Ob Gyn: Menstrual Cycle, AUB, dysmenorrhea and PMS

During a normal menstrual cycle, [Estrogen] declines precipitously on day _____

14

Primary amenorrhea suspected in absence of menstruation in a __ with normal growth and secondary sexual development

15 year old

Most potent form of estrogen is

17B-estradiol

If no fertilization of the ovum by day __ the corpus luteum degenerates into the ___ ____

24 corpus albicans

A diagnosis of PMDD requires _______ or more symptoms to be present during __________

5 the week prior to menses and resolving within a few days after menses starts

amenorrhea is diagnosed if menses are absent for >

6 months

During _________________, estrogen continues to be released from the dominant follice, causing growth and thickening of the uterine lining

Anovulation

Tx of PMDD

Anxiolytics SSRI BC to inhibit ovulation

Menstrual blood is mainly _________ and contains ________, ______, and ________

Arterial tissue debris, prostaglandins, and fibrinolysin

PMDD Tx: Last resort

B/L oophorectomy

Hypomenorrhea may be a normal desirable effect of

BC use

menometrorrhagia

Bleeding at irregular intervals which is also heavy

With AUB you should order

CBC, HCG, and TSH cytology pelvic us endometrial biopsy hysteroscopy D n C

Medical therapies for AUB include

Contraceptives Nsaids Antifibrinolytic therapy

When the _______ regresses, hormonal support of the endometrium is withdrawn

Corpus luteum

Polymenorrhea- Definition, usually associated with ______________

Cycles that occur too frequently anovulation

Exclusion of all possible pathological causes of abnormal bleeding leads to a diagnosis of

Dysfunctional Uterine Bleeding (DUB).

Management of dub

Dysfunctional uterin bleeding hysterectomy depends on age of patient and severity of symptoms

Hormone which causes proliferation of the endometrium

Estrogen

PMDD treatment

First line- anxiolytics, SSRIs, contraceptives Second line- GnRH agonists (chemical menopause) Last resort- oophorectomy

What are the two phases of the menstrual cycle? Which phase of the menstrual cycle is more regular?

Follicular (estrogen dominant) and luteal (progesterone dominant) Luteal phase is more regular

Normal menstrual cycle id divided into

Follicular phase- 14-21 Luteal phase- generally 14 days (less variable dt ovarian structure) 21-35 day normal variation

PMDD second line Tx

GnRH agonist- goal to cause a chemical menopause

Menorrhagia: causes

Heavy and/or porlonged bleeding Gushing, accompanied by clots Causes include uterine fibroids, adenomyosis, malignancies, BC ADR

Estrogen has positive feedback on the _________ and ________ on days ______; the rest of the cycle estrogen and ___________ provide ____________

Hypothalamus (inc GnRH) Anterior pituitary (inc LH and FSH) progesterone negative feedback

HPO axis

Hypothalamus --> GnRH Anterior pituitary -->FSH and LH FSH= growth of ovarian follicles LH= ovulation trigger

This triggers ovulation

LH surge (leutinizing hormone) Happens when [estrogen] reaches a certain threshold

Oligomenorrhea

Menses that occur more than 35 days apart

Contact bleeding

Post coital bleeding

PMDD

Premenstrual dysmorphic disorder

Follicular phase

Proliferative phase: Day 1= first day when period starts Estrogen dominant- secreted by cells in the ovarian follicles Rapid proliferation of the endometrium and uterine glands

Luteal phase

Secretory phase Progesterone dominant- secreted by corpus luteum stabilization of the endometrial lining so its perfect for egg implantation More regular portion of the cycle

Antifibrinolytic therapy

Tranexamic acid

Hypomenorrhea

Unusually light menstrual flow

Post-menopausal bleeding needs to R/O

Uterine cancer Endometrial biopsy

In ___________ there is no formation of the corpus luteum

anovulation

In ______________, the uterine lining becomes thick and eventually sloughs off in an unpredictable and erratic fashion

anovulation

Average blood loss of a normal menstual cycle is

approximately 30 ml

Ovulatory bleeding occurs

between menstrual cycles (metrorrhagia)

Progesterone is secreted by the

corpus luteum remaining structure from ruptured follicle

D n C

dilation and curetage diagnostic and curative scrape out lining to stop heavy bleeding in hopes that the menstrual cycle will reset itself

secondary dysmenorrhea could be caused by

endometriosis, adenomyosis, or uterine fibroids

Follicular phase is

estrogen dominant

Significantly more cycle variablity in

first 5-7 years after menarche and last ten years prior to menopause

These cell secrete estrogen

granulosa and theca cells

2 types of arteries in endometriumm

long coiled- shed monthly short straight basilar artery not shed

PMS symptoms correlate with the _______________ phase of the cycle

luteal (production of progesterone) diagnosis by history differentiate pms from pmdd (significant change in personality every month)

Secondary amenorrhea

menses stops for > 6 months in a previously menstruating woman

dysmenorrhea

painful menstruation caused by prostaglandins Associated symptomsN/V/D HA NSAIDS and oral contraceptives

Membranous dysmenorrhea

passing a single cast of the endometrial cast shed as a single cavity; painful

____ is absolutely vital to sustain a pregnancy

progesterone (secreted by corpus luteum)

luteal phase is

progesterone dominant secreted by the corpus luteum

Causes cramps during menstrual cycle

prostaglandins

Recommended Txs for PMS

reduce salt, exercise, b vitamins perhaps, contraceptives, occasionally anti-depressant or anxiolytics

adenomyosis

uterine lining growing into the walls globular boggy feeling uterus