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Repro > Lecture 4: Menstrual Disorders > Flashcards

Lecture 4: Menstrual Disorders Flashcards

1
Q

What is menarche?

How long after 1st menarches is first ovulation?

A

onset of menses (period)

1st ovulation = 6-9 months after 1st menses

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2
Q

What 2 hormones dominate the follicular phase (day 0-14)?

which is more dominant day 0-5?

What causes ovulation on day 14?

What hormone predominates during luteal/secretory phase (day 14-28)

A

follicular = Estrogen and FSH

Estrogen = day 0-5

ovulation: d/t LH surge

luteal phase = progesterone

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3
Q

3 possible definitions of primary amenorrhea:

What is a marker of ovarian fxn?

A

Absence of menses:
1. before age 16 in presence of norm pubertal development

  1. before age 14 in ABSENCE of norm pub. development
  2. 2 yrs after sexual maturity

breast exam = marker of ovarian fxn

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4
Q

pt has low/normal FSH, what type of problem do they have? Where is problem if FSH is high?

A

low FSH –> hypothal or pituitary problem

high FSH –> ovarian problem

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5
Q

3 major classification of primary amenorrhea

A
  1. Ovarian failure
  2. Outflow Tract (Uterus problem)
  3. Obstruction
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6
Q

Ovarian Failure:

  1. what labs seen?
  2. what is present/absent?
  3. What is MC cause of ovarian failure?
A

Ovarian Failure:

  1. Labs - high FSH/LH, LOW estradiol
  2. what is present/absent?
    - no breasts but + uterus
  3. What is MC cause of ovarian failure?
    - Gonadal Dysgenesis
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7
Q

Infertile patient presents w/webbed neck, short stature, heart defects and learning disabilities…Dx?

What is this d/o assoc w/?

A

Turner Syndrome (45, X0)

Congenital cause of Gonadal Dysgenesis

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8
Q

Turner Syndrome:

  1. What is it?
  2. What does no ovaries lead to?
  3. How to Dx?
  4. Tx ?
A
  1. partial or complete loss of X chrom
  2. no ovaries –> “gonadal streak” (fibrous tissue)
  3. Dx = karotype
  4. replace estrogen + give progesterone to induce menses/shed lining
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9
Q

Outflow tract problem:

What is Mullerian agenesis? Result of this?

A

Mullerian agenesis = congenital malformation of mullerian duct (forms vagina, uterus, etc) –> NO uterus + shortened vagina

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10
Q

How does Mullerian Agenesis differ from Turner’s?

what is the Tx for Mullerian Agenesis

A

Mullerian Agenesis

  • breasts present
  • NO uterus
  • normal karyotype
  • norm hormone levels
  • Tx = surgical reconstruction of vag

Turner’s

  • NO breasts
  • Uterus present
  • abn karyotype
  • abn hormone levels
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11
Q

2 types of obstruction for primary amenorrhea?

are breasts and a uterus present? hormone levels?

What are the Sxs?
Tx?

A
  1. Imperforate Hymen
  2. Transverse vaginal septum

both breasts and uterus are present; hormone levels normal

Sxs = retention –> cyclic abd pain, bloating/ distended abd

Tx = surgery

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12
Q

How does imperforate hymen and transverse vaginal septum cause obstruction?

A

imperforate hymen
- hymen doest perf during dev –> blocks vagina

transverse vaginal septum
- wall of tissue blocking the vagina

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13
Q

definition of secondary amenorrhea?

MC cause?

A

absence of menstruation:

  • > 3 months (cycles) in pts w/prev prior reg cycles or..
  • 6 mo in pts w/irreg cycles

MC cause = preg

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14
Q

Pt presents w/ body habitus (thin), hirustism/acne, galactorrhea, dry/atrophic vagina and dyspareunia. But uterus present/normal size.

What type of d/o does she have?

A

secondary amenorrhea

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15
Q

Progestin Withdrawal test:

  1. what does it determine?
  2. how performed?

What is a + withdrawal bleed

  • what does this indicate
  • Tx?

What 2 things are a/w (-) withdrawal bleed

A
  1. determine if estrogen defic or ovulation prob
  2. Give pt Provera (medroxyprogesterone) for 10 days–> look for withdrawal bleed

+ withdrawal bleed = bleeding 2-7 days after complete provera

  • ovarian problem –> pt not ovulating
  • Tx = OCPs

(-) withdrawal bleed = estrogen defic or outflow problem

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16
Q

What is the hypothalamus d/o related to 2ndary amenorrhea?

A

Functional Hypothalmic Amenorrhea

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17
Q

Pt has low FSH, LH, and estradiol; norm PRL. She has admitted to wt loss d/t excessive exercising lately. You find out she has already been Dx w/AN. What is Tx?

A

Tx = nutrition, OCPs (estrogen)

Dx = Functional Hypothalmic Amenorrhea

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18
Q

What is the female athlete triad?

A
  1. eating d/o (AN)
  2. amenorrhea
  3. Osteopenia
19
Q

What are the 2 pituitary d/o related to 2ndary amenorrhea?

Labs seen? (what is incr/result)

A
  1. Sheehan Syndrome
  2. Pituitary adenoma

decr FSH, LH and estradiol

INCR PRL –> galactorrhea

20
Q

What is Sheehan syndrome d/t, who occur in and result?

How to Dx/Tx?

