Menarche, Thelarche, Puberty

subserosal, interstitial, submucosal

A leiomyoma can be __________________, meaning it is found on the outer aspect of the uterus, it can be ______________, or found in the wall of the uterus, or it can be _________________ meaning it is found underneath the uterine mucosa.

21

At what age does ACOG recommend the first pap smear?

1, 3, 9, 27

Endometrial hyperplasia can be in 4 different forms Simple with atypia ____% of cancer complex without atypia ____% of cancer Simple with atypia ____% of cancer Complex with atypia ____% of cancer

Von Willibrand disease (coagulopathy)

If you have a female come in with her first menses, but it was very heavy flow, what could you suspect? (C in COEIN)

IV

Menarche normally occurs 2-3 years before thelarche at tanner stage ____.

absence, labia, pubes, thigh, thigh

Tanner staging is also used to describe the pubertal development via pubic hair growth. Stage 1 has the _____________ of pubic hair. Stage 2 has sparse soft hair along the ___________ Stage 3 has darker hair spreading sparsely over the ___________. Stage 4 has adult type hair but none on the ___________ Stage 5 has hair spreading to the ____________.

structural, nonstructural, polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

The PALM-COEIN classification system for abnormal bleeding refers to the PALM being ______________ causes and _____________ being nonstructural causes. P: A: L: M: C: O: E: I: N:

thelarche, adrenarche (pubic/axillary hair), growth, menarche

The acronym TAGME is used to describe stages of puberty. What does it stand for?

menarche, menopause

The factors that create a leiomyoma are often unknown, but they rarely form before ______________ or after ______________.

13-15

The first routine reproductive health visit should take place between the ages of ____-____ and should focus on discussion of normal menses, pubertal development, STI and pregnancy prevention etc.

papilla, bud, areola, secondary mound, papilla

The tanner staging describes the development of normal female pubertal development of breasts. Stage 1 is elevation of the _________ only. Stage 2 is breast _______ stage. Stage 3 is enlargement of ___________ Stage 4 is projection of areola and papilla to form the ___________ ___________. Stage 5 is projection of the __________ only from recession of the areola.

adenomyosis

These are the A in PALM-COEIN and are defined as extensions of the endometrial glands and stroma into the uterine musculature, and is often associated with endometriosis. They can lead to dyspareunia and dysmenorrhea and menorrhagia

leiomyomas (fibroids)

These are the L in PALM-COEIN and are benign tumors derived from the smooth muscle of the uterus. They are the most common neoplasm of the uterus. They can cause excessive uterine bleeding, pelvic pain, infertility. It is an indication for hysterectomy. Risk factors are age, nulliparity, family history, race

polyps

These are the P in PALM COEIN and can cause menorrhagia or post menopausal bleeding. Most are benign but need to be removed with hysteroscopy since endometrial hyperplasia and carcinoma can present in this form.

Endometrial hyperplasia

This is an example of the M in PALM COEIN, and is an overabundance growth of the endometrial lining as a result of persistant unopposed estrogen. This can be caused by tamoxifen, granulosa/theca cell tumors, obesity, or PCOS. It is a precursor to endometrial cancer.

polymenorrhea

This is defined as abnormally frequent menses at intervals less than 21 days

primary amenorrhea

This is defined as abscence of menarche by 13 years old without secondary sexual development, OR absence by the age of 15 WITH secondary sexual development

menorrhagia

This is defined as excessive and prolonged menses (greater than 80mL and greater than 7 days) at regular intervals

menometrorrhagia

This is defined as heavy and irregular uterine bleeding

metrorrhagia

This is defined as irregular episodes of uterine bleeding

oligomenorrhea

This is defined as menstrual cycles at greater than 35 days

intermenstrual bleeding

This is defined as scant bleeding at ovulation for 1-2 days.

secondary amenorrhea, pregnancy

This is defined as the abscence of menstruation for 6 months in adolescents or young women, and the most common cause is _______________.

IUD, IUS

What are some causes of iatrogenic AUB?

medium, 34 days

What is flow generally like with the first menses and what is the median length?

Endometrial adenocarcinoma, clear cell and papillary serous

What is the most common type of endometrial hyperplasia? The second most common?

black, hispanic

What races generally go through puberty earlier?