PAEA OBGYN EOR Topics Questions and
Answers| Latest Update
What is normal discharge/bleeding in the postpartum/puerperium period? Especially days
4-10, pinkish brown vaginal bleeding called *lochia serosa* that should cease by *3-4 weeks*
postpartum
T/F: lactating/breast feeding mothers remain anovulatory *true* but still use back up
contraception just in case
When do regular menses return postpartum? 6-8 weeks (if not breastfeeding)
the pathophysiology of PCOS is from excess/unopposed estrogen which is driven by?
*increased LH levels* which are driven by *increased insulin levels*
what lab/radiology results will a pt with PCOS have? -*inc testosterone*, ≥3:1 LH:FSH
ratio (nml is 1.5:1), inc lipid panel, in blood glucose, pelvic US with bilateral enlarged ovaries
with peripheral cysts aka *"string of pearls"* appearance
-turns out LH:FSH ratio is BS according to UpToDate but its on PPP so who knows...
what do you need to make the diagnosis of PCOS? Rotterdam Criteria: *2 out of 3*
1. polycystic ovaries on US
2. clinical hyperandrogenic signs (hirsutism, acne, male-pattern hair loss)
,3. oligo and/or anovulation/amenorrhea
how is PCOS treated? -mainstay of tx: *combination OCPs* (normalizes bleeding and
suppresses androgen)
-anti-androgenix agents for hirsutism (*spironolactone*, leuprolide, finasteride)
-infertility 1st line: *clomiphene* (SERM)
-*metformin*: helps with insulin resistance, fertility, hirsuitism, and menstrual irregularity
-life style changes: wt loss by diet/exercise
-surgical (wedge resection of ovary): to restore fertility when clomiphene fails
what are some complications of untreated PCOS? -infertility
-endometrial hyperplasia/cancer risk d/t unopposed estrogen thickening lining
-insulin resistance = DM, HL, HTN, CAD, MI risks
what is an adenomyosis? an island of endometrial tissue w/i the myometrium *muscular
layer of the wall)
when comparing leiomyomas (fibroids) and adenomyosis signs of uterine symmetry,
hard/softness, and tenderness, what is the difference? -leiomyomas: asymmetrical, firm,
nontender uterus
-adenomyosis: symmetrical, soft, tender uterus
*both present with menorrhagia and dysmenorrhea
,how is adenomyosis diagnosed? treated? *diagnosis of exclusion!*
-cannot see on US so must do *MRI* or post-TAH examination of uterus
-tx: only effective is TAH but can do OCPs/NSAIDs to preserve fertility
what are the risks of untreated adenomyosis? induces hypertrophy/hyperplasia of
surrounding myometrium where ectopic endometrial tissue is implanted
Follicular Phase vs. Luteal phase 1. Estrogen dominant (Day 1-14)
2. Progesterone dominant (Day 14-28)
FSH vs. LH 1. Causes follicle & egg maturation
2. Stimulate maturing follicle to produce estrogen
Estrogen vs. Progesterone 1. Thickens endometrium
2. Enhances lining of uterus to prepare for implantation
In the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a
_______ to develop which produces ________ to help proliferate the lining of the endometrium;
at the end of this phase _______ surges causing ovulation 1. Primary ovarian follicle
2. Estrogen
3. LH
, In the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________
which produces _________ which maintains the endometrial lining for fertilization 1.
Corpus luteum
2. Progesterone
In the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the
corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________
begins 1. Corpus luteum
2. Menstruation
In the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus
luteum; if fertilization does occur __________ gets released by the developing
trophoblast/placenta which maintains the __________ to continue making progesterone/estrogen
1. hCG
2. Corpus luteum
Cryptomenorrhea Light flow or spotting
Metrorrhagia vs. Menometrorrhagia 1. Irregular bleeding between expected menstrual
cycles
2. Irregular EXCESSIVE bleeding between expected menstrual cycles
Oligomenorrhagia Infrequent menstruation *(prolonged cycle length >35 days but <6
months)*
Answers| Latest Update
What is normal discharge/bleeding in the postpartum/puerperium period? Especially days
4-10, pinkish brown vaginal bleeding called *lochia serosa* that should cease by *3-4 weeks*
postpartum
T/F: lactating/breast feeding mothers remain anovulatory *true* but still use back up
contraception just in case
When do regular menses return postpartum? 6-8 weeks (if not breastfeeding)
the pathophysiology of PCOS is from excess/unopposed estrogen which is driven by?
