Obgyn 22-0 Abnormalities Of The Menstrual Cycle

Front 1

1. Primary vs. Secondary Dysmenorrhea?

Back 1

a. Primary: idiopathic menstrual pain w/identifiable pathology.
b. Secondary: Painful menses due to underlying pathology (endometriosis, fibroids, adenomyosis, PID, cervical stenosis).

Front 2

2. Why does primary Dysmenorrhea usually start in late teens as opposed to menarche?

Back 2

a. Bc it is associated w/ovulatory cycles (early on periods are anovulatory).

Front 3

3. Cause of 1º Dysmenorrhea?

Back 3

a. Thought to result from ↑’d levels of endometrial prostaglandin production.

Front 4

4. Pain of 1º Dysmenorrhea vs. pain of endometriosis?

Back 4

a. Pain of 1º Dysmenorrhea often begins are 1st or 2nd day of menstruation, whereas pain from endometriosis may begin 1-2 weeks before menstruation, worsens 1-2 days before menstruation, and is relieved at or right after onset of menstrual flow.

Front 5

5. First-line tx for 1º Dysmenorrhea?

Back 5

a. NSAIDs.
b. Should be taken w/onset of menses and continued for 1-3 days.
c. Then taken as needed.

Front 6

6. Second-line tx for 1º Dysmenorrhea?

Back 6

a. OCPs.
b. Mechanism of relief is either secondary to cessation of ovulation or due to the ↓ in endometrial proliferation leading to decreased prostaglandin production.

Front 7

7. Prognosis of 1º Dysmenorrhea?

Back 7

a. Often decreases in severity throughout pt’s 20s and 30s.

Front 8

8. How does cervical stenosis cause 2º Dysmenorrhea?

Back 8

a. By obstructing outflow during menstruation.
b. Can be congenital (1º in this case) or 2º to scarring from infection, trauma, or surgery.

Front 9

9. Presentation of cervical stenosis as a cause of 2º Dysmenorrhea?

Back 9

a. Pts often complain of scant menses associated w/severe cramping pain that is relieved with increased menstrual flow.

Front 10

10. Tx of cervical stenosis?

Back 10

a. Dilation with dilators surgically.
b. Laminaria (seaweed) may also be placed in the cervix.
c. These dilate over 24 hours period by absorbing water from surrounding tissue. However, these often recur, requiring multiple dilations.

Front 11

11. Pregnancy with cervical stenosis?

Back 11

a. Pregnancy w/vaginal delivery often leads to permanent cure.

Front 12

12. When to suspect adhesions as a cause of 2º dysmenorrhea?

Back 12

a. If they present w/pain associated w/movement or activity.
b. Adhesions are NOT visible using traditional imaging modalities (MRI/US/CT).

Front 13

13. Tx of pelvic adhesions as a cause of Dysmenorrhea?

Back 13

a. Pts Usually respond to the anti-prostaglandins prescribed for 1º dysmenorrhea (NSAIDS/OCPs).
b. Can be both diagnosed and tx’d via laparoscopy.

Front 14

14. Diagnosis of PMS or PMDD?

Back 14

a. Sx must occur in the 2 wks prior to menstruation and there must be at least a 7-day sx-free interval in the first half of the menstrual cycle.
b. Symptoms must occur in at least 2 consecutive cycles for diagnosis.
c. Pathophys: Due to improper interaction between 5-HT and ovarian steroids. They may have an abnormal response to normal hormonal changes.

Front 15

15. Tx of PMS and PMDD?

Back 15

a. SSRIs. Prozac (fluoxetine).
b. SNRIs (Effexor-Venlafaxine)

Front 16

16. Normal menstrual cycle and normal blood lost?

Back 16

a. 28 days.
b. Lasting 3-5 days.
c. 30-50ml of blood lost.

Front 17

17. Dysfunctional Uterine Bleeding (DUB)?

Back 17

a. Describes heavy and/or irregular bleeding that CANNOT BE ATTRIBUTED TO ANOTHER CAUSE.

Front 18

18. Menorrhagia?

Back 18

a. Pts w/ Menorrhagia have regularly timed cycles but the flow is either excessive long (>7 days) or volume (>80 mL/cycle)
b. May have clots along w/excessive flow.

Front 19

19. Most common cause of Menorrhagia?

Back 19

a. Uterine fibroids
b. Adenomyosis
c. Endometrial polyps.

Front 20

20. Less common cause of Menorrhagia?

Back 20

a. Endometrial hyperplasia or cancer or cervical polyps/cancer.

Front 21

21. Such should teenagers w/ Menorrhagia be evaluated for?

Back 21

a. Primary bleeding disorders such as:
i. von Willebrand disease
ii. ITP
iii. Platelet dysfunction
iv. Thrombocytopenia from malignancy.

Front 22

22. Hypomenorrhea?

Back 22

a. Pts with hypomenorrhea have regularly timed menses but unusually light amount of flow.
b. Commonly caused by hypogonadotropic hypogonadism in anorexics or athletes.

Front 23

23. Other causes of Hypomenorrhea?

Back 23

a. Atrophic endometrium can also occur in:
i. Asherman’s syndrome (intrauterine adhesions)
ii. Congenital malformations
iii. Infection
iv. Itrauterine trauma.

Front 24

24. Drug causes of Hypomenorrhea?

Back 24

a. Pts on OCPs, Depo-Provera, and the progestin-containing IUDs can also have atrophic endometrium and often have light menses as do women who have undergone endometrial ablation.