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21 Cards in this Set
- Front
- Back
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Reproduction System- Bleeding Complications by Aliff
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Reproduction System- Bleeding Complications by Aliff
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What is a cycle length? what's avg length?
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The first day of a bright red bleeding to the next first day of bright red bleeding...
-avg is 28 days; 21-35 still within normal limits *oligomenorrhea > 35 day cycles *hypermenorrhea < 21 day cycles irregular periods are when the LENGTH of the menstrual cycle is inconsistent |
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Oligomenorrhea... and causes
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-Anovulation
-Extremes of age – teens and perimenopause; Reassurance -Oral contraceptives until 51 yrs; easiest way to cycle them. -Cyclic progestins- force a period to come. not as good as BC -“Skip” periods and eventually may have a heavy bleed -Out of synch shedding causes bleeding between ovulatory cycles HYPOthyroidism Prolactinoma Obesity Polycystic Ovarian Syndrome Anorexia |
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Why hypothyroidism?
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Autoimmune – Hashimoto’s Thyroiditis
Cold intolerance, fatigue, constipation With or without TRH induced elevations in prolactin **Diagnosed with ^TSH, low free T4 Treat with thyroid hormone – clinical response in 6 – 8 weeks |
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What about HYPERthyroidism
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Oligomenorrhea or hypermenorrhea
Grave’s disease -Heat intolerance, agitation, exopthalmos, brisk reflexes, weight loss |
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Prolactinoma
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Amenorrhea, galactorrhea
Bitemporal hemianopsia MRI of sella turcica TRH - TSH - Prolactin ****Treat hypothyroidism if TSH is elevated ****Treat with bromocriptine if isolated ^prolactin (won't be asked about treatments) |
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Anorexia gives you what?
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Hypogonadotropic hypogonadism
Central suppression? check LH, FSH, TSH Poor enamel on teeth Marks on nail beds and cuticles |
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Obesity... high circulating levels of what?
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-Peripheral conversion of testosterone to estrogens
-High baseline estrogen negatively feeds back and drops GnRH levels |
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Polycystic Ovarian Syndrome.. how do you diagnose?
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-Obesity, acne, hirsuitism, oligomenorrhea
-Chronic anovulation – multifactorial -Infertility -Insulin resistence – acanthosis nigricans -Hyperinsulinemia, ^androgens, ^estrogens - Increase Insulin like growth factor -CLINICAL DIAGNOSIS (walk in and see it without labs) Patho: Ovaries produce excess androgen (testosterone) and insulin like growth factor |
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PCOS Elevated Testosterone
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PCOS: Elevated Testosterone:
Increased appetite – weight gain – more conversion to estrogen Decreased SHBG – more free (active) testosterone and estrogen Acne; Hirsuitism; Male pattern balding |
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PCOS – Elevated Estrogens
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Stimulate endometrial proliferation
May lead to endometrial cancer Causes elevated LH, suppressed FSH (2:1) Follicles become arrested at the ovarian surface – rosary bead appearance on ultrasound Anovulation results **give birth control pills. it'll increase the amount of sex hormone binding globulin to bind to the free stuff, so there will be less clinical effect of extra estrogen. |
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PCOS – Insulin resistence
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-Insulin like growth factor abnormally stimulates an already overestrogenized endometrium – furthers endometrial cancer risk
-Increase insulin levels – further increases testosterone levels -Acanthosis nigricans -Increases appetite -The patient is programmed to become diabetic -HTN, hyperlipidemia, CAD |
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PCOS - Treatment
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-Education – present and future risks
-Diet & Exercise; Weight loss – even a 10% weight loss increases ovulation -Oral contraceptives -Increase SHBG – decrease free testosterone -Improves acne, hair growth, male pattern balding -Empties uterus monthly – may reduce long term risk of endometrial cancer One of the biggest roles of a primary care physician is preventative medicine: Infertility, Diabetes, Hyperlipidemia, Obesity, CAD, Endometrial Cancer |
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What does metformin do?
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-Decreases hepatic gluconeogenesis
-Increases insulin sensitivity -Decreases insulin levels -Decreases LH levels -Decreases testosterone levels -May aid in weight loss – also due to GI side effects -Often results in spontaneous ovulation |
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Hypermenorrhea is usually due to what?
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Hyperthyroidism
Usually due to an anatomical abnormality, not a physiologic dysfunction May be associated with anovulation – areas of endometrium out of synch and shed when they outgrow their blood supply |
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Dysfunctional vs. Abnormal
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Dysfunctional uterine bleeding – physiological dysfunction (anovulation)
Abnormal uterine bleeding – anatomical abnormality (A-A) |
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Abnormal Uterine Bleeding
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Fibroids
Adenomyosis Endometrial Hyperplasia – precancerous Endometrial Cancer – postmenopausal bleeding Cervical Cancer – postcoital bleeding Infection – cervicitis, endometritis Endometrial polyps |
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Abnormal Uterine Bleeding
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-Endometrial atrophy - menopause, Depo provera, long term progesterone
-Foreign body – IUD -Bleeding disorders – Von Willebrand’s -Aspirin, anticoagulants -Pregnancy -Unopposed estrogen, tamoxifen |
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Treatment Options
what do you see if bleeding is due to an anatomical cause? |
OCP’s
Cyclic progestins Continuous progestins – includes Depo Provera, Mirena IUD ****If the bleeding is due to an anatomical cause, it won’t respond. |
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Dilation and Curettage..what can happen if you have a D & C too many times?
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D&C
Scrape endometrium Too many? Asherman’s Syndrome – amenorrhea, uterine synechiae, infertility Rarely effective Add endometrial ablation – 80% reduction in flow not a treatment option... just to get a sample. |
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how do you stage endometrial cancer?
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how thick it penetrates through the uterine wall...
so if you ablate, you're burning to the myometrium, so if you have cancer, you can't stage. you dont want to ablate a woman unless you know for sure she doesn't have endometrial cancer. |
