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Repro. Med 2 > Menstrual D/O > Flashcards

Menstrual D/O Flashcards

1
Q

___ is the absence of menarche by 15 y/o

A

Primary amenorrhea

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2
Q

____ is the absence of menses for 6+ months in a woman previously menstruating

A

Secondary amenorrhea

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3
Q

What are some causes of primary amenhorrhea?

A

Chromosomal abnormalities

Structural abnormalities

Hypothalamic/pituitary/ovarian causes

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4
Q

____ is the most common cause of primary amenorrhea and is characterized by a woman only having 1 chromosome

A

Turner syndrome

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5
Q

____% of 45, XO (turner syndrome) conceptions are lost prior to birth, usually in the first or second trimester

A

99%

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6
Q

What are common S/s of a pt w/ turner syndrome?

A

Short stature
Infertility
Primary gonadal failure
Osteoporosis

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7
Q

What is meant by “streak gonads”?

A

Description given to ovaries of a pt w/ turner syndrome

*little to no estrogen is produced

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8
Q

T/F Pregnancy is possible in a pt w/ turner syndrome w/ a donated egg or IVF

A

T

**pts w/ turner syndrome have a normal uterus and vagina

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9
Q

~ ___% of girls w/ turner sydnrome are missing the X chromosome in SOME of their cells, which is then called _______

A

30%

turner mosaic syndrome

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10
Q

People with mosaic 45,XO syndrome are at risk for ____ and have (MORE/LESS) sx?

A

premature menopause

LESS

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11
Q

How do you manage a pt w/ turner syndrome?

A

Hormone replacement starting in their teens

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12
Q

What are structural causes of primary amenorrhea?

A

Absence of the uterus, cervix, or vagina

Transverse vaginal septum

Imperforate hymen

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13
Q

Mullerian abnormalities are caused by the failure of the ______ to fuse

What are possible consequences of this failure?

A

Paramesonephric ducts

Absence of the uterus, cervix, and upper 1/3 of vagina

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14
Q

WTF do you think Mayer-Rokitansky-Kuster-Hauser syndrome means?

A

“Old school” name for the family of Mullerian agenesis conditions, LOL

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15
Q

___ is the result of abnormal apoptosis of the vaginal plate and can obstruct the outflow of blood causing amenhorrhea

A

Transverse Vaginal Septum

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16
Q

_____ is the absence of appropriate apoptosis of the cells of the hymenal membrane, which originates from cells of the urogenital sinus (external tissue)

A

Imperforate hymen

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17
Q

____ is the collection of blood due to outlet obstruction that can cause pain

A

Hematocolpos

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18
Q

What is the management for primary amenorrhea?

A

Resection if it is an imperforate hymen, vaginal septum

Hysterectomy for absent cervix

Creation of neovagina if necessary

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19
Q

____ is a hypothalamic malfunction due to significant physical or psychological stressors such as:

  • Eating d/o (anorexia nervosa)
  • Vigorous exercise
  • Very low body fat
  • High emotional or physical stress
A

Functional hypothalamic amenorrhea
**can cause secondary amenorrhea too!

**affects 4-8% of the population at some point (usually presents as secondary amenorrhea)

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20
Q

How do you tx functional hypothalamic amenorrhea?

A

Address behavioral issues/stressors –> Weight gain if indicated

Hormone supplementation

Consider combined OCs for osteoporosis prevention

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21
Q

____ is a congenital GnRH deficiency classically associated w/ anosmia, that also causes primary amenorrhea

A

Kallmann Syndrome

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22
Q

GnRH neurons are born from stem cells in the ____

What is the most common cause of Kallmann Syndrome?

A

Nasal placode

Migration failure is the most common cause–> GnRH neurons that fail to migrate properly are nonfunctional

People born w/ olfactory tract dysgenesis are at very high risk for Kallman Syndrome

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23
Q

What sx may a pt w/ Kallman Syndrome have besides anosmia?

How can they be managed?

A

Delayed tanner staging

Manage w/ estrogen/progestin therapy

GnRH can be used to induce ovulation

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24
Q

Infiltrative dz and tumors of the hypothalamus can cause primary amenhorrhea (can also cause secondary amenorrhea!)

What are some examples of these? (just FYI)

A

Tumors –> 90% prolactinomas

Craniopharyngioma
Germinoma
Lymphoma
Sarcoidosis

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25
Q

What are pituitary causes of priamry or secondary amenorrhea?

