Exam

Menstrual Bleeding

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Menstrual Bleeding, Menses, Menarche

  • Definitions
  1. Normal Cycles
    1. Cycle Duration: 28 days (21-35 days)
    2. Days of Flow: 4.6 days (2-8 days)
    3. Estimated Blood Loss: 35 ml per cycle (20-80 ml)
  2. Abnormal Cycle Length
    1. Polymenorrhea: Cycle less than 21 day cycles
    2. Oligomenorrhea: Cycle greater than 35 day cycles (>45 days in adolescents)
    3. Metrorrhagia: Irregularly frequent Menses
  3. Abnormal Menstrual Flow
    1. Menorrhagia (Hypermenorrhea)
      1. Over 80 cc blood loss per cycle
      2. Change pad or tampon every 1-2 hours
      3. Blood clots >1 inch (2.5 cm)
      4. More than 7 days of menstrual flow
    2. Menometrorrhagia (Metrorrhagia and Menorrhagia)
      1. Prolonged, irregularly frequent, heavy Menses
  4. Dysfunctional Uterine Bleeding
    1. Excessive, prolonged, or irregular uterine bleeding
  • Physiology
  • Ages of Menstrual Landmarks
  1. Thelarche: (10.2 to 11.3 years)
    1. See Tanner Girls Breast Development Stage
    2. Onset of secondary Breast development (marks the start of Puberty)
    3. Precedes Menarche by 24 months
  2. Menarche: 12.8 years (9.1 to 17.7 years)
    1. Precedes regular Menses by 12 months
    2. Anovulatory Cycles predominate initially
      1. Years 1 to 2 after Menarche: 55-85% of cycles
      2. Years 3 to 4 after Menarche: 30-50% of cycles
      3. Years 5 to 6 after Menarche: <20% of cycles
  3. Menopause: 51.4 years (48 to 55 years)