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REPRODUCTIVE ENDOCRINOLOGY . . . CONT.

Notes

Oligomenorrhea episodic vaginal bleeding occurring at intervals > 35 days • usually associated with anovulation

Polymenorrhea episodic vaginal bleeding occurring at intervals < 21 days • usually associated with anovulation

Metrorrhagia uterine bleeding occurring between periods • organic pathology • endometrial/cervical polyps or cancer • anovulation • estrogen withdrawal

Menometrorrhagia uterine bleeding irregular in frequency, and also excessive in amount • organic pathology • endocrine abnormality • early pregnancy

Postmenopausal Bleeding any bleeding > 1 year after menopause investigations • endometrial sampling - biopsy or D&C • sonohystogram with possible ultrasound for endometrial thickness and polyps • hysteroscopy

D Y S F U N C T I O N A L U T E R I N E B L E E D I N G ( D U B ) a b n o r m a l b l e e d i n g w i t h n o o r g a n i c c a u s e ( d i a g n o s i s o f e x c l u s i o n ) r u l e o u t : b l o o d d y s c r a s i a s , t h y r o i d d y s f u n c t i o n , m a l i g n a n c y , P C O D , e n d o m e t r i o s i s , P I D , f i b r o i d s , u n o p p o s e d e s t r o g e n , o r p o l y p s

Adolescent Age Group DUB due to immature hypothalamus with irregular LH, FSH, estrogen and progesterone pattern

Reproductive Age Group DUB due to an increase or decrease in progesterone level

P e r i m e n o p a u s a l A g e G r o u p D U B d u e t o i n c r e a s e d o v a r i a n r e s i s t a n c e t o L H a n d F S H treatment i f a n e m i c , i r o n s u p p l e m e n t m i l d D U B B C P 1 t a b t i d f o r 1 0 d a y s t h e n 1 t a b o d f o r 4 - 6 m o n t h s o r m e d r o x y p r o g e s t e r o n e a c e t a t e ( P r o v e r a ) 5 - 1 0 m g o d o n f i r s t 1 0 - 1 4 d a y s o f e a c h m o n t h s e v e r e D U B r e p l a c e f l u i d l o s s e s m e d r o x y p r o g e s t e r o n e a c e t a t e ( P r o v e r a ) 1 0 m g f o r n e x t 7 - 1 0 d a y s a c u t e , s e v e r e D U B : e s t r o g e n ( P r e m a r i n ) 2 5 m g I V q 4 - 6 h s u r g i c a l e n d o m e t r i a l b i o p s y ( f o r d i a g n o s i s ) D & C e n d o m e t r i a l a b l a t i o n a f t e r p r e t r e a t m e n t w i t h d a n a z o l o r G n R H a g o n i s t s h y s t e r e c t o m y

Mid-Cycle Spotting may be physiologic due to mid-cycle fall of estradiol

Premenstrual Spotting may be due to progesterone deficiency, endometriosis, adenomyosis and fibroids

Gynecology 12

MCCQE 2000 Review Notes and Lecture Series

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