*increased LH levels* which are driven by *increased insulin levels*
what lab/radiology results will a pt with PCOS have? -*inc testosterone*, ≥3:1 LH:FSH
ratio (nml is 1.5:1), inc lipid panel, in blood glucose, pelvic US with bilateral enlarged ovaries
with peripheral cysts aka *"string of pearls"* appearance
-turns out LH:FSH ratio is BS according to UpToDate but its on PPP so who knows...
what do you need to make the diagnosis of PCOS? Rotterdam Criteria: *2 out of 3*
1. polycystic ovaries on US
2. clinical hyperandrogenic signs (hirsutism, acne, male-pattern hair loss)
,3. oligo and/or anovulation/amenorrhea
how is PCOS treated? -mainstay of tx: *combination OCPs* (normalizes bleeding and
suppresses androgen)
-anti-androgenix agents for hirsutism (*spironolactone*, leuprolide, finasteride)
-infertility 1st line: *clomiphene* (SERM)
-*metformin*: helps with insulin resistance, fertility, hirsuitism, and menstrual irregularity
-life style changes: wt loss by diet/exercise
-surgical (wedge resection of ovary): to restore fertility when clomiphene fails
what are some complications of untreated PCOS? -infertility
-endometrial hyperplasia/cancer risk d/t unopposed estrogen thickening lining
-insulin resistance = DM, HL, HTN, CAD, MI risks
what is an adenomyosis? an island of endometrial tissue w/i the myometrium *muscular
layer of the wall)
when comparing leiomyomas (fibroids) and adenomyosis signs of uterine symmetry,
hard/softness, and tenderness, what is the difference? -leiomyomas: asymmetrical, firm,
nontender uterus
-adenomyosis: symmetrical, soft, tender uterus
*both present with menorrhagia and dysmenorrhea
,how is adenomyosis diagnosed? treated? *diagnosis of exclusion!*
-cannot see on US so must do *MRI* or post-TAH examination of uterus
-tx: only effective is TAH but can do OCPs/NSAIDs to preserve fertility
what are the risks of untreated adenomyosis? induces hypertrophy/hyperplasia of
surrounding myometrium where ectopic endometrial tissue is implanted
Follicular Phase vs. Luteal phase 1. Estrogen dominant (Day 1-14)
2. Progesterone dominant (Day 14-28)
FSH vs. LH 1. Causes follicle & egg maturation
2. Stimulate maturing follicle to produce estrogen
Estrogen vs. Progesterone 1. Thickens endometrium
2. Enhances lining of uterus to prepare for implantation
In the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a
_______ to develop which produces ________ to help proliferate the lining of the endometrium;
at the end of this phase _______ surges causing ovulation 1. Primary ovarian follicle
2. Estrogen
3. LH
, In the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________
which produces _________ which maintains the endometrial lining for fertilization 1.
Corpus luteum
2. Progesterone
In the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the
corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________
begins 1. Corpus luteum
2. Menstruation
In the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus
luteum; if fertilization does occur __________ gets released by the developing
trophoblast/placenta which maintains the __________ to continue making progesterone/estrogen
1. hCG
2. Corpus luteum
Cryptomenorrhea Light flow or spotting
Metrorrhagia vs. Menometrorrhagia 1. Irregular bleeding between expected menstrual
cycles
2. Irregular EXCESSIVE bleeding between expected menstrual cycles
Oligomenorrhagia Infrequent menstruation *(prolonged cycle length >35 days but <6
months)*
