Menstrual Disorders

what’s graafian follicle

the dominant follicle during the follicular phase

main hormone during follicular phase

estrogen → causes endometrium to thicken

what causes menstruation to start

steep decrease in estrogen and progesterone (from when the corpus luteum degenerates if no implantation)

what structure in ovaries produces mainly progesterone

corpus luteum

what and when replaces the role of the corpus luteum

placenta takes over around 8 weeks gestation

what hormone is responsible for increased basal body temperature during ovulation

progesterone

what layer of endometrium is shed during menstruation

functional layer (whereas basal layer stays intact)

structural causes of abnormal uterine bleeding

PALM

1. polyps

2. adenomyosis

3. Leiomyomas

4. Malignancy/hyperplasia

nonstructural causes of abnormal uterine bleeding

COEIN

1. coagulopathy

2. Ovulatory dysfunction (ex.PCOS)

3. Endometrial

4. Iatrogenic

5. Not otherwise classified

when in the cycle does PMS sxs occur

luteal phase and relieved within 2-3 days of menses

MC physical and emotional sx of PMS

physical → abdominal bloating and fatigue

emotional → irritated

causes of primary vs secondary dysmenorrhea

primary - inc prostaglandins (no pelvic issues)

secondary - due to pelvic/uterus issue

demographic of primary vs secondary dysmenorrhea

primary → starts 1-2 yrs after menarche (during teenge years); improves over time

Secondary → starts usually >25y/o and worsens w age

1st line medical therapy for dysmenorrhea

NSAIDs or hormonal therapy

MCC of secondary dysmenorrhea in younger pts

endometriosis ***

PID

T or F: leiomyomas are estrogen dependent

true

MC symptom of fibrioids

abnormal uterine bleeding

RF of fibroids

1. >35y/o

2. black woman

3. nulliparity

MCC of hysterectomy in the US

fibroids

how would leiomyomas vs adenomyosis feel on bimanual exam

both are mobile

leiomyoma → firm, nontender, and asymmetric

adenomyoma → soft “boggy”, symmetrically enlarged, ± tender

definitive dx of adenomyosis

Histologic confirmation after hysterectomy

what is considered a large cervical polyp

>3cm

endometriosis triad

1. cyclic pelvic pain

2. dysmenorrhea

3. dyspareunia

risk factor for endometriosis

prolonged estrogen exposure

(ex: nulliparity, early menses, short cycles, late 1st preg, etc)

tamoxifen drug class

SERM (selective estrogen receptor modulator)

what SERM would you recommend to someone who is concerned about endometrial cancer due to family hx

raloxifene (unlike tamoxifen that is estrogen agonist in uterus)

Raloxifene “relaxes” the uterus (no cancer risk)

Tamoxifen is “toxic” to the uterus (increased risk)

Contraindications to estrogen

1. endometrial cancer (estrogen only)

2. breast cancer

3. CVD → heart disease, untreated HTN, TIA, stroke

4. liver disease

5. thromboembolism

female athlete triad

1. amenorrhea

2. lpw energy

3. dec bone mineral density

RF for endometrial cancer

unopposed estrogen and postmenopausal (60-70y/o)

MC type of ovarian cyst

follicular

happens after follicle fails to rupture so it contineus to grow

whar characteristics on TVUS is suspicious for malignancy when looking into ovarian cyst

1. solid

2. thick septations

3. nodular

when do you have to surgically excise ovarian cyst

>8cm or persistent

rotterdam criteria

for PCOS

2/3:

1. hyperandrogenism

2. ovulatory dysfunction

3. cystic ovaries on US

string of pearls sign on TVUS indicates

PCOS

what gyn cancer has highest mortality

ovarian has highest mortality

1st and 2nd MC benign breast masses

1. fibrocystic changes of breast

2. fibroadenoma (benign tumor)

breast fine needle aspiration shows fibrous tissue & collagen arranged in a “swirl”

fibroadenoma

1st line medical management of gynecomastia in boys/men

tamoxifen

most common type of breast cancer

infiltrative ductal carcinoma