BMC | Obstetrics and Gynecology Residency Program

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Reproductive Endocrinology
Menstrual and Endocrine Disorders

1. Describe the principal causes of dysfunctional uterine bleeding (DUB).
2. Elicit a pertinent history to determine the etiology of DUB.
3. Perform a focused physical examination to determine the etiology of DUB.
4. Perform selected tests to determine the etiology of DUB, such as:

a. Microbiologic cultures of the lower and upper genital tract
b. Endometrial biopsy
c. Endovaginal ultrasonography
d. Hysteroscopy
e. Laparoscopy

a. Qualitative and quantitative serum hCG
b. Complete blood count and coagulation studies
c. Endocrinologic assays
d. CT or MRI

1. Describe the classification of dysmenorrhea (ie, primary versus secondary).
2. List the principal causes of primary and secondary dysmenorrhea.
3. Elicit a pertinent history to determine the most likely cause of dysmenorrhea.
4. Perform a focused physical examination to determine the cause of dysmenorrhea.
5. Perform selected tests to determine the cause of dysmenorrhea, such as:

a. Microbiologic cultures of the lower genital tract
b. Endometrial biopsy
c. Endovaginal ultrasonography/hysterosonography
d. Hysteroscopy
e. Laparoscopy

a. Histology of the endometrium
b. CT or MRI

1. Describe the classification of amenorrhea (ie, primary versus secondary).
2. List the major causes of primary and secondary amenorrhea.
3. Elicit a pertinent history to determine the most likely cause of amenorrhea.
4. Perform a focused physical examination to determine the cause of amenorrhea.
5. Perform selected diagnostic tests to determine the cause of amenorrhea, such as:

a. Progestin challenge test
b. Hysteroscopy
c. Hysterosalpingogram
d. Endovaginal ultrasonography

6. Interpret other diagnostic tests, such as:

a. Qualitative and quantitative serum hCG
b. Serum gonadotropin assays
c. Thyroid-stimulating hormone assay
d. Prolactin assay
e. Dexamethasone suppression test
f. Corticotropin stimulation test
g. Peripheral blood karyotype
h. CT or MRI

7. Describe the long-term follow-up for a patient with amenorrhea, focusing particularly on the risks for endometrial hyperplasia and hypoestrogenism.

1. Describe the cause of galactorrhea.
2. Elicit a pertinent history in a patient with galactorrhea, including assessment of the following areas:

a. Nipple discharge
b. Menstrual abnormalities
c. Headaches
d. Visual disturbances
e. Drug use (eg, phenothiazines)
f. Current or past chest wall lesions or trauma
g. Repetitive breast stimulation

3. Perform a targeted physical examination, noting:

a. Distribution of sexual hair
b. Character of nipple discharge
c. Development of secondary sexual characteristics
d. Size of thyroid
e. Presence of visual field defects

4. Order and interpret selected diagnostic studies, including:

a. Serum prolactin
b. Serum thyroid-stimulating hormone
c. MRI of sella turcica

5. Treat galactorrhea medically with dopamine agonists.
6. Describe the indications for referral to a neurosurgeon for surgical treatment.
7. Describe long-term follow-up for the patient with galactorrhea, focusing particularly on the risk of complications, such as:

a. Headaches
b. Visual field defects
c. Infertility
d. Hypoestrogenism

1. Describe the principal causes of hirsutism.
2. Elicit a pertinent history to determine the most likely etiology of hirsutism.
3. Perform a focused physical examination to determine the most likely etiology of hirsutism.
4. Perform selected tests to determine the etiology of hirsutism, such as:

a. Adrenal suppression and stimulation testing
b. Imaging studies such as ultrasonography and MRI

5. Interpret the results of other tests to determine the etiology of hirsutism, such as:

a. Serum androgen and 17-OH progesterone assays
b. Serum gonadotropin assays
c. CT or MRI

6. Treat hirsutism with medical and surgical interventions.
7. Describe the indications for referral to a subspecialist.
8. Describe the long-term follow-up for an affected patient and counsel her about possible effects on reproduction.

1. Describe the diagnostic criteria for premenstrual syndrome (PMS).
2. List the possible causes of PMS.
3. Elicit a pertinent history to confirm the diagnosis of PMS and determine its most likely etiology.
4. Describe the differential diagnosis of PMS.
5. Treat PMS with interventions, such as:

a. Psychosocial support or referral
b. Counseling about a healthy lifestyle
c. Medication

1. Describe the clinical features of PCOS.
2. Describe the genetic and environmental factors contributing to pathogenesis.
3. Elicit a pertinent history to determine the likelihood of the diagnosis.
4. Perform a focused physical examination to elicit findings to confirm the diagnosis.

a. Serum testing, including ovarian, adrenal, pituitary, and pancreatic function

5. Perform selected tests to determine the diagnosis, such as:

a. Serum testing, including ovarian, adrenal, pituitary, and pancreatic function
b. Endovaginal ultrasonagraphy

6. Describe the medical treatment for PCOS in patients who do not desire pregnancy.
7. Describe the medical and/or surgical treatment for PCOS in patients who desire pregnancy and require ovulation induction.
8. Describe the indications for referral for subspecialty consultation.
9. Describe the long-term follow-up for an affected patient and counsel her about the effects on reproduction and on risk of cancer and cardiovascular disease.

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