Menstrual Dysfunction

Question 1

Primary amenorrhea

Answer 1

• No period by age 17

Question 2

Secondary amenorrhea

Answer 2

• Had a period, but no longer does

*#1 cause = pregnancy

Question 3

Oligomenorrhea

Answer 3

• Cycles >q 35 days

Question 4

Polymenorrhea

Answer 4

• Cycles <q>
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Question 5

Menorrhagia (hypermenorrhea)

Answer 5

• Heavy bleeding that occurs on a regular basis

Question 6

Menorrhagia (non cyclic bleeding)

Answer 6

• Bleeding that occurs whenver it wants

Question 7

Menometrorrhagia

Answer 7

• Bleeding all over the place (no cycle to it)

Question 8

Infertility

Answer 8

• No conception after one year of unprotected intercourse

*depends on how old the pt. is

Question 9

Causes of abnormal bleeding (Puberty)

Answer 9

• Coagulation disorders
• Genetic problems
• Congenital defects

Question 10

Causes of abnormal bleeding (reproductive age women)

Answer 10

• Pregnancy
• Premature ovarian failure
• Hormonal or anatomic problems
• Hyperplasia or malignancy

Question 11

Causes of abnormal bleeding (post menopausal women)

Answer 11

• Amenorrhea is normal
• Cancer
• Anatomic abnormalities

Question 12

Normal menstrual cycle

Answer 12

• Cyclic bleeding
• First day of bleeding is day #1
• Length 21-35 days
• Ovulation is 14 days prior to menses

*if a women has a 21 day cycle, she ovulates on day 7 (14 days prior)

• Normal menses is a hormone withdraw bleed
• Amt of flow varies from woman to woman

Question 13

Organs to consider when presented with menstrual irregularity

Answer 13

• Hypothalamus
• Pituitary
• Thyroid
• Adrenal glands
• Ovaries
• Uterus
• Vagina

Question 14

Causes of hypothalamus induced amenorrhea

Answer 14

• Stress
• Exercise

*runners may have seasonal variation in menses due to light exposure and melatonin

• Anorexia nervosa

Question 15

Causes of elevated prolactin

Answer 15

• DRUGS
• Pituitary tumors
• Nipple stimulation

Question 16

Elevated prlactin suppresses…

Answer 16

• Estrogen production

Question 17

Sheehan’s Syndrome

Answer 17

• Pituitary infarct
• Results in metabolic disorders where after having a baby no milk production can occur
• Assoc. w/ post partum hemorrhage and hypotension

Question 18

DHEAS

Answer 18

• Dehydro Epi Aldosterone Sulfate

*“S” part is important (sulfate); comes from the adrenals, rest of it from ovaries

• Potent androgen from adrenal glands
• Neg. feedback on FSH

Question 19

Polycystic Ovary Syndrome (PCOS)

Answer 19

• Excess androgen of ovarian origin
• Excess estrogen in a steady state
• Multiple follicles in arrested development
• Insulin resistance
• Infertility due to anovulation
• Amenorrhea or abnormal bleeding

Question 20

Factors of infertility

Answer 20

• Male factor: 40%
• Female factor: 40%
• Unknown: 20%

Question 21

Female infertility causal factors

Answer 21

• Pituitary disorders
• Thyroid disorders
• Adrenal disorders
• Ovarian disorders
• Uterine/Mullerian disorders including endometriosis
• Cervical factors

Question 22

Determinants of menarche and menopause onset

Answer 22

• Menarche is determined by genetics and environmental factors
• Menopause is solely genetically determined

Question 23

PALM-COEIN Classification system for abnormal bleeding

Answer 23

Uterine causes

• Polyps (AUB-P)
• Adenomyosis (AUB-A)
• Leiomyoma (AUB-L)
• Malignancy (AUB-M)

Nonstructural causes

• Coagulopathy (AUB-C)
• Ovulatory Dysfunction (AUB-O)
• Endometrial (AUB-E)
• Iatrogenic (AUB-I)