••• Chapter 24^ Functional and Dysfunctional Uterine Bleeding^241
❍ Define menometrorrhagia.
Menses with heavy and irregular bleeding.
❍ Define primary amenorrhea.
No menarche by age 16 in a female with normal growth and secondary sex characteristics; or, no menarche by age
13 without development of secondary sex characteristics.
❍ Define secondary amenorrhea.
The absence of bleeding for at least three usual cycle lengths or 6 months in women who previously had menses.
❍ Define dysmenorrhea.
Pain associated with menstruation.
❍ What is the incidence of dysmenorrhea?
50% to 75% of women report that they have experienced dysmenorrhea.
❍ What are the main treatments of dysmenorrhea?
NSAIDs, oral contraceptive pills (OCPs); alternatively GnRH agonist can be considered if first-line treatments fail.
❍ What percentage of patients present with chief complaint of abnormal vaginal bleeding?
Approximately 12% of gynecology referrals are because of menorrhagia. Among women between ages 30 and
49, 5% consult physician for evaluation of menorrhagia.
❍ What percentage of women complaining of excessive or prolonged bleeding meet criteria for menorrhagia?
40%.
❍ What is the percentage of women with menorrhagia that consider their periods as light or moderate?
40%.
❍ What are the two direct (definitive) signs of ovulation?
Pregnancy and visualization of follicle rupture either during laparoscopy or ultrasound.
❍ Broadly characterize the causes of abnormal uterine bleeding?
Reproductive tract disease, systemic disease, trauma, pharmacologic alterations, anovulation, and ovulation.
❍ Define dysfunctional uterine bleeding (DUB).
Bleeding that is not attributable to an underlying organic pathologic condition. DUB usually refers to anovulatory
bleeding (90%).
❍ What are the components of the workup for abnormal uterine bleeding?
A complete history, physical examination, laboratory studies, imaging studies, and tissue sampling.