Menstrual Cycle & Benign Ovarian Conditions

Question 1

Define menorrhagia

Answer 1

heavy menstrual bleeding

Question 2

define metrorrhagia

Answer 2

intermenstrual bleeding

Question 3

define amenorrhea

Answer 3

absence of menstruation

Question 4

define dysmenorrhea

Answer 4

menstrual cramps

Question 5

define cryptomenorrhea

Answer 5

light flow or spotting

Question 6

define oligomenorrhea

Answer 6

infrequent menstruation

Question 7

define polymenorrhagia

Answer 7

frequent menstruation

Question 8

define menometrorrhagia

Answer 8

irregular intervals & varying degrees of bleeding (aka abnormal uterine bleeding)

Question 9

What are the 5 key components to a reproductive history

Answer 9

• age of first menarche
• first day of last menstrual period
• pattern of bleeding (days, duration, intensity)
• presence of dysmenorrhea or other sxs
• family history (age of menarche, dysmenorrhea)

Question 10

What are the 3 major components of a sexual history

Answer 10

• current sexual activity (hx STIs)
• contraception or barrier protection
• pregnancy history

Question 11

define thelarche

Answer 11

appearance of breast tissue primarily d/t action of estradiol from the ovaries

Question 12

define pubarche

Answer 12

appearance of pubic hair primarily from androgens of the adrenal glands

Question 13

define menarche

Answer 13

time of first menstrual bleed often not associated with ovulation & typically caused by estradiol on endometrium

Question 14

what is the average age of breast budding

Answer 14

10.5 years old

Question 15

what is the average age of menarche in north america

Answer 15

age 12.5 about 2.6 years after onset of puberty

Question 16

What is the average length of the menstrual cycle

Answer 16

21-35 days (avg 28 days)
- will peak ate age 25-30 then gradually decline
- more irregular in adolescence
- changes in cycle length happens in follicular phase, luteal phase is a fixed 14 days

Question 17

what is the average loss of blood during menstruation

Answer 17

30-80 mL of blood (avg 40)

Question 18

List the 3 forms of estrogen

Answer 18

• estradiol (most potent)
• estrone
• estriol

Question 19

what are the 3 phases of the menstrual/uterine cycle

Answer 19

1. menstruation (follicular)
2. proliferative phase (follicular)
3. secretory phase (luteal)

Question 20

List the ovarian cycle of menstruation

Answer 20

1. follicular (proliferative)
2. ovulation
3. luteal phase (secretory)

Question 21

Describe the hormonal processes of the follicular phase

Answer 21

high FSH which is later inhibited by estrogen production

Question 22

describe the hormonal process during ovulation

Answer 22

huge spike in LH and slight FSH which triggers ovulation

Question 23

describe the hormonal process of the luteal phase

Answer 23

rising levels of estrogen and progesterone inhibit both LH and FSH

Question 24

describe the hormonal process during menstruation

Answer 24

corpus luteum degenerates and estrogen/progesterone levels fall, FSH levels rise

Question 25

Define mittelschmerz

Answer 25

mid-cycle abdominal pain (+/- clear discharge or bleeding) from follicular release of prostaglandin containing fluid

Question 26

describe primary dysmenorrhea

Answer 26

- increased prostaglandins causing painful uterine contractions - usually starts 1-2 years after menarche - likely to improve in women who become pregnant

Question 27

define secondary dysmenorrhea

Answer 27

- due to pelvic pathology (endometriosis, adenomyosis, adhesions, PID, etc) - often seen 25+ years old - red flags: uterine bleeding, non-midline pelvic pain, dyspareunia, progression of severity

Question 28

Describe the presentation of dysmenorrhea (primary/secondary/general & red flags)

Answer 28

Question 29

Describe the treatment for dysmenorrhea

Answer 29

Question 30

Describe the etiology of premenstrual syndrome

Answer 30

Question 31

Describe the presentation of premenstrual syndrome

Answer 31

Question 32

Describe the treatment of premenstrual syndrome

Answer 32

Question 33

Describe the presentation of premenstrual dysphoric disorder

Answer 33

Question 34

Describe the treatment of PMDD

Answer 34

Question 35

Describe the etiology of menorrhagia

Answer 35

Question 36

Describe the presentation of menorrhagia

Answer 36

Question 37

Describe the treatment for menorrhagia

Answer 37

Question 38

Describe the etiology of dysfunctional uterine bleeding

Answer 38

Question 39

Describe the diagnosis of dysfunctional uterine bleeding

Answer 39

Question 40

Describe the treatment of dysfunctional uterine bleeding

Answer 40

Question 41

Describe the etiology of amenorrhea (primary/secondary)

Answer 41

Question 42

Describe the presentation of Turner's Syndrome related amenorrhea

Answer 42

Question 43

Describe the presentation of an ovarian cause of amenorrhea

Answer 43

Question 44

Describe the diagnosis of primary/secondary amenorrhea

Answer 44

Question 45

Describe the treatment for amenorrhea

Answer 45

Question 46

Describe the etiology of PCOS

Answer 46

Question 47

Describe the presentation of PCOS

Answer 47

Question 48

Describe the diagnosis of PCOS

Answer 48

Question 49

Describe the treatment for PCOS

Answer 49

Question 50

Describe the etiology of primary ovarian insufficiency

Answer 50

Question 51

Describe the presentation of primary ovarian insufficiency

Answer 51

Question 52

Describe the diagnosis of primary ovarian insufficiency

Answer 52

Question 53

Describe the etiology of a functional ovarian cyst

Answer 53

Question 54

Describe the presentation of a functional ovarian cyst

Answer 54

Question 55

Describe the treatment of functional ovarian cysts

Answer 55

Question 56

Describe the etiology of an ovarian cyst

Answer 56

Question 57

Describe the diagnosis & treatment of an ovarian cyst

Answer 57

Question 58

Describe the presentation of a ruptured ovarian cyst & how to diagnose

Answer 58

Question 59

Describe the treatment of a ruptured ovarian cyst

Answer 59

Question 60

Describe the etiology of ovarian torsion

Answer 60

Question 61

Describe the presentation of ovarian torsion

Answer 61

Question 62

Describe the diagnosis & treatment of ovarian torsion

Answer 62

Question 63

Describe the etiology of endometriosis

Answer 63

Question 64

Describe the presentation of endometriosis

Answer 64

Question 65

Describe the diagnosis of endometriosis

Answer 65

Question 66

Describe the treatment of endometriosis

Answer 66