Abnormal Uterine Function

Amenorrhea

Primary

  • Definition: Absence of menarche based presence/absence of secondary sexual characteristics and age

    • Secondary sexual characteristics present: Age 14 years

    • Absent: Age 16 years

  • Etiologies

    • Gonadal dysgenesis, e.g. Turner syndrome (43% of cases)

    • Anatomical defects

      • Mullerian agenesis (10% of cases)

      • Other: Imperforate hymen, transverse vaginal septum, etc.

    • Hormonal dysregulation: Hypothalamic amenorrhea, hyperprolactinemia, elevated FSH, polycystic ovary syndrome

  • Initial workup: Confirm negative beta-hCG and obtain pelvic ultrasound

    • If no anatomic defects on ultrasound, obtain serum prolactin, FSH, LH, testosterone levels

    • Consider karyotype based if high suspicion for genetic disorder

Secondary: Defined as cessation of menses for 3 months or irregular menses for 6 months

  • Most common etiologies

  • Initial work-up

    • If pregnancy test negative, obtain TSH, LH, FSH

    • If visual changes (peripheral vision loss) or galactorrhea present, obtain prolactin level

Abnormal Uterine Bleeding

#Adenomyosis: > 40 y/o F with h/o prior uterine surgery presents with dysmenorrhea. Reports heavy menstrual bleeding and chronic pelvic pain. Diffuse uterine enlargement and uterine tenderness on exam.

  • Obtain CBC to evaluate for anemia

  • U/S shows thickened myometrium

  • Pathology confirms adenomyosis

  • Pt has not completed childbearing; pt counseled that Mirena IUD may provided limited symptoms relief

  • Refer to OBGYN for discussion of hysterectomy

#Leiomyoma (fibroids): Pt with h/o [PMH] presents with [timing] [CC]. [HPI]. [PE] on exam.

  • [Labs]

  • [Imaging]

  • [Intervention]

  • Pt advised to [anticipatory guidance]

#Malignancy/hyperplasia: Pt with h/o [PMH] presents with [timing] [CC]. [HPI]. [PE] on exam.

  • [Labs]

  • [Imaging]

  • [Intervention]

  • Pt advised to [anticipatory guidance]

#Coagulopathy: Pt with h/o [PMH] presents with [timing] [CC]. [HPI]. [PE] on exam.

  • [Labs]

  • [Imaging]

  • [Intervention]

  • Pt advised to [anticipatory guidance]

#Ovulatory dysfunction: Pt with h/o [PMH] presents with [timing] [CC]. [HPI]. [PE] on exam.

  • [Labs]

  • [Imaging]

  • [Intervention]

  • Pt advised to [anticipatory guidance]

#Endometrial etiology: Pt with h/o [PMH] presents with [timing] [CC]. [HPI]. [PE] on exam.

  • [Labs]

  • [Imaging]

  • [Intervention]

  • Pt advised to [anticipatory guidance]

#Iatrogenic: Pt with h/o [PMH] presents with [timing] [CC]. [HPI]. [PE] on exam.

  • [Labs]

  • [Imaging]

  • [Intervention]

  • Pt advised to [anticipatory guidance]