1Chamberlain wk 5 study guide 1.Menorrhagia(hypermenorrhea) is heavy or prolonged menstrual flow. The presence of clots may not be abnormal but may signify excessive bleeding. “Gushing” or “open-faucet” bleeding is always abnormal. Submucous myomas, complications of pregnancy, adenomyosis, IUDs, endometrial hyperplasias, malignant tumors, and dysfunctional bleeding are causes of menorrhagia.2.Hypomenorrhea(cryptomenorrhea) is unusually light menstrual flow, sometimes only spotting. An obstruction such as hymenal or cervical stenosis may be the cause. Uterine synechiae (Asherman's syndrome) can be causative and are diagnosed by a hysterogram or hysteroscopy. Patients receiving oral contraceptives occasionally complain of light flow and can be reassured that this is not significant.3.Metrorrhagia(intermenstrual bleeding) is bleeding that occurs at any time between menstrual periods. Ovulatory bleeding occurs midcycle as spotting and can be documented with basal body temperatures. Endometrial polyps and endometrial and cervical carcinomas are pathologic causes. In recent years, exogenous estrogen administration has become a common cause of this type of bleeding.4.Polymenorrheadescribes periods that occur too frequently. This usually is associated with anovulation andrarely with a shortened luteal phase in the menstrual cycle.5.Menometrorrhagiais bleeding that occurs at irregular intervals. The amount and duration of bleeding alsovary. Any condition that causes intermenstrual bleeding can eventually lead to menometrorrhagia. Sudden onset of irregular bleeding episodes may be an indication of malignant tumors or complications of pregnancy.6.Oligomenorrheadescribes menstrual periods that occur more than 35 days apart. Amenorrhea is diagnosedif no menstrual period occurs for more than 6 months. Bleeding usually is decreased in amount and associated with anovulation, either from endocrine causes (eg, pregnancy, pituitary-hypothalamic causes, menopause) or systemic causes (eg, excessive weight loss). Estrogen-secreting tumors produce oligomenorrhea prior to other patterns of abnormal bleeding.7.Contact bleeding(postcoital bleeding) is self-explanatory but must be considered a sign of cervical cancer until proved otherwise. Other causes of contact bleeding are much more common, including cervicaleversion, cervical polyps, cervical or vaginal infection (eg, Trichomonas), or atrophic vaginitis. A negative cytologic smear does not rule out invasive cervical cancer, and colposcopy, biopsy, or both may be necessary.Evaluation of Abnormal Uterine BleedingDetailed history, physical examination, cytologic examination, pelvic ultrasound, and blood tests are the first steps inthe evaluation of abnormal uterine bleeding. The main aim of the blood tests is to exclude a systemic disease, pregnancy, or a trophoblastic disease. The blood tests usually include complete blood count, assay of the β subunit of human chorionic gonadotropin (hCG), and thyroid-stimulating hormone (TSH).