Ovarian causes of primary or secondary amenorrhea?

A

Pituitary adenoma

PCOS: cause of 20% secondary amenorrhea

Premature ovarian failure: depletion of functional oocytes <40 y/o)
** CA tx, genes, autoimmune things cause this

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26
Q

___ is characterized by 46 XY karyotype w/ nonfunctional androgen receptors

A

Androgen insensitivity syndrome (“testicular feminization”)

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27
Q

A pt w/ Androgen insensitivity syndrome (“testicular feminization”) have a ___ phenotype but ___ may be absent, and __ may be present in the labia

A

female (XX phenotype)

female organs

testes (XY genotype )

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28
Q

What labs should you order for a pt w/ primary amenorrhea if a uterus/vagina are present?

A

B-HCG
FSH
Karyotype if FSH elevated
Prolactin

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29
Q

What labs should you order for a pt w/ primary amenhorrhea if a uterus/vagina are absent?

A

Karyotype

Serum testosterone

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30
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

*Must get a b-hCG every time!

31
Q

Other than pregnancy, what are the other causes of secondary amenorrhea?

A

Hypothalamic – 35%
Ovarian – 40%
Pituitary – 19 %
Uterus – 5%

32
Q

What medical interventions can cause secondary amenorrhea? (x4)

A

Hormonal contraceptives

Progestin IUD

Metoclopramide (Reglan) (Causes hyperprolactinemia)

Antipsychotic drugs (Thorazine, Haldol, Risperdal) (Cause hyperprolactinemia)

33
Q

___ is a nutritional deficiency that can impact hypothalamic function and cause secondary amenorrhea

A

Celiac dz

34
Q

Is Athletic Amenorrhea a real thing?

A

Yep. Yupp. Yeppers.

35
Q

T/F Elevated prolactin levels can cause amenorrhea

A

T

36
Q

T/F TSH will not impact the menstrual cycle

A

F, it will!

37
Q

____ is acquired scarring of the endometrial lining, due to prior surgery or intrauterine infection and can cause (secondary/primary) amenorrhea

A

Asherman’s syndrome

Secondary

38
Q

If a pt has a BMI >30 and is experiencing amenorrhea, what underlying condition should you suspect?

A

PCOS

39
Q

If a pt has a BMI <18.5 and is experiencing amenorrhea, what underlying condition should you suspect?

A

Functional hypothalamic amenorrhea

40
Q

What labs should be ordered to work-up secondary amenorrhea?

A 
B-hCG
Prolactin
FSH
TSH
Serum testosterone (if signs of androgen excess)
41
Q

Describe the Progestin w/drawal test

What does w/drawl bleeding indicate?

A
  1. Provera 10 mg/d x 10 d, then stop.

If they have w/drawal bleeding, they are not making progesterone, and may not be ovulating

42
Q

If no menses occurs after preforming the Progestin w/drawal test what should be done next?

What would a lack of bleeding indicate?
What would bleeding at this point indicate?

A

Supplement w/ estrogen, then repeat progestin w/drawal

No bleeding= Asherman’s syndrome

Bleeding = intact uterus/endometrium that is not receiving estrogen/progesterone– POF, hypothalamic amenorrhea

43
Q

What other tests may you order to work up secondary amenorrhea?

A

US for endometrial thickness

pituitary MRI

Karyotype if FSH elevated (r/o partial chromosome deletion)

Evaluate for ovarian or adrenal tumor if high androgen levels

44
Q

How is hyperprolactinemia tx’d?

A

Rx: Dopamine agonist (cabergoline, bromocriptine)

Surgery for selected macroadenomas (large, poor response to medication)

45
Q

What is the tx for premature ovarian failure?

A

Estrogen/progestin therapy to prevent bone loss, manage menopausal sxs

46
Q

What is the recommended tx for Asherman’s syndrome?

A

Hysteroscopic lysis of adhesions

Long-term estrogen supplementation for endometrial growth

47
Q

___ is pelvic pain that occurs during menstruation in the absence of pelvic pathology

Cramps may be accompanied by what other sx?

A

Primary dysmenorrhea

N/V/D, back pain, HA, dizziness

48
Q

___ is pain w/ menses that results from pathologic changes in the pelvic viscera

A

Secondary dysmenorrhea

49
Q

Primary dysmenorrhea begins w/ the onset of what?

