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  • Image not available. Unrecognized pregnancy is the most common cause of amenorrhea. A urine pregnancy test should be one of the first steps in evaluating this disorder.
  • Image not available. For hypoestrogenic conditions associated with primary and secondary amenorrhea, estrogen (with a progestin) is provided.
  • Image not available. Causes of menorrhagia are either systemic disorders or specific uterine abnormalities.
  • Image not available. Pregnancy, including intrauterine pregnancy, ectopic pregnancy, and miscarriage, must be at the top of the differential diagnosis for any woman presenting with heavy menses.
  • Image not available. The reduction in menorrhagia-related blood loss with use of nonsteroidal antiinflammatory drugs and oral contraceptives is directly proportional to the amount of pretreatment blood loss.
  • Image not available.Intrauterine devices (IUDs) are considered therapeutic options in a variety of menstruation-related disorders. Guidelines from the American College of Obstetricians and Gynecologists indicate that both nulliparous and multiparous women at low risk of sexually transmitted diseases are good candidates for IUD use.
  • Image not available. Anovulatory bleeding is the standard terminology used to describe bleeding from the uterine endometrium as a result of a dysfunctioning menstrual system, specifically excluding an anatomic lesion of the uterus.
  • Image not available.Polycystic ovarian syndrome can present as a variety of menstruation disorders, including amenorrhea, menorrhagia, and anovulatory bleeding. Although its definition continues to evolve, it is generally considered a disorder of androgen excess that often includes polycystic ovarian morphology and ovulatory dysfunction.
  • Image not available.Metformin and thiazolidinedione use for anovulatory bleeding associated with PCOS is beneficial not only for anovulatory bleeding and fertility but also for improving glucose tolerance and other metabolic parameters that contribute to cardiovascular risk.
  • Image not available. The selective serotonin reuptake inhibitors are first-line pharmacologic treatment options for premenstrual dysphoric disorder.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the underlying etiology of amenorrhea, menorrhagia, anovulatory bleeding, and dysmenorrhea.
  • 2. Describe the pathophysiology of amenorrhea, menorrhagia, anovulatory bleeding, and dysmenorrhea.
  • 3. Explain how the pathophysiology of amenorrhea, menorrhagia, anovulatory bleeding, and dysmenorrhea relates to the selection of effective treatment modalities.
  • 4. Differentiate between premenstrual syndrome and premenstrual dysphoric disorder with respect to pathophysiology and clinical presentation.
  • 5. Differentiate between premenstrual syndrome and premenstrual dysphoric disorder relative to their respective treatment(s).
  • 6. Describe the clinical presentation of amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, and premenstrual dysphoric disorder.
  • 7. Identify the potential negative health implications of amenorrhea, menorrhagia, and polycystic ovarian syndrome.
  • 8. Recommend appropriate lifestyle and dietary modifications for patients with amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, premenstrual symptoms, and premenstrual dysphoric disorder.
  • 9. Recommend appropriate pharmacologic interventions for patients with amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, premenstrual symptoms, and premenstrual dysphoric disorder.
  • 10. Compare the available therapeutic options for patients with amenorrhea, menorrhagia, anovulatory bleeding, and dysmenorrhea dependent upon patient age, concomitant disease states (when necessary), and desire for contraception.
  • 11. Evaluate the role(s) of metformin and the thiazolidinediones in the management of polycystic ovarian syndrome.
  • 12. Identify the desired therapeutic outcomes for patients with amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, premenstrual symptoms, and premenstrual dysphoric disorder.
  • 13. Identify the timeframe within which the desired therapeutic outcomes for amenorrhea, ...

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