Mullerian Anomalies, IUDs, Procedures, HRT & Misc. GYN Topics

state after reaching puberty which menses occur every 21-28 days

menarche

days 1-4 of menstrual cycle

menstruation

parity

pregnancy

time before onset of menses

premenarche

cessation of menses

menopause

absence of ovulation

anovulation

pain with ovulation

mittleschmerz

pain associated with sexual intercourse

dyspareunia

absence of menstruation

amenorrhea

cycle with an interval less than 21 days

polymenorrhea

cycle prolonged for more that 35 days

oligomenorrhea

abnormally heavy or long periods

menorrhagia

painful periods

dysmenorrhea

increased flow during cycle

hypermenorrhea

decreased flow during cycle

hypomenorrhea

irregular cycles, intermenstrual bleeding, breakthrough bleeding, & spotting is called ______

metrorrhiagia

irregular cycles with heavy bleeding

menometrorrhagia

what are mullerian anomalies/congenital uterine anomalies

malformations that occur during embryonic development

mullerian ducts develop to form _______

upper vagina, cervix, uterus, and fallopian tubes

the mullerian ducts must elongate, fuse, and form lumens between ____ weeks of embryonic development

7-12 wks

what are 3 ways the mullerian ducts fail to form properly which result in uterine anomalies

1. improper fusion

2. incomplete development of one side

3. incomplete vaginal canalization

if mullerian anomalies are encountered the ____ should be examined for _______

kidneys, renal agenesis or abnormalities

condition in which the vagina is abnormally closed or absent

vaginal atresia

vaginal atresia can lead to _____ or ______

hydrocolpos, hematometrocolpos

fluid filled vagina

hydrocolpos

blood filled vagina and uterus

hematometrocolpos

hematometrocolpos (pt has vaginal atresia)

failure of uterus to form

uterine agenesis

what is more common, partial agenesis or complete agenesis of the uterus

partial

many consider arcuate uterus ____

normal

what is an arcuate uterus

thickened fundal wall that dips into uterine cavity tissue (<1cm)

to be considered arcuate uterus, the tissue of the fundal wall needs to dip into the uterine cavity by what measurement

less than 1 cm

when is arcuate uterus best evaluated on US (phase of menstural cycle)

secretory

arcuate uterus

arcuate uterus

what is the difference between septum and arcuate uterus

septate is greater than 1 cm and arcuate is less than 1 cm

what happens to the mullerian ducts with unicornuate uterus

one mullerian duct doesnt form resulting in one horn

unicornuate uterus are assoicated with ____

renal defects (ipsilateral renal agenesis, pelvic kidney, or horseshoe kidney)

are unicornuate uterus associated with infertility and pregnancy loss

yes

unicornuate uterus are _____ on US

hard to determine

unicornuate uterus

unicornuate uterus

what kind of uterus is this showing

unicornuate

what is uterine didelphys

complete duplication of the uterus, cervix, and vagina

failure of fusion of the mullerian ducts describes what kind of uterus

uterine didelphys

failure of one mullerian duct to form

unicornuate uterus

uterine didelphys is commonly associated with ___

renal agenesis

is uterine didelphys usually associated with fertility problems

no

uterine didelphys

uterine didelphys with IUP

uterine didelphys

what happens to the mullerian ducts to produce a bicornuate uterus

partial fusion of the mullerian ducts

what are the 2 subtypes of bicornuate uterus

bicollis and unicollis

with bicornuate bicollis how many uterus and cervix are there

2 uterus and 2 cervix

with bicornuate unicollis, how many uterus and cervix are there

2 uterus and 1 cervix

bicornuate uterus

bicornuate uterus is commonly associated with _____

unilateral renal agenesis or horshoe kidney

bicornuate uterus

bicornuate uterus

____ is the most common congenital anomaly of the uterus

septate uterus

describe what septate uterus is

verticle seperation of fundus and body

incomplete reabsorption of the sagittal septum describes what kind of uterus

septate uterus

partial septum (subseptate uterus) involves endometrial canal but not ____

cervix

with septate uterus, the septum is considered “complete“ if it extends to either the ________

internal or external os

septate uterus are commonly associated with ____

increased incidence of 1st trimester miscarriage

septate uterus

septate uterus

what does DES stand for

diethylstilbestrol

what is (DES) T shaped uterus a result of

exposure to the drug DES in utero

T shaped uterus (DES)

what is (DES) T shaped uterus commonly associated with

congenital renal anomalies, ectopic pregnancy, cervical cancer, increased risk for spontaneous abortion

during menopause what 2 hormones produced by the ovaries decline

estrogen and progesterone

phase before menopause

perimenopause

what happens during perimenopause

ovaries produce less eggs and ovulation becomes irregular

when is menopause diagnosed

after 12 months without period, vaginal bleeding, or spotting

when does menopause usually occur

40 or 50s

what is the average age for menopause in the U.S.

51

what causes the symptoms related to menopause

drop in estrogen levels

delete

.

What would you expect to see regarding the uterus size after menopause?

smaller

What would you expect to see regarding the endometrium after menopause?

endometrium atrophies (<5mm)

What would you expect to see regarding the ovarian size after menopause?

smaller, no follicular activity

If you don't see ovaries on a post-menopausal woman, is that a good sign or bad sign?

good sign

what is endogenous estrogen

estrogen you make from ovaries

what is exogenous estrogen

estrogen you take

estrogen makes the endometrium grow which puts woman at risk for ____

endometrial cancer

what does HRT stand for

hormone replacement therapy

_____ keeps the endometrium from overgrowing

progesterone

HRT is a combination of what two hormones

estrogen and progesterone

what is the most common HRT treatment plan

estrogen patch and progesterone IUD

there is _______ between estrogen and breast cancer

no correlation

what is better, continuous or sequential estrogen and progesterone

continuous

what are the beneficial effects of estrogen (WO)

1. alleviates menopause symptoms

2. reduces risk for osteoporosis

3. reduces risk for heart attack and stroke

4. reduces risk for alzheimers disease

what are the beneficial effects of progesterone (WO)

1. causes endometrial atrophy

2. reduces risk for endometrial hyperplasia/cancer

what is the negative effect of estrogen (WO)

1. increases risk for endometrial hyperplasia/cancer

what are the negative effects of progesterone (WO)

1. increases risk for breast cancer

2. can cause irritability, depression, breast tenderness

reverse cell growth, decrease in cell size

atrophy

excessive cell growth, increase in cell size

hypertrophy

excessive cell growth, increase in the number of cells due to higher rate of cell division

hyperplasia

abnormal changes in shape, size, and organization of mature cells

dysplasia