bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb

bbbbbbbbbbbDIFFERENTIAL DIAGNOSIS OF
COMMONGYNECOLOGICAL COMPLAINTS. . .
CONT.Non-Gynecological Causesothyroid disease (hyper-/hypo- thyroid)ochronic liver
diseaseovon Willebrand diseaseoleukemiaoidiopathic thrombocytopenic
purpuraohypersplenismorectal or urethral bleedingorenal failureoadrenal insufficiency
and excessodrugs: spironolactone, danazol, psychotropic agentsometastatic
cancer REPRODUCTIVE ENDOCRINOLOGYSTAGES
OF PUBERTY1. accelerated growth2. thelarche (breast budding)3. pubarche and
adrenarche (growth of pubic and axillary hair)4. maximal growth (peak height velocity)5.
menarche• Tanner Staging (see Pediatrics Notes)MENSTRUAL
CYCLECharacteristicsomenarche at age 11-14 oentire cycle 28 +/– 7 days, with
bleeding for 1 - 6 days opolymenorrheaif
<pppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp
ppp 21 days ooligomenorrheaif > 35 days o25-60 mL of blood loss per cycleFigure 2.
Hormone Levels During Normal Menstrual
CycleProliferallllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll
llllllllllllllllllllllllllllllllllllllllllllltive/Follicular Phaseofirst day of menses to ovulation
ovariable in lengtholow basal body temperatureoestrogenicoendometrial
primingoovarian follicular developmentMENSTRUAL CYCLEFSHLHFSHLHFSHLHDay 1Day
4Day 10Day 12 Day 14Day 20Day 28• Day 1 to days 3-7: Menstruation, FSH and LH levels are
rising.hhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh• Rising FSH stimulates growth of
several ovarian follicles and maturation of an ovum.• FSH and rising LH stimulate the follicles to produce estrogen.• Estrogen causes proliferation of
endometrium and further stimulates ripening of the ovum.• Estrogen triggers a LH surge which is responsible for ovulation.• After ovulation, progesterone
produced by the corpus luteum stimulates secretory changes in the endometrium.• Deterioration of the corpus luteum causes progesterone to decrease.•
Decreasing progesterone and estrogen stimulate pituitary to produce FSH and
LH.ESTROGENPROGESTERONEMENSTRUALPROLIFERATIVESECRETORYOvulationNew Cycle Begins

DIFFERENTIAL
DIbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbAG
NOSIS OF COMMONGYNECOLOGICAL
COMPLAINTS. . . CONT.Non-Gynecological Causesothyroid disease
(hyper-/hypo- thyroid)ochronic liver diseaseovon Willebrand
diseaseoleukemiaoidiopathic thrombocytopenic purpuraohypersplenismorectal or
urethral bleedingorenal failureoadrenal insufficiency and excessodrugs: spironolactone,
danazol, psychotropic agentsometastatic cancer REPRODUCTIVE
ENDOCRINOLOGYSTAGES OF PUBERTY1. accelerated
growth2. thelarche (breast budding)3. pubarche and adrenarche (growth of pubic and
axillary hair)4. maximal growth (peak height velocity)5. menarche• Tanner Staging (see
Pediatrics Notes)MENSTRUAL
CYCLECharacteuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
uuuuuuuuuuuuuuuuuuuuuuuuuuuristicsomenarche at age 11-14 oentire cycle 28 +/– 7
days, with bleeding for 1 - 6 days opolymenorrheaif < 21 days ooligomenorrheaif > 35
days o25-60 mL of blood loss per
cycleFigurnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn
nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnne 2. Hormone Levels During Normal
Menstrual CycleProliferative/Follicular Phaseofirst day of menses to ovulation ovariable
in lengtholow basal body temperatureoestrogenicoendometrial primingoovarian
follicular developmentMENSTRUAL CYCLEFSHLHFSHLHFSHLHDay 1Day 4Day 10Day 12 Day
14Day 20Day 28• Day 1 to days 3-7: Menstruation, FSH and LH levels are rising.• Rising FSH stimulates growth of several ovarian follicles and
maturation of an ovum.• FSH and rising LH stimulate the follicles to produce estrogen.• Estrogen causes proliferation of endometrium and further
stimulates ripening of the ovum.• Estrogen triggers a LH surge which is responsible for ovulation.• After ovulation, progesterone produced by the corpus
luteum stimulates secretory changes in the endometrium.• Deterioration of the corpus luteum causes progesterone to decrease.• Decreasing progesterone
and estrogen stimulate pituitary to produce FSH and
LH.ESTROGENPROGESTERONEMENSTRUALPROLIFERATIVESECRETORYOvulationNew Cycle Begins

