PALMCOEIN
This is the O in PALMCOEIN
What is ovulatory dysfunction
Cervical malignancy or pre-malignancy
Pap smear
A 16 year old presents with primary amenorrhea, normal laboratory evaluation including beta HCG
HPO axis immaturity
HPO Axis Immaturity
Time!
You may see a smooth, round, protrusion coming from the cervix with an apparent stalk on speculum exam
What is a polyp
Iatrogenic
Detailed medical history
A 60 year old patient presents with post menopausal bleeding and a TVUS demonstrates an 8 mm EMS
Endometrial hyperplasia vs. malignancy
Endometrial polyp
On ultrasound, you note Venetian blind like shadowing on the uterus.
What is adenomyosis
Fibroids
TVUS
A sexually active 26 year patient without contraception presents with secondary amenorrhea.
Pregnancy!
Intermenstrual bleeding secondary to nexplanon
Alternate contraceptive or supplement with OCP
This condition is a precursor to endometrial cancer
What is endometrial intraepithelial neoplasia (EIN)
Endometrial hyperplasia or endometrial malignancy
Endometrial biopsy
A 32 year old presents with inter menstrual and postcoital bleeding with intermittent vaginal discharge and odor
Cervicitis
Adenomyosis
NSAIDS, menstrual suppression, hysterectomy
These lesions may present with an irregularly shaped uterus
What is leiomyoma
Ovulatory dysfunction
FSH, LH, estradiol, DHEA-S, 17-OHP, Prolactin
A 26 year old patient with hirsutism and elevated DHEA-S presents with irregular menses.
PCOS
Fibroids
Observation, hysteroscopy, open vs. laparoscopic myomectomy