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Organic causes of chronic pelvic pain (9)
- 1. Endometriosis
- 2. Chronic PID
- 3. Ovarian cyst
- 4. Adenomyosis
- 5. Leiomyomas
- 6. Pelvic congestion syndrome
- 7. Cystitis
- 8. GI
- 9. Neuromuscular
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Management of CPP (5)
- 1. Physical therapy
- 2. Trial of menstruation supression
- 3. NSAIDS
- 4. Antidepressant
- 5. Surgery if pathology is found
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Abnormalities
- 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
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Treatment of DUB
- 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.
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Primary Amenorrhea
no spontaneous uterine bleeding by 15 years old w/ normal secondary sexual characteristics
OR
13 years w/ abnormal secondary sexual characteristics
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Secondary Amenorrhea
absence of menstrual periods for 3-6 mnths or 3 cycles
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Amenorrhea causes (6)
- 1. pregnancy (most common)
- 2. hypothalamic effects
- 3. pituitary defects
- 4. ovarian/ovulatory dysfunction
- 5. uterine causes
- 6. other
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Hypothalamic causes of amenorrhea
- 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)
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Pituitiary causes of amenorrhea
- 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)
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Ovarian causes of amenorrhea
- 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)
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Uterine causes of amenorrhea
- 1. Congenital absence of malformation of the uterus
- 2. Unresponsive or atrophic endometrium
- 3. Imperforate hymen
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Pregnancy causes of amenorrhea
- 1. Rising hCG levels
- 2. Sx of pregnancy
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Causes of secondary dysmenorrhea
- 1. Endometriosis
- 2. Fibroids/Adenomyosis
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