30 Questions
What is a common cause of menorrhagia in girls during menarche?
Immaturity of the hypothalamic-pituitary-ovarian axis
What is a result of high estrogen levels?
Menometrorrhagia
What is the treatment for luteal phase insufficiency?
Giving progesterone to regulate the cycle
What is a characteristic of patients with PCOS?
Regular menstrual cycles with few ovulatory and anovulatory cycles
What is a result of ovulation with lowered progesterone levels?
Spotting or intermenstrual bleeding
What is a common cause of frequent miscarriages?
Luteal phase insufficiency
What is the duration of absent bleeding required to be classified as amenorrhea?
>6 months
What is the primary cause of DUB?
Hormonal changes leading to anovulation
What occurs in anovulatory cycles?
Continuous estrogen production with no corpus luteum formation
What is the result of estrogen unopposed by progesterone?
Endometrial hyperplasia
During which life stages can anovulatory cycles be seen?
Both in adolescents after menarche and in perimenopausal years
What would happen to the corpus luteum if pregnancy takes place?
It would remain and secrete progesterone
What is the primary indicator of ovulation during the mid-cycle?
Increased LH levels
What is the typical duration of normal menstruation?
2-7 days
What is the term for heavy or prolonged menstrual bleeding at regular intervals?
Menorrhagia
What is the term for bleeding in irregular intervals and more frequently than normal?
Metrorrhagia
What is the term for a combination of heavy bleeding at irregular intervals and more frequently?
Menometrorrhagia
What is the term for spotting of blood in between menstrual cycles?
Intermenstrual bleeding
What is the first step in diagnosing a patient with abnormal bleeding?
Order an abdominal or transvaginal ultrasound
What is the normal endometrial thickness in reproductive ages?
15-16 cm
What is the diagnosis if the endometrial thickness is 10-12 cm and the patient is amenorrheic?
Endometrial hyperplasia
What must be excluded in any patient presenting with abnormal uterine bleeding?
Normal pregnancy, early or ectopic pregnancy, and miscarriage
Where can adenomyosis occur in the uterus?
In different locations within the uterus
What is the expected endometrial thickness after menstruation?
5-6 cm
What is the primary purpose of performing a pap smear?
Screening for cervical cancer
What is the primary method used to visualize the vagina, cervix, and ovaries?
Transvaginal ultrasound
What is the purpose of performing an endometrial biopsy?
To identify abnormal endometrial cells
What is the role of hysteroscopy in D&C?
To visualize the cervical canal during the procedure
When can a pap smear be performed?
As a regular screening test every 3 years
What is the purpose of D&C?
To treat overgrowth in the uterus
Study Notes
Amenorrhea and Abnormal Bleeding
- Amenorrhea is defined as no bleeding for more than 6 months, while absent bleeding for 2-3 months is not considered amenorrhea.
Dysfunctional Uterine Bleeding (DUB)
- DUB can be caused by anovulatory or ovulatory factors.
- Anovulatory DUB is characterized by continuous estrogen production with no corpus luteum, leading to no progesterone production.
- Anovulatory cycles are common in adolescents during menarche and in perimenopausal years due to declining hormone levels.
Anovulation
- In anovulation, there is continuous estrogen release (E2) with no ovulation, leading to growth of endometrial lining and potentially causing endometrial hyperplasia.
- Measuring mid-cycle LH levels can help diagnose ovulation.
Definitions
- Normal menstruation: 2-7 days, 21-35 days between periods, and blood loss of less than 80ml.
- Menorrhagia: heavy or prolonged menstrual bleeding, often requiring more pads.
- Metrorrhagia: bleeding at irregular intervals, more frequently than normal.
- Menometrorrhagia: a combination of heavy and irregular bleeding.
- Intermenstrual bleeding: spotting of blood between menstrual cycles, often due to thickened endometrium.
Ovulatory DUB
- Ovulatory DUB is caused by a defect in the corpus luteum, leading to prolonged progesterone production, spotting, or intermenstrual bleeding.
- This can cause frequent miscarriages, and treatment involves regulating the cycle with progesterone.
Endocrine Causes
- Endocrine causes are the most important to exclude, particularly in patients with PCOS.
- Patients with PCOS may have regular menstrual cycles with few ovulatory and anovulatory cycles.
Diagnosis
- Abdominal or transvaginal ultrasound are commonly used to diagnose abnormal bleeding.
- Endometrial thickness should be measured, especially in amenorrheic patients, to diagnose endometrial hyperplasia.
- Hysteroscopy and dilation of the cervix may be used for biopsy and treatment.
Other Diagnostic Tools
- Pap smear is used to screen for cervical cancer.
- D&C and hysteroscopy can be diagnostic and therapeutic.
- Transvaginal ultrasound is commonly used to diagnose abnormalities in the vagina, cervix, and ovaries.
Learn about the changes in hormone levels throughout the menstrual cycle, including LH and FSH, and how they relate to ovulation and pregnancy. Understand the different phases of the cycle and how to calculate the last menstrual period.
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