DIFFERENTIAL DIAGNOSIS OF
COMMONGYNECOLOGICAL COMPLAINTS. . .
CONT.Non-Gynecological Causesothyroid disease (hyper-/hypo- thyroid)ochronic liver
diseaseovon Willebrand diseaseoleukemiaoidiopathic thrombocytopenic
purpuraohypersplenismorectal or urethral bleedingorenal failureoadrenal insufficiency
and excessodrugs: spironolactone, danazol, psychotropic agentsometastatic
cancer REPRODUCTIVE ENDOCRINOLOGYSTAGES
OF PUBERTY1. accelerated growth2. thelarche (breast budding)3. pubarche and
adrenarche (growth of pubic and axillary hair)4. maximal growth (peak height velocity)5.
menarche• Tanner Staging (see Pediatrics Notes)MENSTRUAL
CYCLECharacteristicsomenarche at age 11-14 oentire cycle 28 +/– 7 days, with
bleeding for 1 - 6 days opolymenorrheaif < 21 days ooligomenorrheaif > 35 days o25-60
mL of blood loss per cycleFigure 2. Hormone Levels During Normal Menstrual
CycleProliferative/Follicular Phaseofirst day of menses to ovulation ovariable in
lengtholow basal body temperatureoestrogenicoendometrial primingoovarian follicular
developmentMENSTRUAL CYCLEFSHLHFSHLHFSHLHDay 1Day 4Day 10Day 12 Day 14Day
20Day 28• Day 1 to days 3-7: Menstruation, FSH and LH levels are rising.• Rising FSH stimulates growth of several ovarian follicles and maturation of
an ovum.• FSH and rising LH stimulate the follicles to produce estrogen.• Estrogen causes proliferation of endometrium and further stimulates ripening of
the ovum.• Estrogen triggers a LH surge which is responsible for ovulation.• After ovulation, progesterone produced by the corpus luteum stimulates
secretory changes in the endometrium.• Deterioration of the corpus luteum causes progesterone to decrease.• Decreasing progesterone and estrogen
stimulate pituitary to produce FSH and
LH.ESTROGENPROGESTERONEMENSTRUALPROLIFERATIVESECRETORYOvulationNew Cycle Begins
DIFFERENTIAL DIAGNOSIS OF
COMMONGYNECOLOGICAL COMPLAINTS. . .
CONT.Non-Gynecological Causesothyroid disease (hyper-/hypo- thyroid)ochronic liver
diseaseovon Willebrand diseaseoleukemiaoidiopathic thrombocytopenic
purpuraohypersplenismorectal or urethral bleedingorenal failureoadrenal insufficiency
and excessodrugs: spironolactone, danazol, psychotropic agentsometastatic
cancer REPRODUCTIVE ENDOCRINOLOGYSTAGES
OF PUBERTY1. accelerated growth2. thelarche (breast budding)3. pubarche and
adrenarche (growth of pubic and axillary hair)4. maximal growth (peak height velocity)5.
menarche• Tanner Staging (see Pediatrics Notes)MENSTRUAL
CYCLECharacteristicsomenarche at age 11-14 oentire cycle 28 +/– 7 days, with
bleeding for 1 - 6 days opolymenorrheaif < 21 days ooligomenorrheaif > 35 days o25-60
mL of blood loss per cycleFigure 2. Hormone Levels During Normal Menstrual
CycleProliferative/Follicular Phaseofirst day of menses to ovulation ovariable in
lengtholow basal body temperatureoestrogenicoendometrial primingoovarian follicular
developmentMENSTRUAL CYCLEFSHLHFSHLHFSHLHDay 1Day 4Day 10Day 12 Day 14Day
20Day 28• Day 1 to days 3-7: Menstruation, FSH and LH levels are rising.• Rising FSH stimulates growth of several ovarian follicles and maturation of
an ovum.• FSH and rising LH stimulate the follicles to produce estrogen.• Estrogen causes proliferation of endometrium and further stimulates ripening of
the ovum.• Estrogen triggers a LH surge which is responsible for ovulation.• After ovulation, progesterone produced by the corpus luteum stimulates
secretory changes in the endometrium.• Deterioration of the corpus luteum causes progesterone to decrease.• Decreasing progesterone and estrogen
stimulate pituitary to produce FSH and
LH.ESTROGENPROGESTERONEMENSTRUALPROLIFERATIVESECRETORYOvulationNew Cycle Begins

DIFFERENTIAL DIAGNOSIS OF
COMMONGYNECOLOGICAL COMPLAINTS. . .
CONT.Non-Gynecological Causesothyroid disease (hyper-/hypo- thyroid)ochronic liver
diseaseovon Willebrand diseaseoleukemiaoidiopathic thrombocytopenic
purpuraohypersplenismorectal or urethral bleedingorenal failureoadrenal insufficiency
and excessodrugs: spironolactone, danazol, psychotropic agentsometastatic
cancer REPRODUCTIVE ENDOCRINOLOGYSTAGES
OF PUBERTY1. accelerated growth2. thelarche (breast budding)3. pubarche and
adrenarche (growth of pubic and axillary hair)4. maximal growth (peak height velocity)5.
menarche• Tanner Staging (see Pediatrics Notes)MENSTRUAL
CYCLECharacteristicsomenarche at age 11-14 oentire cycle 28 +/– 7 days, with
bleeding for 1 - 6 days opolymenorrheaif < 21 days ooligomenorrheaif > 35 days o25-60
mL of blood loss per cycleFigure 2. Hormone Levels During Normal Menstrual
CycleProliferative/Follicular Phaseofirst day of menses to ovulation ovariable in
lengtholow basal body temperatureoestrogenicoendometrial primingoovarian follicular
developmentMENSTRUAL CYCLEFSHLHFSHLHFSHLHDay 1Day 4Day 10Day 12 Day 14Day
20Day 28• Day 1 to days 3-7: Menstruation, FSH and LH levels are rising.• Rising FSH stimulates growth of several ovarian follicles and maturation of
an ovum.• FSH and rising LH stimulate the follicles to produce estrogen.• Estrogen causes proliferation of endometrium and further stimulates ripening of
the ovum.• Estrogen triggers a LH surge which is responsible for ovulation.• After ovulation, progesterone produced by the corpus luteum stimulates
secretory changes in the endometrium.• Deterioration of the corpus luteum causes progesterone to decrease.• Decreasing progesterone and estrogen
stimulate pituitary to produce FSH and
LH.ESTROGENPROGESTERONEMENSTRUALPROLIFERATIVESECRETORYOvulationNew Cycle Begins