Chronic Pelvic Pain

Front 1

abnomalities of menstruation before manarche:

Back 1

newborns: withdrawal bleeding
before menarche: form malignancy, trauma, sexual abuse, foreign body, urinary tract problems, irritation
50% of cases involve lesions of genital tract

Front 2

abnormalities of menstruation childbearing years

Back 2

by 18-21 should be normal, hypothalamic-pituitary axis has matured
may be from pregnancy and preg related conditions
may be meds, other medical problems, IUD, GYN disorders

Front 3

evaluations of abnormal preg

Back 3

first rule out pregnancy then consider, coagulopathy, pelvic lesions, malignancy, thyroid, dysfunctional uterine bleeding

Front 4

diagnostic tests of abnormal bleeding in childbearing years

Back 4

hCG, CBC
plt
bleeding time
liver function
thyroid
pap smear

Front 5

eval of abnormal bleeding after menopause
dx and tx

Back 5

CANCER UNTIL CONSIDERED OTHERWISE
bengin causes: atrophic vaginitis, polyps, endometrial hyperplasia
tx: dilation and curettage, biopsy

Front 6

eval of abnormal bleeding in perimenopause

Back 6

rule out endometrial cancer and pregnancy

Front 7

tx of abnormal bleeding

Back 7

-stabilize pt
-high dose estrogen to support endometrium and stop bleeding, if successful follow with low dose estrogen and progestin
-dilation and curretage if estrogen fails
-OCs for mild bleeding
-hysterectomy if necessary

Front 8

Dysfuntional Uterine Bleeding (DUB)

Back 8

abnormal unterine bleeding in women between menarche and menopause and cannot be attributed to meds, blood disorders, systemic disease, trauma, uterine neoplasms or preg
-commonly seem around menarche and meopause
-teens: from immaturatiy of the hypothalamic-pituitary system
-perimenopausal: may be from declining functioning of ovary

Front 9

DUB dx

Back 9

exclusion, rule out everything else

Front 10

DUB tx

Back 10

-OC's (dont give to smokers >35yo)
-cyclic progestins: expected to bleed if they don't bleed then you know they don't have enough estrogen
-hysterectomy last resort

Front 11

sonohysterogrpahy

Back 11

put saline into uterine cavity and look with U/S to evaluate for uterine or endometrial pathology

Front 12

amenorrhea

Back 12

absence of menstrual bleeding

Front 13

primary amenorrhea

Back 13

no spontaneous uterine bleeding by age 15 with normal secondary sex characteristics or 13 yo with abnormal secondary sex characteristics

Front 14

secondary amenorrhea

Back 14

absence of menstrual periods for 3 cycles or 6 consecutive months in a women who had periods previously

Front 15

causes of amenorrhea

Back 15

1. preg
2. hypothalamic defects
3. pituitary defects
4. ovarian/ovulatory dysfunction
5. uterine cuases
6. others

Front 16

congenital deficiency of GnRH

Back 16

cause of amenorrhea
- no GNRH secretion
- ovulation doesn occur
male:female 5:1

Front 17

defect of GnRH transport

Back 17

cause of amenorrhea
-hypothalamic lesions
-benign brain tumor
-preventys flow from hypothal to pituitary

Front 18

defects of GnRH pulse production

Back 18

cause of amenorrhea
-not released at appropriate time
-anorexia
-extreme wt lose
-severe stress
-athletics

Front 19

congential absence of pituitary

Back 19

cause of amenorrhea
rare-lethal usually

Front 20

pituitary defects: cause of amenorrhea

Back 20

1. Sheehan's Syndrome: pituitary necrosis from hemorrage and sever hypotension
2. Iron deposition in pituitary: pts with very high iron levels

Front 21

PCOS

Back 21

cause of amenorrhea

Front 22

Turners syndrome

Back 22

cause of amenorrhea
-abnormal X chromosome
-webbed neck, increase carrying angle (cant put hands at side)

Front 23

Premature Ovarina Failure

Back 23

cause of amenorrhea
-depletion of ova before age 40

Front 24

congenital absence or malformation of uterus

Back 24

cause of amenorrhea
-unresponsive or atrophic endometrium

Front 25

imperforated hymen

Back 25

cause of amenorrhea

Front 26

lab findings of amenorrhea

Back 26

-FHS and LH
-testosterone
-thyroid studies
-preg test
-MRI/Ct of hypothal/pituitary
-genetic eval
-U/S

Front 27

treatment of primary amenhorrea

Back 27

depends on cause
-turners syndrome: estrogen
-pituitary tumors: bromocriptine (inhibits prolactin secretion), srugery, radiation
-support

Front 28

secondary amenhorrea: causes

Back 28

-preg most common cause
-ovarian failure or dysfunction
-stoping OCs
-hypothal/pituitary causes
-obesity
-cushings disease (adrenal overactivity)
-menopause

Front 29

secondary amenhorrea: PE

Back 29

-androgen excess
-breast exam: galactorrhea (prolactinc excess)
-estrogen deficiency
work up tailored to H&P

Front 30

tx of secondary amenhorrea

Back 30

-hormone replacement therapy, tx for tumores, systemic disease, support

Front 31

primary dysmenorrhea
cause
ssx

Back 31

17-22 yo
no readily identified cause
-uterine contractions with ischemia
-cramping, lower abdomen to things and back, pain with altered bowel habits, nausea, vomiting, fatigue, dizziness
-PE usually normal

Front 32

primary dysmen tx

Back 32

-NSAIDs (motrin)
-OCs
-topical heat
-diet low in fat
-if not response consider seconardy

Front 33

secondary dysmenorrhea

Back 33

-painful menstruation due to some underlying cause
-starts in 30s-40s
-during, before, or after menses
-ssx: dysparuenia, infertility, or abnormal uterine bleeding
-do pelvic exam

Front 34

causes of secondary dysmenorrhea

Back 34

1. Endometriosis
2. Fibroids. Adenomyosis
3. Pelvic congestion (dull ache, diminished with menses)
4. IUD
5. polyps
6. adhesions
7 cervical stricture or stenosis

Front 35

eval of secondary dysmenorrhea

Back 35

-cervical cx to rule our STI
-WBC
-hCG
-Pelvic US
-laparoscopy

Front 36

tx of secondary dysmenorrhea

Back 36

-treat underlying disease
-NSAIDs
- OCs

Front 37

premenstural syndrome (PMS)

Back 37

emotional and physical symptoms in luteal phase of menstural cycle
80% of women have it
5% have severe symptoms (Premenstural dysphoric disorder PMDD)
-exact cause not known

Front 38

theories of PMS

Back 38

1. homonal basis
2. ovarian function involved
3. genetic factors
4. serotonin deficicncy

Front 39

ssx of PMS

Back 39

1. depressed mood
2. anxiety
3. emotional liability
4. irritability
5. decreased interest in activities
6. fatigue
7. sleep disturbances
8. ab pain, breast tenderness, bloating, wt. gain, edema, headache

Front 40

dx and tx of PMS

Back 40

Dx: nothing specific, symptoms diary for 2-3 periods
Tx: reassurance, rest, exercise, low sodium, caffeine, chocolate and alcohol
-midol, vitamins, mid diuretics, anti-anxiety meds, SSRIs, GnRH agonists, NSIDs
**OCs not reccommended