A

Hemorrhage in postpartum pt –> HotN and infarct/necrosis of pituitary gland

Dx = MRI

Tx = replace pituitary hormones

21
Q

What are the 2 ovary d/o related to 2ndary amenorrhea?

A
  1. Premature Ovarian failure

2. PCOS (polycystic ovarian syndrome)

22
Q

Premature Ovarian failure:

  • what is it? age?
  • Presentation (what are Sxs similar to)
  • Hallmark?
  • how to Tx?
A

early menopause (< 40)

  • Sxs = similar to menopause (hot flashes, atrophic/dry vag, etc)
  • hallmark = incr FSH
  • Tx = HRT (estro + progest), Vit D and Ca
23
Q

What are the 4 main signs of PCOS?

A
  1. hyperandrogenism
  2. obesity
  3. Irreg pds (oligo/amenorrhea)
  4. Anovulatary bleeding
24
Q

How to Dx/what seen and how to Tx PCOS?

A

US –> polycystic ovaries

Tx = OCPs, metformin

25
Q

Main uterine d/o a/w 2ndary amenorrhea?

A

Ashermann Syndrome

26
Q

What is Ashermann Syndrome?

- MC cause?

A

intrauterine adhesions/fibroids

MC caused by D&Cs

27
Q

What can be used to Dx AND Tx of Ashermann Syn?
- what see on Pelvic US

other Tx?

A

Dx + Tx = Hysteroscopy
- can use it to remove adhesions

  • pelvis US –> no norm uterine stripe

Other Tx = estrogen –> endometrial regen

28
Q

Definition of dysmenorrhea?

A

pain w/menstrual cycle (cyclic)

29
Q

Difference b/t primary dysmenorrhea and secondary?

what are each d/t?

A

Primary

  • no pelvic pathology (d/t incr PGs)
  • pain is during 1st 2-3 days of cycle

Secondary
- pathology (MC
= endometriosis)
- new onset pain

30
Q

Mainstay of Tx for dysmenorrhea?

Other 2 Tx options?
- what no given?
other 2 supportive Tx options?

A
  1. NSAIDs + OCPs

Others

  • IUDs (NOT COPPER–> more pain)
  • Depo Provera

Supportive Tx
- heat, Vit E

31
Q

What NSAIDs given for dysmenorrhea?

When should they be given?

How do they work to decr pain a/w dysmenorrhea?

A
  1. Ibuprofen
  2. Naproxen Sodium

Start 1-2 days before menses and continue for 2-3 days

decr PGs –> less inflam–> less pain

32
Q

Definition of endometriosis? result?

MC sites?

Theory for pathogenesis?

A

growth of endometrial tissue outside the uterine cavity (ectopic) –> inflammatory response (pain)

MC = ovary (and ant/post cul-de-sac)

retrograde menstruation –> backflow of cells thru fallopian tubes to peritoneal cavity

33
Q

Classic triad a/w endometriosis?

3 other signs:

A

“PAIN”

  1. Cyclic pelvic pain
  2. Dysmenorrhea
  3. Dyspareunia

others

  1. dyschezia
  2. infertility
  3. urinary Sxs
34
Q

2 Signs on PE indicating endometriosis?

Gold std = for Dx?
- see raised patches of thickened, discolored, scarred or powder burned implants of tissue

A
  1. Tender nodularity (cul-de sace and uterine ligaments)
  2. Fixed/immobile uterus

gold std for dx = laparascopy

35
Q

Mainstays of Tx for endometriosis?

Why?

A
  1. NSAIDs + continous hormonal therapy

- continous hormonal therapy–> decr ovulation –> less pain

36
Q

What are the 3 infreq used methods for Tx endometriosis?

A
  1. GnRH agonists (leuprolide)
  2. Danazol
  3. Aromatase inhib
37
Q

Definition of PMS (premenstrual syndrome)

When does it resolve?

A

Physical, behav and mood changes that occur repetitively in 2n half of menstrual cycle (luteal phase) & 1st few days of menses

resolves w/onset of menses (criteria discussed later is more spp)

38
Q

What is PMS possibly d/t?

A

ovarian hormonal fluctuations and NT disturbances (serotonin)

39
Q

2 mai requirements for Dx of PMS?

A
  1. 1 or more behavioral/emot or somatic Sxs 5 days before menses in last 3 menstrual cycles
  2. Sxs relieved w/in 4 days of menses –> cant recur til at least day 13 (7 days of no sxs in follicular phase)
40
Q

How does PMDD differ from PMS?

A

PMDD = more severe

41
Q

Dx criteria for PMDD requires 5+ Sxs during most cycles in last year AND 1 of Sx must be (4 options)

A
  1. Depressed mood
  2. Anxiety/tension
  3. Lability
  4. Angry/irritable
42
Q

what 3 other things must be present to make Dx of PMDD?

A
  1. Markedly interferes w/life
  2. Not exacerbation of another d/o
  3. Confirmed by prospective daily ratings in 2 consec cycles w/Sxs
43
Q

Tx for PMS AND PMDD:

  1. what is tx for mild Sxs?
  2. what is tx for mod-severe Sxs?
A
  1. Mild Sxs –> lifestyle modifications

2. mod-severe Sxs –> SSRIs

44
Q

What 2 SSRIs used for PMS and PMDD

A
  1. Fluoextine

2. Sertraline

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