menarche
onset of menstruation (begins ~ age 12; until approx 51)
duration of menstruation cycle
21-35 days (normal); average 28 days
typical menstruation
3-5 days
30-50 ml
human chorionic gonadotropin (HCG)
Trophoblast cells from the fertilized oocyte secrete HCG into the maternal bloodstream
HCG can be detected up to 10-14 days after ovulation
Reaches maximum at 10-12 weeks
Function: Maintains corpus luteum causing it to secrete larger quantities of progesterone and estrogen for 6-7 weeks; progesterone and estrogen maintain the endometrium (placenta takes over)
primary amenorrhea
No menstrual cycle by age 13 in a girl without secondary sexual development
No menstrual cycle by age 15 in a girl with secondary sexual development
secondary amenorrhea
Previously menstruating, but none in the past 6 months
oligomenorrhea
Infrequent, usually irregular cycles
> 40 days between periods or since last period, but not yet 6 months between cycles
hypomenorrhea
Decreased menstrual flow or decreased days of flow
menorrhagia
Heavy or prolonged bleeding with regular cycles/frequency
metrorrhagia
Irregular bleeding or bleeding between periods
menometrorrhagia
Heavy bleeding, irregular cycles/timing
dysfunctional uterine bleeding (DUB)
Irregular menstruation without anatomic lesion in the uterus
cervical cancer - stats
1.5 % of cancer deaths (rare)
mean age at diagnosis: 47
88% of cases in developing countries
cervical cancer -symptoms
postcoital bleeding, abnormal uterine bleeding, watery, purulent, malodorous discharge
cervical cancer - screening
begin: age 21 (not earlier)
frequency: 1-3 yrs until 30; 3-5 yrs if last HPV neg after 30
Stop: 65-70 or after hysterectomy (of not due to cancer)
colposcopy
A follow-up exam for abnormal cytology results (gold standard)
Uses high-magnification and acetic acid to identify and biopsy suspicious cervical lesions (histology
note: results compared to ASCCP guidelines
endocervical curettage (ECC)
removes pre-cancerous cells
Frequently performed with a colposcopy exam to collect cells from the endocervix
Results are vague in that exact site of lesion is not known
Provides guidance for performing further exploration
endometrial biopsy
Performed to detect endometrial cancer
Done with colposcopy in follow-up for certain abnormal cytology results (esp glandular cell pathology)
LEEP: loop electrosurgical excision procedure
removes pre-cancerous cells
Heated wire loop
Done in office
Diagnostic and Therapeutic (tissue removed and sent to lab)
Sometimes called: LLETZ- Large Loop Excision of the Transformation Zone
cervical conization
removes pre-cancerous cells
Minor surgical procedure under general or regional anesthesia
Provides a deeper biopsy of the transformation zone
Frequently provides simultaneous diagnosis and treatment
Types:
Cold knife scalpel and scissors (as above)
Sometimes called “Cold Cone”
Sometimes use CO2 laser or loop electrode
cervical conization - indications
Used to follow-up high grade abnormal colposcopy results.
Incomplete/unsatisfactory colpo: entire SCJ (squamocolumnar junction) is not visualized on colpo or abnormal area is not viewed entirely
Positive ECC
Pap smear and biopsy do not agree
Treatment of known CIN 2 or CIN 3 lesion