Repro Oortman - Clinical Aspects Of Menstrual Cycle 2/16; Kek

Front 1

how many mL in a normal flow of menses?

Back 1

30-80mL (>80 is menorrhagia; <10 is hypomenorrhea)

Front 2

what is anovulation and when would it normally occur?

Back 2

absence of ovulation; may have normal bleeding without ovulation; commonly occurs prior to menopause or soon after menarche; these cycles are shorter than the normal 28 days b/c only stimulated by estrogen (which thickens the lining) sheds in irregular fashion; period starts and stops and will last ~8-9days

Front 3

why would a patient have a delayed cycle and think they are pregnant, but not be...

Back 3

luteal phase problem like an ovarian cyst that produces progesterone maintaining the lining and preventing the cycle from starting; usually come in because they think they're pregnant

Front 4

what % of women are affected by premenstrual syndrome?

Back 4

75%; 5% with severe distress; 20-40% physically incapacitated; associated symptoms: bloating, pelvic pain, headaches

Front 5

what is the disorder that is characterized by PMS with psychiatric components, such as sever dysphoria and large mood swings?

Back 5

PMDD (pre-menstrual dysphoric disorder)

Front 6

what neurotransmitter may be decreased in PMS?

Back 6

serotonin; tx include SSRIs (serotonin is effected by estradiol)

Front 7

diagnosis of PMS requires symptoms that last for at least ____ cycles and the symptoms must be in the ______ phase.

Back 7

2 cycles; secretory or luteal phase

Front 8

How do you treat the symptoms of mild PMS?

Back 8

decrease caffeine (decrease breast tenderness); decrease alcohol consumed; smoking cessation

Front 9

what meds would you use in PMS?

Back 9

calcium carbonate; spironolactone (diuretic to decrease bloating and breast tenderness); SSRIs (good for severe and dysphoric disorders)

Front 10

what is the term used to describe painful cramping due to menses?

Back 10

dysmenorrhea

Front 11

explain primary dysmenorrhea and its cause and association with ovulation.

Back 11

primary dysmennorrhea has no organic cause; associated with prostaglandins; if the woman is ovulating there should be pain/cramping

Front 12

explain what secondary dysmenorrhea is and what are the possible causes.

Back 12

pain that may or may not involve prostaglandins; causes: endometriosis, adenomyosis(endometrial tissue growing into the myometrium), endometrial polyps

Front 13

what is membranous dysmenorrhea?

Back 13

woman passes the entire functional layer of the endometrium is shed at one time; women usually thinks she has miscarried since it is such a large mass of tissue and blood

Front 14

what is the treatment for dysmenorrhea?

Back 14

NSAIDs are the gold standard (help with cramping and decrease the amount of bleeding)

Front 15

what is the number one thing that causes abnormal bleeding?

Back 15

pregnancy

Front 16

name some growths that cause menorrhagia?

Back 16

fibroids, myomas (esp. submucoid myomas); submucoid myomas cause abnormal development of the endometrial lining

Front 17

what are some reasons for hypomenorrhea?

Back 17

(decrease in amount of bleeding); common in obstruction of the cervix, vagina, imperforate hymen; Oral contraceptives; Ashermann's Syndrome (D&C performed dilation and curettage - removing the lining of the uterus) can cause scarring of the uterus and possibly lead to infertility

Front 18

what is the term used to describe vaginal bleeding amoung premenopausal women that is not synchronized with their menstrual period?

Back 18

metrorrhagia (common with polyps and CA; anovulatory bleeds are types of metrorrhagia b/c they are totally unpredicatable)

Front 19

name the term used to describe multiple episodes of bleeding throughout the cycle that is associated with anovulation.

Back 19

polymenorrhea

Front 20

what is the difference in polymenorrhea and oligomenorrhea?

Back 20

polymenorrhea is menses every 21 days or fewer; oligomenorrhea is menses that is infrequent and frequency exceeds 35 days

Front 21

who commonly gets oligomenorrhea?

Back 21

menstrual cycles that occur >35 days apart are common in: perimenopausal women; anovulatory pts with excessive weightloss

Front 22

what is menometrorrhagia?

Back 22

prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal; possible causes: fibroids,hormonal imbalances, endometriosis, CA (in class he said sudden onset of bleeding usually associated with a tumor or complication of pregnancy)

Front 23

what is contact bleeding and why does it occur?

Back 23

vaginal bleeding due to external contact (most likely intercourse); older women that lack estrogen may get vaginal atrophy and lose the elasticity and bleed easier

Front 24

what are the 1st steps in evaluating a woman's abnormal bleeding?

Back 24

HISTORY IS IMPORTANT - get the patient to keep a calendar of menses and document bleeding pattern; most patients don't really know their LMP (guesstimate); pregnant due dates end up being +/-2weeks; PHYSICAL EXAM: look for large, IRREGULAR uterus that indicates fibroids; it is is diffusely enlarged, probably pregnant or adenomyosis

Front 25

what is a pelvic Ultrasound good for in looking at a female's repro system?

Back 25

assessing size of the uterus, what's going on inside the uterus, and good view of the ovaries and fallopian tubes

Front 26

what can you use to view the inside of the uterus?

Back 26

hysteroscopy (have to minimally dilate the cervix and insert the hysteroscopy) - allows good view of the lining

Front 27

name the procedure that is characterized by injecting saline in the uterine cavity and taking U/S pics; this allows you to view any abnormal growths (polyps, hypertrophy, etc) of the lining.

Back 27

sonohysteroscopy

Front 28

describe an endometrial biopsy and why it is done.

Back 28

go inside uterus and scrap off/suck out a piece of endometrial lining. EB are good to determine unknown reasons for heavy bleeding; also good for patients with anovulatory cycles, if there are any CAs present; the effects of progestin and estrogens on the lining (if any)

Front 29

what is a D&C?

Back 29

dilation and curettage is a gyn surgical procedure that involves dilating the cervix and removing the lining of the uterus while the woman is under an anaesthetic; curettage is performed with a curette (a metal rod with a handle on one end and a sharp loop on the other); may need after incomplete miscarriage or to remove uterine lining for other reasons

Front 30

what is the 1st lab study you should do on a female with abnormal bleeding?

Back 30

pregnancy test (hCG) since this is the most common reason for abnormal bleeding

Front 31

what lab study should you do on a pt with heavy cycles (menorrhagia)?

Back 31

get Hemoglobin and Hematocrit (make sure she's not anemic)

Front 32

what lab study should you do on a pt with anovulatory cycles?

Back 32

LH, FSH, TSH

Front 33

most abnormal bleeding can be treated with _______.

Back 33

hormones (progestins or combo Birth control); perimenopausal women may prefer a progestin releasing IUD to control constant bleeding

Front 34

what is the ideal IUD patient?

Back 34

doesn't want to pregnant for at least 5 years; best in patients that have already had children; S/E increased menstrual bleeding (patients that are nulliparous have the most complaints - cramps and bleeding)