Complications of Menstruation

Premenstrual Syndrome (PMS) criteria

1. at least 1 physical symptom and 1 emotional symptom interefere w daily life

2. starts in luteal phase → within 5 days of menses

3. ends <4 days after menses start

4. >2 consecutive cycles

5. CANT reoccur during follicular phase

PMS vs PDD

PDD is PMS but more severe and psychological impacts more on daily life

what foods to avoid for Premenstrual Syndrome (PMS)/ Premenstrual Dysphoric Disorder (PMDD)

1. caffeine

2. chocolate

3. tobacco

4. alcohol

5. sodium

3 SSRIs that have FDA approval for PMDD

(SPF)

1. sertraline

2. paroxetine

3. fluoxetine

what is calcium carbonate good for

supplement in PMS/PMDD → helps w

1. bloating

2. food craving

3. pain

Which hormonal therapy can be used to temporarily suppress menstruation in severe PMDD

GnRH agonist

What pharmacologic option can help manage water retention in PMS?

spironolactone

primary vs secondary dysmenorrhea

primary → prostaglandin hypersecretion

secondary → structural or pathological cause

tx of primary dysmenorrhea

nonpharm → heat, exercise, TENS

NSAIDS or oral contraceptives

normal blood loss in period

30-80mL

menorrhagia blood loss

>80

excessive weight loss causes polymenorrhea or oli

difference between Polymenorrhea and oligomenorrhea and amenorrhea

poly → cycle less than 21 days

oligo → cycle over 35 days

amenorrhea → no menses in >6 months

Metrorrhagia

intermenstrual

Bleeding or “spotting” between cycles

menometrorrhagia

menorrhagia + metrorrhagia

heavy, prolonged bleeding with irregularity

Causes of postcoital bleeding

1. cervical cancer, 

2. cervical eversion, 

3. cervical polyps, 

4. infection (trichomonas), 

5. atrophic vaginitis

Structural causes of abnormal uterine bleeding

(PALM)

1. Polyp

2. adenomyosis

3. leiomyoma

4. malignancy/hyperplasia

Non-structural causes of abnormal uterine bleeding

COEIN

1. coagulopathy

2. ovulatory dysfunction (adolescents, peri-menopause, PCOS, thyroid, hyperprolactinemia, anorexia)

3. endometrial (inflammation, infection, cancer)

4. iatrogenic (Copper IUD, hormonal contraception, HRT, anticoagulants)

5. not otherwise classified

when to biopsy for AUB

>45 or <45 w risk factors like (PCOS and obesity)

1st line vs gold standard for dx of AUB

1st line → TVUS

gold standard → hysteroscopy

Post Menopausal Bleeding

Vaginal bleeding ≥12 months after the final menstrual period

Always considered abnormal-> Malignancy must be ruled out

most common cause of post menopausal bleeding

endometrial atrophy

benign causes of post-menopausal bleeding

• Endometrial atrophy (most common)

• Vaginal atrophy

• Polyps (endometrial/cervical)

• HRT

when does post-menopausal bleeding patient need a biopsy to assess

if endometrial stripe is over 4mm on transvaginal ultrasound

Management of endometrial atrophy with PMB may include

vaginal estrogen