MCCQE - OBGYN block study guide
latest update
ovulatory abnormal pre-menopausal menstrual bleeding
- definition
normal cycle length (28 days +/- 7) but abnormal
(excessive) volume of blood loss:
a) menses >7days
b) blood loss >80mL
-soak through menstrual products q1-2 hours
-passage of clots larger than a dime
-self reported 'very heavy' periods
shorter luteal phase & increased fibrinolysis contributes
to menorrhagia
anovulatory pre-menopausal menstrual bleeding
- DDx (3 categories)
1. HPO issues
- Immature HPO axis (young)
- aging ovarian follicles (older)
- premature ovarian failure (e.g. chemo/rads to pelvis)
,- stress, weight loss, exercise
2. Diseases
a) Hypothyroid
b) PCOS (androgen excess)
c) Cushing's (androgen excess)
3. Tumors/masses
a) Prolactinoma
b) STRUCTURAL --> fibroids, tumors pushing into the
cavity can cause sketchy bleeding!ova
abnormal pre-menopausal menstrual bleeding
- DDx
PALM COEIN
Structural:
Polyp
Adenomyosis
Leiomyoma (fibroids)
Malignancy
,Non-structural
Coagulopathy
- e.g. VWD
Ovulatory
- weight loss/exercise, PCOS, etc.
Endometrial
- hyperplasia/cancer
- endometritis
Iatrogenic
- e.g. anticoagulation, IUD, FB, trauma
Not otherwise classified:
- chronic disease: hypothyroidism, liver disease, CKD,
obesity
- pregnancy
- infection: STI
, pre-menopausal menstrual bleeding
- pregnancy related causes (4)
1. Implantation bleed
2. Miscarriage
3. Ectopic pregnancy
4. Gestational trophoblastic disease
PCOS
- risks with anovulatory cycles (3)
- Tx causing infertility (2)
- Tx for those desiring fertility (2)
Risks
1. Infertility
2. Dysfunctional uterine bleeding (DUB)
- Can be VERY heavy
- Obesity = increased peripheral E ("fertilizer") for the
lining**Impt to use OCP or IUD with these pts
3. Endometrial hyperplasia/endometrial cancer
Tx -
1. OCP
latest update
ovulatory abnormal pre-menopausal menstrual bleeding
- definition
normal cycle length (28 days +/- 7) but abnormal
(excessive) volume of blood loss:
a) menses >7days
b) blood loss >80mL
-soak through menstrual products q1-2 hours
-passage of clots larger than a dime
-self reported 'very heavy' periods
shorter luteal phase & increased fibrinolysis contributes
to menorrhagia
anovulatory pre-menopausal menstrual bleeding
- DDx (3 categories)
1. HPO issues
- Immature HPO axis (young)
- aging ovarian follicles (older)
- premature ovarian failure (e.g. chemo/rads to pelvis)
,- stress, weight loss, exercise
2. Diseases
a) Hypothyroid
b) PCOS (androgen excess)
c) Cushing's (androgen excess)
3. Tumors/masses
a) Prolactinoma
b) STRUCTURAL --> fibroids, tumors pushing into the
cavity can cause sketchy bleeding!ova
abnormal pre-menopausal menstrual bleeding
- DDx
PALM COEIN
Structural:
Polyp
Adenomyosis
Leiomyoma (fibroids)
Malignancy
,Non-structural
Coagulopathy
- e.g. VWD
Ovulatory
- weight loss/exercise, PCOS, etc.
Endometrial
- hyperplasia/cancer
- endometritis
Iatrogenic
- e.g. anticoagulation, IUD, FB, trauma
Not otherwise classified:
- chronic disease: hypothyroidism, liver disease, CKD,
obesity
- pregnancy
- infection: STI
, pre-menopausal menstrual bleeding
- pregnancy related causes (4)
1. Implantation bleed
2. Miscarriage
3. Ectopic pregnancy
4. Gestational trophoblastic disease
PCOS
- risks with anovulatory cycles (3)
- Tx causing infertility (2)
- Tx for those desiring fertility (2)
Risks
1. Infertility
2. Dysfunctional uterine bleeding (DUB)
- Can be VERY heavy
- Obesity = increased peripheral E ("fertilizer") for the
lining**Impt to use OCP or IUD with these pts
3. Endometrial hyperplasia/endometrial cancer
Tx -
1. OCP
