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Exam 2: NU664D/ NU 664D (Latest 2025/ 2026 Update) Primary Care Adult Woman I Review| Questions & Answers | Grade A (100% Correct Solutions)- Regis
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when does menarche typically begin?
2 - 3 years after thelarche (breast buds)
thelarche
breast buds
average age of menarche in the US
what can lead to earlier menarche?
high BMI
what regulates the menstrual cycle?
HPO axis
three characteristics of menstrual bleeding
frequency, volume, length
normal menstrual bleeding frequency
24 - 38 days with each new cycle within 7-9 days of the last
normal menstrual volume
5 - 80 ml
shift from estrogen to progesterone dominance follicle ruptures corpus luteum forms progesterone is produced the follicle ceases growth and endometrium secretes
how long is luteal phase
14 days (14-28)
how long/when is follicular phase
days 1- 14
what triggers end of luteal phase and beginning of menses?
drop in progesterone (and estrogen too but less important)
what do estrogen levels do throughout follicular and luteal phases?
surges with ovulation (end of follicular phase and beginning of luteal phase)
what happens to the egg at the end of luteal phase and how long after ovulation does this change take place?
corpus luteum turns into corpus albicans approx 9-11 days after ovulation
what phase of the uterine cycle corresponds with the follicular phase of the ovarian cycle?
proliferative phase same time as follicular phase
what is happening to endometrium during proliferative phase and why?
surge in estrogen thickens endometrial lining to prepare for pregnancy also forms progesterone receptors to increase endometrial blood flow
what phase of the uterine cycle corresponds with the luteal phase of the ovarian cycle?
amenorrhea
absence of menstrual bleeding for 3 or more usual cycles
oligomenorrhea
infrequent menstrual bleeding happening greater than every 38 days
polymenorrhea
frequent menstrual bleeding happening 21-24 days or fewer
hypomenorrhea
regular menstrual bleeding less than normal volume
heavy menstrual bleeding greater than 80 ml per cycle or lasting longer than 7 days or irregular heavy bleeding
intermenstrual bleeding bleeding at any time in between normal cycles
primary amenorrhea
no menses by age 16
reasons to evaluate 14 year old with no menses
hirsuitism
pregnancy (ectopic, MAB) lactation menopause
thyroid dysfunction (hypo or hyper)
pituitary dysfunction (tumor such as prolactinoma) drug related hypothalamic (ED, athleticism, weight loss more than 10%) disease/stress (celiac, depression/anxiety, diabetes) congenital syndromes (rare) primary ovarian insufficiency (menopause is usually age 51) adrenal dysfunction (tumor or PCOS) anatomic abnormalities (asherman's)
most important/telling part of amenorrhea visit data
subjective history
what is virilization?
male sex characteristics hirsutism, alopecia, acne, voice changes
diagnostic tests for amenorrhea
hCG TSH and prolactin FSH, LH, estradiol DHEA-S, 17-OHP, testosterone, cortisol, fasting BG
TSH that would indicate hypothyroidism
usually above 4
prolactin level that would indicate hyperprolactinemia
greater than 50
HPO axis lab results that would indicate ovarian insufficiency
elevated FSH and LH
typical LH
5 - 20 mlU/ml
typical estradiol
25 - 75 pg/ml
when in cycle to check HPO axis labs
day 2-6 of menstrual cycle with day 1 being first day of period
LH:FSH ratio that may be seen with PCOS
typical total testosterone
6.0-86 ng/dl
typical free testosterone
0.7-3.6 pg/ml
typical DHEA-S
35 - 430 ug/dl suspect adrenal tumor if above 7 00
typical prolactin
less than 25 ng/ml
meds that cause hyperprolactinemia
what is secondary dysmenorrhea
cramping/pain in lower abdomen associated with pelvic pathology... often pain occurs even in between menstrual cycles
what is the patho behind dysmenorrhea
prostaglandins released during menstruation causes contractions of the uterus... when the uterus contracts, ischemia occurs and pain is felt
sxs that often accompany dysmenorrhea
N/V, diarrhea, H/A, malaise, fatigue
physical exam findings for primary dysmenorrhea
usually only tender uterus if no pelvic pathology possible exam findings for secondary dysmenorrhea r/t endometriosis
nodularity, thickening, or focal tenderness of uterosacral ligament cervical stenosis fixed ovaries/uterus due to adhesions ovarian fullness
diagnostic testing for sexually active woman with dysmenorrhea
gonorrhea, chlamydia wet mount UA, UC pelvic U/S hCG
differentials for secondary dysmenorrhea before diagnosis of primary dysmenorrhea can be made
pelvic infection adenomyosis fibroid (leiomyoma) IUD polyps ovarian cysts MAB pelvic adhesions ectopic
NSAIDs COCs DMPA (good for endo) Implant (good for endo) IUD (good for endo) Vitamin B and magnesium
what is PALM COEIN used for?
AUB classification
what does PALM COEIN stand for?
Polyps Adenomyosis Leiomyoma Malignancy and hyperplasia
Coagulopathy
Ovulation dysfunction (can be r/t HPO axis, thyroid, or PCOS) Endometrial Iatrogenic (infection, meds, IUD) Not classified
at what point should adolescents expect AUB to subside and why?
by the third year before this, HPO axis is immature and it is likely bleeding up until this point has been anovulatory
why is AUB seen in perimenopausal women?
HPO axis fluctuations r/t decline in follicular number
AUB physical exam VS
pelvic exam: site of bleeding, appearance of cervix, characteristics of uterus (contour, size, tenderness)
