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Clin Med3: Womens Health > Menses/Abnormal Uterine Bleeding > Flashcards

Menses/Abnormal Uterine Bleeding Flashcards

(74 cards)

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1
Q

what is the normal range for cycle length

A

21-35 days

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2
Q

what is the average blood loss during menstrual cycle

A

30ml; normal variation spotting to 80ml

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3
Q

what is the first menstrual period

A

menarche

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4
Q

what is the hypothalamus’s effect on the menstrual cycle

A

GnRH is secreted in pulsatile manner beginning several days before onset of menstruation

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5
Q

what is the anterior pituitary’s effect on menstrual cycle

A

GnRH stimulates production and release, also in pulsatile fashion, of FSH and LH

production of FSH and LH down-regulates release of GnRH from hypothalamus

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6
Q

What days of menses is the follicular phase

A

days 6-14

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7
Q

what day of menses us ovulation

A

day 14

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8
Q

what days of menses is the luteal phase

A

day 15-28

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9
Q

What is amenorrhea

A

lack of menses/period

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10
Q

what is dysmenorrhea

A

pain with menses

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11
Q

what is primary amenorrhea

A

absence of menses by age 16 or age 14 without onset of puberty - usually anatomical or hormonal, genetic

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12
Q

what is secondary amenorrhea

A

absence of menses for 3 menstrual cycles or total of 6 months in women who have had normal menstruation

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13
Q

what are some causes of primary amenorrhea if normal secondary sexual characteristics

A

imperforate hymen
transverse vaginal septum
cervical or mullerian agenesis (absence of vagina and or uterus)

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14
Q

what are some causes of primary amenorrhea if incomplete development of secondary sexual characteristics

A

hypothalamus or pituitary tumor
hypothyroidism
premature ovarian failure
hyperprolactinemia

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15
Q

what are some of the causes of primary amenorrhea if secondary sexual characteristics are ABSENT

A

physiological delay of puberty (not common in girls)
gonadal agenesis or dysgenesis (Turners)
Ovarian resistance syndrome
GnRH-deficiency (rare)
hyperprolactinemia
CNS mass lesion

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16
Q

what is the most common cause of secondary amenorrhea

A

pregnancy

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17
Q

what are other causes of secondary amenorrhea

A

drug use
stress
significant weight changes
excessive exercise

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18
Q

what is menorrhagia

A

heavy, prolonged menstrual flow (>7 days or > 80mL)

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19
Q

what is metrorrhagia

A

uterine bleeding at irregulat intervals, esp. between expected mnestrual periods

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20
Q

what is menometrorrhagia

A

excessive uterine bleeding both at expected time of menses and at irregular intervals

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21
Q

what is mid-cycle spotting

A

spotting that occurs just before ovulation, usually due to decline in estrogen

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22
Q

what is considered AUB

A

any bleeding prior to menarche is abnormal
any post-menopausal bleeding is abnormal

