asherman Syndrome (common in people with a number of abortions)

Question 13

What is a common syndrome that causes anovulatory abnormal uterine bleeding?

Answer 13

PCOS

Question 14

What are the two main types of abnormal uterine bleeding?

Answer 14

Anovulatory

Ovulatory

Question 15

What causes anovulatory AUB?

Answer 15

Endometrium outgrows its blood supply and sloughs at irregular and unpredictable times. Bleeding can be light and infrequent or frequent and heavy (can alternate)

Question 16

What causes ovulatory AUB?

Answer 16

Luteal phase defect.
Corpus luteum doesn’t develop fully.
There is insufficient progesterone secretion.

Question 17

How long does the corpus luteum live?

Answer 17

14 days

Question 18

What do you measure for ovulatory AUB?

Answer 18

Progesterone (often at day 21)

Question 19

What tests do you do for AUB?

Answer 19

Pap smear
vaginitis/ STI screening
Endometrial biopsy
Labs
Pelvic ultrasound
sonohysterogram

Question 20

What are some risks associated with AUB?

Answer 20

Anemia, acute hemorrhage, endometrial hyperplasia/ CA

Question 21

What is some treatment for AUB?

Answer 21

Minera IUD
Prover 10 mg 10-14 days
cyclic progesterone
OCP
high dose estrogen
OCP 4x4, 3x3, 2x2, 1 PO q day

Question 22

If people with AUB has no reponse to medical thearpy what can be done?

Answer 22

D&C
Ablation of uterine lining
Hysterectomy

Question 23

What is excess of protaglandins leading to painful uterine muscle cramping.

Answer 23

Primary dysmenorrhea

Question 24

what is painful uterine muscle cramping caused by clinically identifiable causes: extrauterine, tumors, intramural, intrauterine.

Answer 24

Secondary dysmenorrhea

Question 25

What is the main difference b/w chronic pelvic pain and dysmenorrhea?

Answer 25

Chronic pelvic pain isn’t cyclical, where dysmenorrhea is

Question 26

What are some common cause of secondary dysmneorrhea?

Answer 26

Endometriosis, adenomyosis, adhesions, PID, leiomyomata

Question 27

When is secondary dysmenorrhea most common?

Answer 27

Later in life

Question 28

What are common therapy for primary dysmenorrhea?

Answer 28

NSAIDS (prostaglandin inhibitors) 
Heat
exercise
psychotherapy
reassurance
oral contraceptives

Question 29

What is used for cases of severe pain that don’t respond to conventional therapy. This disrupts the presacral nerves.

Answer 29

Presacral Neurectomy

Question 30

How do you treat secondary dysmenorrhea?

Answer 30

Correct underlying condition when possible.

OCP can also be used

Question 31

How long does pelvic pain need to have lastsed to be diagnosed as chronic pelvic pain?

Answer 31

Longer than a year

Question 32

Is chronic pelvic pain just combined to the uterus?

Answer 32

No, can also involve diseases of reproductive, genitourinary, and GI tracts

Question 33

What is a condition that can cause chronic pelvic pain and is a chronic inflammatory condition of the bladder?

Answer 33

Interstitial cystitis (ICS)

Question 34

What is when there is the presence of endometrial glands and stroma in any extrauterine site

Answer 34

Endometriosis

Question 35

What do you use for diagnosis of endometriosis?

Answer 35

Tissue biopsy

Question 36

What are the three major theories of endometriosis?

Answer 36

1. Retrograde menstruation
2. Vascular and lymphatic dissemination
3. Coelomic metaplasia

Question 37

What should you think when you see “mulberry, brown lesions, “chocolate cysts”

Answer 37

Endometriosis

Question 38

What is the triad of endometriosis?

Answer 38

Dysmenorrhea, dyspareunia, dyschezia

Question 39

What are the two types of surgery for endometriosis?

Answer 39

Conservative

Extirpative (everything removed)

Question 40

What is medical treatment for endometriosis?

Answer 40

NSAIDS, continuous OCP’s, Depo-Provera, Danazol, GnRH agonists (Depo-Lupron) with add-back therapy.

Question 41

What are benign muscular tumors or the uterus. Highest prevalence in 5th decade?

Answer 41

Uterine Leiomyomas (fibroids)

Question 42

What type women have a higher prevalence of uterine fibroids?

Answer 42

African-American women

Question 43

What are the three most common types of leiomyomas?

Answer 43

Intramural
Subserosal
Submucosal

Question 44

What is The presence of ectopic endometrial tissue within the myometrium. Causes irregular bleeding and pain. Only treatment is hysterectomy. Commonly found at time of hysterectomy.

Answer 44

Adenomyosis