Menstrual Disorders. Oguchi A. Nwosu M.D. Assistant Profressor Emory Family Medicine Dept. 6/28/07. Menstrual Cycle. Definitions. Menorrhagia Excessive (>80ml) uterine bleeding Prolonged (>7days) regular DUB Abnormal Bleeding, no obvious organic cause usually anovulatory
Oguchi A. Nwosu M.D.
Emory Family Medicine Dept.
Metrorragia, Menometrorrhagia, Polymenorrhea
Oligo or Amenorrhea +/- Menorrhagia
Regular menstrual cycles (plus premenstrual symptoms such as dysmenorrhea and mastalgia
-Defn: Excessively heavy, prolonged or frequent bleeding of uterine origin that is not due to pregnancy, pelvic or systemic disease
-Diagnosis of exclusion
-Usually extremes of reproductive life and in pts with PCOS
– sample endometrium
Usually followed by OCP or progestin
-Heavy vaginal bleeding that is not DUB
-Usually secondary to distortion of uterine cavity- heavy with or without prolongation (anatomic).
Uterus unable to contract down on open venous sinuses in the zona basalis
-Other causes organic, endocrinologic, hemostatic and iatrogenic
Had normal 28 day cycles lasting 5 days
Last 1 year or so very heavy periods with clots and occ. ‘flooding’ in the first 3 days with need to use >8pads/day fully soaked, spots for up to 1 week after this.
Dysmenorrhea, severe, aching pain lower legs
Normal recent pap40 year old with menorrhagia x 12 months
Other tests as INDICATED by HX and PE
-Androgen insensitivity syndrome
-Turners syndrome (45, X0)
Use step wise approach to diagnosis
H & P, follow the stepwise algorithm for diagnosis
Master-Hunter T, Heiman D, Amenorrhea: Evaluation and Treatment. AFP April 15th 2006.