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13 Cards in this Set

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nl menstrual interval
28 +/-7 days
avg duration of flow
4 days
abnl menstrual interval
oligomenorrhea: interval > 35d
polymenorrhea: interval < 21d
menorrhagia
heavy bleeding at REGULAR intervals (>7 days or >80 ml)
metrorhaggia
bleeding at IRREGULAR intervals
menometrorrhagia
prolonged bleeding, IRREGULAR intervals
dysmenorrhea
painful uterine bleeding
how much blood loss in menstruation assoc w/anemia?
80 ml (most nl women lose less than 60 ml)
Et of abnl uterine bleeding
A. Organic Cause
1.Systemic dz
a. Coagulationd d/o
-vWF
-Hx: prolonged heavy bleeding at beginning of menarche
b. Thyroid dz
-Hypothyroid ~menometrorrhagia
-Hyperthyroid~oligomenorrhea, amenorrhea (makes sense: skinny ppl don't menstruate)

c. Liver Dz
-deficient clotting factors
-reduced ab to metabolize estrogens

2. D/o of Reproductive Tract
a.Abnl Preg
-R/O ectopic preg!
b.Malignancy
c.Benign Uterine Lesions
-myoma (goljan: leiomyoma=MC tumor in women)
-adenomyosis (endometrial tissue within myometrium)
d.Foreign Body-IUD

B. Dysfunctional Uterine Bleeding (DUB)
-ALWAYS d/t endocrine abnl (no organic cause)--goljan
-most pts anovulatory secondary to altered neuroendocrine fxn:
continuous unopposed estrogen==>less GnRH release
==>no LH/FSH release to start follicular phase (req for next ovulation)
how evaluate pt with abnl bleeding
A. Hx
1. det if pt is oculating
-menstrual calendar
-PMS
-basal body temp
-midluteal progest level

2. timing of bleeding
at time of expected menses? intemittent spotting?
post-coital?

3. char of bleeding
a. passing clots, associated cramping

B. Physical
1. careful exam-inspecting
a. vulva
b. vagina
c. cervix: polyp, cervicitis

2. Bimanueal exam
3. Endometrial biopsy
Tx abnl bleeding
A. Medical
1. steroid hormones
2. NSAIDS
B. Surgical
hysteroscopic, transvaginal, transabdominal

C. Acute bleeding/hemorrhage
1. Estrogen therapy
-est causes rapid growth of endometrium (covers denuded areas)
-after bleeding stops, combine with progestin for 7-10 d. Then expect heavy synchronized bleeding.
-OCP's: 2 pills QID til bleeding stops, then finish the package

2. Anovulatory bleeding: Protestin Tx
-not as useful as estrogen to stop the initial bleeding

3. Progestin Tx: Medroxyprogesterone acete
-not effective contraception

E. NSAIDS
1. inhibit platelet fxn-aggregationadn release rxn
2. Block COX==>
a. decr PGI2 (vessel wall relaxation and decr platelet agg)
b. decr thromboxane (vessel wall constriction, incr platelet agg)

F. Surgery
1. uterine curettage (remove tissue)
2. Hysteroscopy
a. polypectomy (remove polyp)
b. myomectomy (remove myometrium)
c. endometrial ablation (ablate endometrium)

3. hysterectomy
Tx acute bleeding/hemorrhage
1. Estrogen therapy=BEST
-est causes rapid growth of endometrium (covers denuded areas)
-after bleeding stops, combine with progestin for 7-10 d. Then expect heavy synchronized bleeding.
-OCP's: 2 pills QID til bleeding stops, then finish the package

2. Anovulatory bleeding: Protestin Tx
-not as useful as estrogen to stop the initial bleeding
surgery for abnl bleeding?
1. uterine curettage (remove tissue)
2. Hysteroscopy
a. polypectomy (remove polyp)
b. myomectomy (remove myometrium)
c. endometrial ablation (ablate endometrium)

3. hysterectomy