Term
Menorrhagia: heavy bleeding; loss of more than 80 mL of blood and/or increased duration of flow (> 7 days) at regular intervals.
Metrorrhagia: bleeding at irregular intervals or bleeding between menstrual periods.
Menometrorrhagia: increased loss or duration of bleeding occurring at irregular intervals.
Polymenorrhea: menstural bleeding occurring at less than 21-day intervals.
Oligomenorrhea: menstrual cycle length of more than 35 days.
Amenorrhea: lack of menstrual periods for more than 6 months.
Intermenstrual bleeding: bleeding between two regular menstrual periods.
Postmenopausal bleeding: bleeding occurring after more than 1 year of reaching menopause |
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| CDC says all sexually active people under 25 should have chlamydia and gonorrhea cultures every year, and should be done on patients over 25 every year for patients with multiple partners. |
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Definition
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| Tmt for adolescent anovulatory cycles: |
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Definition
- Provera 5 mg po for 14 days each month
OR
- OCPs |
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Term
| In an adolescent pt with anovulatory cycles and anemia you need to rule out? |
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Definition
| Clotting d/o (2 most common are platelet disorder of Von Willebrand Disease) |
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| Management of excess bleeding and anovulatory cycles: |
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Definition
- IV conjugated equine estrogen 25 mg q4hrs until bleeding stops for 24 hours
- OCPs after bleeding stops |
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Term
| gestational sac seen on u/s: |
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Definition
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Definition
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| fetal heart motion seen on u/s: |
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Definition
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In a reproductive age woman with menorrhagia not related to
Pregnancy
Cancer
Benign uterine pathology
Think of Systemic Disorders
Endocrine
Hypothyroidism
Liver Disease
Renal Disease
Obesity |
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Definition
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Term
Liver Disease
Impairment of estrogen metabolism → prolonged unopposed estrogen stimulation of endometrium → menorrhagia
Impaired liver synthesis of clotting factors |
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Definition
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Renal Disease
Impairment of estrogen metabolism → prolonged unopposed estrogen stimulation of the endometrium → menorrhagia |
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Definition
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Term
Obesity
Androstenedione is converted to estrone in larger amounts
Anovulation by feedback inhibition of the pituitary output of gonadotropins
Stimulates hyperplastic endometrial growth |
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Definition
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Term
With negative pregnancy test, sampling of the endometrium must be performed in a peri-menopausal female with irregular menstruation to rule out precancerous or cancerous conditions of the uterus.
Hyperplasia of the uterus
Cancer of the uterus |
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Definition
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Term
Postmenopausal
ENLARGED UTERUS AND HEAVY BLEEDING: 90-95% CHANCE OF CANCER
SMALL UTERUS AND HEAVY BLEEDING: 90% CHANCE ITS NOT CANCER, ITS ATROPHIC VAGINA/UTERUS
BUT BIOPSY ALL OF THEM, BUT SOMETIMES CAN’T GET PROBE IN> ULTRASOUND IF ENDOMETRIUM IS 4 MM ORL ESS DON’T WORRY, IF ITS THICKER> DAND C |
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Definition
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Term
Post menopausal bleeding must always be investigated.
Endometrial biopsy
In postmenopausal patients with normal sized uterus and a stenotic cervix, assess the endometrial thickness with an ultrasound
4mm or less
No further investigation – risk of hyperplasia or cancer very low
>4mm
D&C
D&C and hysteroscopy |
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BV is most common vaginal infection.
Yeast is second most common vaginal infection. |
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Definition
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| __ may decrease prevalence of trichomonas. __ may reduce transmission of trichomonads. Infection with trich during pregnancy is associated with __ __ and __ __ __ infants. |
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Definition
- OCPs
- Spermacide
- preterm deliveries
- low birth weight infants |
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Term
| When do trich symptoms peak? |
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Definition
| during or just after menses |
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Term
| Etiology of Atrophic Vaginitis: |
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Definition
Menopause
Decreased ovarian function
Radiation therapy
Chemotherapy
Immune disorder
Oophorectomy
Postpartum loss of placental estrogen
Elevated prolactin level during lactation
Vaginal Nulliparity
Antiestrogen medications:
Tamoxifen (Nolvadex)
Danazol (Danolcrine)
Medroxyprogesterone (Provera)
Leuprolide (Lupron)
Nararelin (Synarel)
Cigarette smoking
Nonfluctuating estrogen levels
Cessation of coital activity |
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Term
| atrophic vagnitis on slide: |
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Definition
Microscopic:
Increased proportion of parabasal cells
Immature (parabasal) squamous epithelial cells with enlarged nuclei
Basophilic granular debris and inflammatory exudate
Round-shaped, amorphous basophilic structures ("blue blobs") present
pH >5 |
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Term
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Definition
- estrogen sensitive tumors
- end-stage liver disease
- hx of estrogen related thromboembolism |
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Term
| Advantages of systemic HRT: |
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Definition
- decreased bone loss
- decreased vasomotor dysfunction |
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Term
| Advantages of transvaginal HRT: |
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Definition
- decreased UTIs
- decreased risk of endometrial carcinoma |
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Term
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Definition
- Throboembolic event
- Pulmonary embolus
- Abnormal uterine bleeding
- Coronary artery disease
- Liver dysfunction
- h/o breast cancer
- h/o endometrial cancer |
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Term
| Koilocytic cell changes on pap smear report? |
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Definition
| HPV (Human Papilloma virus) |
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