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23
Q

what are concerns with bleeding prior to menarche

A

concern for malignancy, trauma, sexual abuse, urinary tract issues

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24
Q

what is the concern with bleeding post-menopausal

A

primary concern is malignancy

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25
when is AUB most common
beginning and end of reproductive years
26
what is acute AUB
EMERGENCY excessive bleeding requiring immediate intervention to prevent further blood loss
27
what is chronic AUB
menstrual bleeding irregularities for most of the previous 6 months
28
What is the treatment of acute AUB
volume replacement with bleeding cessation stabilize hemodynamically (IV fluids, blood products) hormonal control of bleeding may consider, bladder cath inserted into uterus and inflated to tamponade bleeding
29
what is the primary concern with AUB
Endometrial cancer
30
what are the risk factors of endometrial cancer
obesity, nulliparity, DM, infertility/unopposed estrogen/chronic anovulatory cycles, ages >35yo, tamoxifen
31
what has protective effects of endometrial cancer
OCPs
32
what is the most common presenting symptom of endometrial cancer
AUB
33
what is the treatment for endometrial cancer
total hysterectomy (TAH/TVH) and bilateral salpingo-oophorectomy recurrence treated with high dose progestins or anti-estrogens
34
what can be associated symptoms/systemic symptoms of AUB
weight loss, fever, chills pain (pelvic) vaginal discharge bowel/bladder symptoms anemia signs/symptoms
35
what occurs with anovulatory cycle
corpus luteum dose not form estrogen stimulates endometrium unopposed which continues to proliferate endometrium outgrows blood supply and sloughs incompletely; bleeds irregularly and maybe profusely or for a long time
36
what occurs with ovulatory AUB
progesterone secretion is prolonged irregular shedding of endometrium results because estrogen levels remain low, near threshold for bleeding (as occurs during menses)
37
what is the most common cause of anovulatory AUB
PCOS (polycystic ovarian syndrome) endometriosis anorexia
38
what is the clinical presentation of ovulatory AUB
excessive bleeding during regular menstrual cycles may have other symptoms of ovulation (premenstrual symptoms, breast tenderness, mid-cycle cramping.. etc)
39
what is the clinical presentation of anovulatory AUB
occurs at unpredictable times and in unpredictable patterns not accompanied by cyclic changes in basal body temp
40
what are diagnostics/work up test for AUB
signs of pallor, endocrine disorders, coagulopathies, abdominal exam, pelvic exam (visual, speculum, bimanual)
41
what needs to be considered with AUB
pregnancy iatrogenic (meds/herbals) systemic disorders (thyroid, hematologic, hepatic, HPA-axis) Genital tract pathology
42
when is TVUS used for AUB workup
risk factors for endometrial cancer age >35 bleeding that continues despite use of empiric hormone therapy pelvic organs that cannot be examined adequately during PE clinical evidence that suggests abnormalities in ovaries or uterus
43
What is uterine Leiomyoma
fibroids benign tumor that originates from smooth muscle layer and surrounding connective tissue of the uterus
44
what do women with fibroids have an increased risk for
endometrial cancer
45
what can be the clinical manifestations of uterine leiomyomas
often asymptomatic -depends on number, size and location heave/prolonged bleeding pelvic pain or pressure reproductive dysfunction
46
what is the diagnostic imagine of choice for uterine leiomyomas
TVUS
47
what is the treatment for fibroids
depends on pre vs post menopausal or if women desire fertility observation hormonal therapies hysterectomy - only real 'cure'
48
what is adenomyosis
extension of endometrial glands into uterine musculature
49
what is the classic patient presentation of adenomyosis
middle age, parous, severe dysmenorrhea and menorrhagia. diffusely enlarged globular uterus
50
what is the definitive therapy for adenomyosis
hysterectomy
51
how is adenomyosis diagnosed
r/o pregnancy US endometrial biopsy (r/o endometrial cancer) MRI - most accurate imaging tool
52
what are signs and symptoms of endometriosis
dysmenorrhea, dyspareunia, spotting, pelvic pain infertility common
53
what are the diagnostic tests for endometriosis
TVUS, laparoscopy, and biopsy of lesions
54
what is the treatment for endometriosis
NSAIDs and OCP - first line GnRH agnoists Danazol: suppress LH and FSH surgery
55
what is DUB
(dysfunctional uterine bleeding) absence of organic disease or anatomic lesion usually a problem with the hypothalamic-pituitary-ovarian hormonal axis
56
what is the most common cause of DUB
ovulation failure shortly after menarche or during perimenopause
57
what is the treatment of endometrial hyperplasia in postmenopausal women
D&C with strong consideration for hysterectomy
58
what is the treatment of endometrial hyperplasia in premenopausal women
medroxyprogesterone acetate or levonorgesterel-releasing IUD treat for 3-6 months and repeat endometrial sampling
59
what is the treatment for AUB
hormone therapy : OCP, progestogen, IUD
60
what is the mechanism of hormone therapy for the treatment of AUB
suppresses endometrial development re-establishes predictable bleeding patterns decreases menstrual flow
61
what are the benefits of OCP with AUB
decrease menstrual blood loss by 40-50% decrease breast tenderness and dysmenorrhea decreased risk of uterine and ovarian cancer
62
what is the benefit of using Clomiphene
if pregnancy desired and bleeding not heavy, can induce ovulation
63
what are non-hormonal treatments of AUB
NSAIDs: reduces bleeding, relieves dysmenorrhea Tranexamic acid : inhibits plasminogen activator, reduces blood loss
64
what is the most common cause of AUB
ovulatory dysfunction
65
what are the tests for treatable causes of bleeding
pregnancy test CBC and ferritin hormone levels TVUS or hysteroscopy and endometrial sampling
66
what is dysmenorrhea
painful menses that interferes with normal activities
67
what is secondary dysmenorrhea
painful menses due to pelvic pathology incidence increases iwth age
68
what are common causes of new onset/episodic dysmenorrhea
ruptured corpus luteum or ovarian cyst ectopic pregnancy PID ovarian torsion spontaneous abortion
69
what are causes of chronic secondary dysmeorrhea
endometriosis adenomyosis leiomyoma (fibroids)
70
what is PMS
wide range of physical or emotional symptoms usually occurring 5-11 days before monthly menstrual cycle (during luteal phase)
71
what are PMS symptoms
HA swelling of ankles, feet and hands bachache abd cramps/heaviness moodiness, sadness abdominal fullness/gaseous breast tenderness weight gain irritability, hostility or aggressive behavior
72
what is treatment for PMS
exercise and diet change nutritional supplements: Vit B6, calcium, magnesium NSAIDs OCPs
73
What is PMDD
(premenstrual dysphoric disorder) condition marked by sadness, inability of function normally at work or in personal relationships, irritability and anger but which occurs only in the premenstrual period and then abates with the onset of menses or shortly after
74
what is the treatment of PMDD
balanced diet adequate rest regular exercises 3-5 times per week SSRI therapy nutritional supplements

Clin Med3: Womens Health (13 decks)

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