Abnormalities Of The Menstrual Cycle

Front 1

Define: Dysmenorrhea

-overview
-primary vs. secondary

Back 1

pain and cramping during menstruation that interferes w/ normal activities

primary: idiopathic menstrual pain
secondary: due to an underlying pathology such as endometriosis, fibroids, adenomyosis, PID, cervical stenosis

Front 2

What is the most established theory of primary dysmenorrhea?

Back 2

Increased levels of endometrial prostaglandins are released

Front 3

Tx for primary amenorrhea?

(two types)

Back 3

1) NSAIDS to try to reduce the amount of prostaglandins!
2) OCPs or other hormonal contraceptives which *decrease endometrial proliferation and decrease PG synthesis*

Front 4

Define: Premenstrual dysphoric disorder

Back 4

constellation of physical/behavioral changes occuring during second half of menstrual cycle.

HA, weight gain, bloating, breast tenderness, mood fluctuation, anxiety, depression, fatigue.

Front 5

PMS and PDD are most probably related to changes in what neurotransmitter?

Back 5

Serotonin

Front 6

Define: Abnormal Uterine Bleeding

Back 6

Departure from the normal bleeding patterns of the menstrual cycle -- too much or too little

Front 7

Define: Dysfunctional Uterine Bleedgin

Back 7

idiopathic heavy/irregular bleeding that can't be contributed to another cause and is thought to be hormonal.

Front 8

How many pads/day is indicative of menorrhagia?

Back 8

24, or roughly 1 per hour

Front 9

3 mcc's of menorrhagia?

Back 9

1) fibroids
2) adenomyosis
3) endometrial polyps

*don't forget primary bleeding disorders like von willibrands disease as another potential cause of menorrhagia*

Front 10

A patient taking depo-provera complains of having light menses. What is the problem?

Back 10

Nothing! This endometrial atrophy is normal for someone on a progesterone-only contraceptive

Front 11

Define: Metrorrhagia

-most common causes

Back 11

Bleeding that occurs between regular menstrual periods, usually less than or equal to menses

cervical lacerations and endometrial cancer

Front 12

Polymenorrhea vs. metrorrhagia

-mcc polymenorrhea?

Back 12

Polymenorrhea is *frequent periods*, describing periods that are less than 21 days apart. This is separate from metrorrhagia, which is *intermenstrual bleeding*

-mcc: anovulation

Front 13

AUB in a 35+ y/o woman calls for what?

Back 13

EMB to r/o endometrial hyperplasia/cancer

Front 14

most common mechanism of DUB?

Back 14

anovulation. ovary produces estrogen but no corpus luteum forms, so no progesterone. this means taht the endometrium proliferates until it outgrows its blood uspply then breaks off and sloughs in an irregular fashion.

Front 15

Postmenopausal bleeding: most likely is what?

Back 15

Actually, is most likely vaginal atrophy...but endometrial cancer is clearly the biggest concern

Front 16

A 25 y/o girl has a cycle every 34 days and loses approximatley 50 mL of blood. is this normal?

Back 16

Yes.

Normalcy: q21-35 days, lasting 3-5 days, and 30-50 mL of blood lost per cycle

Front 17

What 2 patient populations is DUB most common in?

Back 17

Since DUB is thought to be due to anovulation, it's most common in adolescents and perimenopausal women