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34 Cards in this Set

  • Front
  • Back
how many mL in a normal flow of menses?
30-80mL (>80 is menorrhagia; <10 is hypomenorrhea)
what is anovulation and when would it normally occur?
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
why would a patient have a delayed cycle and think they are pregnant, but not be...
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
what % of women are affected by premenstrual syndrome?
75%; 5% with severe distress; 20-40% physically incapacitated; associated symptoms: bloating, pelvic pain, headaches
what is the disorder that is characterized by PMS with psychiatric components, such as sever dysphoria and large mood swings?
PMDD (pre-menstrual dysphoric disorder)
what neurotransmitter may be decreased in PMS?
serotonin; tx include SSRIs (serotonin is effected by estradiol)
diagnosis of PMS requires symptoms that last for at least ____ cycles and the symptoms must be in the ______ phase.
2 cycles; secretory or luteal phase
How do you treat the symptoms of mild PMS?
decrease caffeine (decrease breast tenderness); decrease alcohol consumed; smoking cessation
what meds would you use in PMS?
calcium carbonate; spironolactone (diuretic to decrease bloating and breast tenderness); SSRIs (good for severe and dysphoric disorders)
what is the term used to describe painful cramping due to menses?
explain primary dysmenorrhea and its cause and association with ovulation.
primary dysmennorrhea has no organic cause; associated with prostaglandins; if the woman is ovulating there should be pain/cramping
explain what secondary dysmenorrhea is and what are the possible causes.
pain that may or may not involve prostaglandins; causes: endometriosis, adenomyosis(endometrial tissue growing into the myometrium), endometrial polyps
what is membranous dysmenorrhea?
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
what is the treatment for dysmenorrhea?
NSAIDs are the gold standard (help with cramping and decrease the amount of bleeding)
what is the number one thing that causes abnormal bleeding?
name some growths that cause menorrhagia?
fibroids, myomas (esp. submucoid myomas); submucoid myomas cause abnormal development of the endometrial lining
what are some reasons for hypomenorrhea?
(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
what is the term used to describe vaginal bleeding amoung premenopausal women that is not synchronized with their menstrual period?
metrorrhagia (common with polyps and CA; anovulatory bleeds are types of metrorrhagia b/c they are totally unpredicatable)
name the term used to describe multiple episodes of bleeding throughout the cycle that is associated with anovulation.
what is the difference in polymenorrhea and oligomenorrhea?
polymenorrhea is menses every 21 days or fewer; oligomenorrhea is menses that is infrequent and frequency exceeds 35 days
who commonly gets oligomenorrhea?
menstrual cycles that occur >35 days apart are common in: perimenopausal women; anovulatory pts with excessive weightloss
what is menometrorrhagia?
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)
what is contact bleeding and why does it occur?
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
what are the 1st steps in evaluating a woman's abnormal bleeding?
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
what is a pelvic Ultrasound good for in looking at a female's repro system?
assessing size of the uterus, what's going on inside the uterus, and good view of the ovaries and fallopian tubes
what can you use to view the inside of the uterus?
hysteroscopy (have to minimally dilate the cervix and insert the hysteroscopy) - allows good view of the lining
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.
describe an endometrial biopsy and why it is done.
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)
what is a D&C?
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
what is the 1st lab study you should do on a female with abnormal bleeding?
pregnancy test (hCG) since this is the most common reason for abnormal bleeding
what lab study should you do on a pt with heavy cycles (menorrhagia)?
get Hemoglobin and Hematocrit (make sure she's not anemic)
what lab study should you do on a pt with anovulatory cycles?
most abnormal bleeding can be treated with _______.
hormones (progestins or combo Birth control); perimenopausal women may prefer a progestin releasing IUD to control constant bleeding
what is the ideal IUD patient?
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)