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28 Cards in this Set
- Front
- Back
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to diagnose dysfunctional uterine bleeding, you must first rule out what?
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everything else
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most pts with dysfunctional uterine bleeding are
a) anovulatory b) metovulatory c) oligovulatory d) polyovulatory |
a) anovulatory
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How do you treat dysfunctional uterine bleeding?
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treatment is age dependent
1) ADOLESCENTS- hormone or contraceptives will control 2) YOUNG WOMEN- Same as adolescents however be aware of greater risk of pathology 3)PREMENOPAUSAL WOMEN-Greater risk of pathology, EMB or hysteroscopy needed 4)POSTMENOPAUSAL WOMEN-Greatest risk for pathology |
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Diagnosis of a postmenopausal bleed
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bleed after 12 months of amennorhea
FSH >30miu/ml |
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Most common cause of postmenopausal bleed
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exogenous hormones
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Definition of primary amenorrhea
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Absence of menses by age 13 in absence of normal growth or secondary sexual development, or by age 15 with normal growth & sexual development
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Menses requires what 3 things
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an intact hypothalamic-pituitary axis;
endometrium competent to respond to hormonal stimulation; an intact outflow tract |
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Difinition of secondary amenorrhea
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Absence of menses for more than 3 cycles or 6 months in previously normal menstruating female
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MOST COMMON CAUSE of secondary amenorrhea
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pregnancy
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What's Asherman's syndrome?
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scarring of the uterus following a D and C
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_______ syndrome is a condition that may occur in a woman who has a severe uterine hemorrhage during childbirth. The resulting severe blood loss causes tissue death in her pituitary gland
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Sheehan
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congenital absence of GnRh = __________’s syndrome
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Kallmann
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most common cause of primary amenorrhea is __________
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gonadal dysgenesis,
(usually associated with sex chromosome abnormalities) |
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Primary amenorrhea presents with hypergonadotropins (^FSH, LH, low serum ______)
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estradiol
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Secondary amenorrhea is caused by hypothalamic failure & presents with hypogonadotropic hypogonadism (low FSH, LH , low ________)
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estradiol
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PITUITARY DEFECTS-Rare- most are secondary to _____ dysfunction
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hypothalamic
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Workup for primary amenorrhea:
If pt has no uterus. |
karyotype:
teesticuular feminization, Mullerian agenesis, 46, XY steroid enzyme defects, puregonadal dysgenesis, or anorchia |
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Workup for primary amenorrhea:
If pt has a uterus, a patent vagina, and breasts, work-up the pt for what type of amenorrhea? |
secondary
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Workup for primary amenorrhea:
If pt has a uterus, a patent vagina, and NO breasts, work-up the pt for what type of amenorrhea? |
progestin-negative secondary amenorrhea
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Workup for amenorrhea - galactorrhea - hyperprolactinemia:
If TSH is normal, prolactin is HIGH or visual symptoms are present, then MRI the pituitary. How do you treat a microadenoma vs a macroadenoma? |
bromocriptine for the micro
surgery for the macro |
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Workup for amenorrhea-galactorrhea-hyperprolactinemia:
If TSH is elevated, what do you do? |
treat hypothyroidism
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Workup for secondary amenorrhea:
if progestin challenge is positive, and pt is hirsute, what do you think? |
polycystic ovary syndrome
r/u ovarian tumor r/u adrenal tumor |
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Workup for secondary amenorrhea:
if progestin challenge is positive, and pt is not hirsute, what do you think? |
mild hypothalamic dysfunction
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Workup for secondary amenorrhea:
if progestin challenge is negative, what do you do? |
r/o Asherman's and then check FSH
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Workup for secondary amenorrhea:
if progestin challenge is negative, and FSH is high, what do you think? |
Ovarian failure
(If FSH is low, there is severe HTN dysfunction.) |
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Treatment for dysmenorrhea
PATIENTS DESIRING PREGNANCY |
Depending on etiology most patients can be induced to ovulate,exception-primary ovarian failure
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Treatment for dysmenorrhea
PATIENTS NOT DESIRING PREGNANCY |
Treatment with combination birth control to prevent bone loss
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Treatment for dysmenorrhea
COMPLICATIONS- |
Infertility, severe osteoporosis,psychosocial developmental delays. Endometrial hyperpasia & carcinoma in patients with positive progestin challenge
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