Sx start (before/after) flow onset and may last several days

A

regular ovulatory cycles

before

50
Q

Primary dysmenorrhea occurs in ___% of teens –> only ___% will seek attention

A

60%

15%

51
Q

What causes primary dysmenorrhea?

A

Excess production of endometrial prostaglandins

52
Q

What are the effects of excess production of endometrial prostaglandins?

A

Increased uterine contractions
Dysrhythmic or tetanic uterine contractions
Increased uterine muscle tone
GI tract stimulation

53
Q

When working up primary dysmenorrhea, when is a pelvic exam indicated?

A

Sxs are severe

Pt is sexually active

54
Q

When should labs be ordered for primary dysmenorrhea?

A

Only if the pt is sexually active
Screen for chlamydia, gonorrhea

*Do a hCG test no matter who it is!

55
Q

What is the primary management for primary dysmenorrhea?

A

NSAIDS!

Ibuprofen, naproxen, mefenamic acid

56
Q

After initiating NSAIDs, what is the next step in managing a pt w/ primary dysmenorrhea?

A

Combined OCPs

**use if pt is sexually active, NSAIDs tx failed, or not tolerated

57
Q

If NSAIDs and OCP fail, what do you need to do next for tx of primary dysmenorrhea?

A

May need to perform a laparoscopy to r/o endometriosis or ovarian pathology

Other indications for laparoscopy

    • Pelvic pain outside of menses
    • Hx of STI
    • Onset of sx w/ menarche
58
Q

What are some causes of secondary dysmenorrhea? (there are a lot just be able to recognize)

A 
Endometriosis
Adenomyosis
Uterine leiomyomata
Ovarian cysts
Pelvic adhesions
Chronic PID
Obstructive uterovaginal anomalies 
Cervical stenosis
Copper IUD
IBS
Inflammatory bowel disease
Interstitial cystitis
59
Q

The prevalence of secondary dysmenorrhea (increases/decrease) with age

The prevalence of primary dysmenorrhea (increase/decreases) with age, and may remit after a term pregnancy

A

increase

decrease

60
Q

what are hx facts that may be suggestive of dysmenorrhea?

A 
onset after 25 y.o.
abnormal uterine bleeding
pain is non-mid-line
absence of other menstrual sxs
dysparunia, dyschezia
progressive sxs
61
Q

How can you tx secondary dysmenorrhea?

A 
NSAIDs
OCPs
tx underlying d/o (below is fyi)
- abx for pelvic infxn
- Cautery of endometrial implants
- Hormonal tx for endometriosis
- Resection of symptomatic fibroids
- Ovarian cystectomy
- Hysterectomy 
- Drug tx for inflammatory bowel disease
- Drug tx for interstitial cystitis
62
Q

___ is menstrual blood loss >80 ml (avg. = 35-40 ml)

A

Menorrhagia

63
Q

___ is duration of menses greater than 7 days

A

Prolonged menses

64
Q

___ is irregular bleeding, especially between menses

A

Metrorrhagia

65
Q

___ is excessive and irregular uterine bleeding

A

Menometrorrhagia

66
Q

___ is abnormal bleeding not from anatomic abnormality, generally anovulatory bleeding.

A

Dysfunctional uterine bleeding (DUB)

67
Q

___ is a cycle length less than 24 days

A

Polymenorrhea

68
Q

What are causes of menorrhagia?

A

Anovulation/DUB
Anatomic abnormalities
Coagulopathy

69
Q

___ is common in adolescence, perimenopause, PCOS, thyroid d/o

A

Anovulation/DUB

70
Q

What is a key thing you should try to determine on the PE of Menorrhagia?

A

where is the bleeding site

71
Q

What should be included in the work-up for Menorrhagia?

A 
B-hCG
CBC
Cervical ctyology
endometrial biopsy
STI screen 
TSH
Coagulation studies 
pelvic US
Hysterscopy
72
Q

how can you treat menorrhagia If it’s due to anovulation?

A

Cycling with combined OCs

Scheduled progestin withdrawal bleeds

Medicated IUD (Mirena)

73
Q

how can you treat menorrhagia If it’s caused by an anatomic abnormality?

A

Hysteroscopic resection of endometrial polyps, submucous myomas

OCs and medicated IUD may have some efficacy at controlling heavy bleeding from myomas and adenomyosis

Endometrial ablation

Myomectomy

Hysterectomy

Repro. Med 2 (12 decks)

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