GU-4

• 1. Endometriosis
• 2. Chronic PID
• 3. Ovarian cyst
• 4. Adenomyosis
• 5. Leiomyomas
• 6. Pelvic congestion syndrome
• 7. Cystitis
• 8. GI
• 9. Neuromuscular

• 1. Physical therapy
• 2. Trial of menstruation supression
• 3. NSAIDS
• 4. Antidepressant
• 5. Surgery if pathology is found

• 1. Menorrhagia - excessive flow
• 2. Metrorrhagia - bleeding from uterus between menses
• 3. Menometrorrhagia - prolongation of flow with intermenstrual bleeding
• 4. Oligomenorrhea - menstrual flow at intervals of > 35 days
• 5. Polymenorrhea - menstrual flow at intervals of < 21 days

• A. Younger pt treated w/ OC for 21 days w/ 7 day withdrawel
• B. Cyclic progestin for first 10 days of month can be used in younger pts w/ sufficient estrogen to prime progesterone receptors
• C. If pt stable w/ moderate bleeding, treat with cyclic estrogens w/ progesterone added for last 10-15 days of 25 day cycle. Repeach each month for 3-6 months.

no spontaneous uterine bleeding by 15 years old w/ normal secondary sexual characteristics

OR

13 years w/ abnormal secondary sexual characteristics

absence of menstrual periods for 3-6 mnths or 3 cycles

• 1. pregnancy (most common)
• 2. hypothalamic effects
• 3. pituitary defects
• 4. ovarian/ovulatory dysfunction
• 5. uterine causes
• 6. other

• 1. Congenital deficiency of GnRH (no GnRH secretion)
• 2. Defect of GnRH transport (prevents flow of GnRH from hypothalamus to pituitary)
• 3. Defect of GnRH pulse production (LH, FSH not released, follicles do not develop. No ovulation)

• 1. Congenital absence of pituitary (rare-lethal)
• 2. Sheehan's Syndrome (pituitary necrosis from postpartum hemorrhage and severe hypotension)
• 3. Polycystic Ovary Syndrome (all the Sx)

• 1. Turner Syndrome (abnormal X chromosome; webbed neck, streak ovaries, infertility)
• 2. Premature ovarian failure (depletion of ova before 40, SSX of menopause, dunno why)

• 1. Congenital absence of malformation of the uterus
• 2. Unresponsive or atrophic endometrium
• 3. Imperforate hymen

• 1. Rising hCG levels
• 2. Sx of pregnancy

• 1. Endometriosis
• 2. Fibroids/Adenomyosis