Abnormal Uterine Bleeding 2 Flashcards Preview

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Flashcards in Abnormal Uterine Bleeding 2 Deck (17):
1

What conditions are ovarian failure, chronic anovulation w estrogen absent and w estrogen present?

failure = hyper hypo
absent = hypo hypo
present = eugonadotropic eugonadism

2

Which chromosomal disorders can cause amenorrhea?

Turners or 46 XX or 46 XY gonadal dysgenesis

3

What is fragile X syndrome?

X linked dominant CGG unstable repeat that expands over generations
hypermethylation FMR1
55-200 repeats = premutation, >200 = full
correlation w POF

4

What iatrogenic or infectious causes are there for POF?

surgery, radiation, chemo
mumps oophoritis

5

When should autoimmunity be considered as a cause of POF?

when no other source found - screen for other autoimmune disorders

6

What are more minor causes of POF?

galactosemia (AR, 85% get POF)
enzymatic (17alpha hydroxylase def)
idiopathic

7

What are the etiologies of chronic anovulation with estrogen low or absent (hypo hypo)?

functional
inherited hypothalamic-pituitary abnormalities - Kallman's syndrome (no sense of smell), idiopathic hypo hypo
hypothalamic-pituitary lesions
hyperprolactinemia
thyroid dz
chronic illness

8

Will women with hypo hypo experience withdrawal bleeding after progesterone treatment?

no - endometrium thin b/c no estrogen stimulation

9

What are the etiologies of chronic anovulation with estrogen present?

PCOS
hyperprolactinemia
thyroid dz
tumors (ovarian or adrenal) - production of excess estrogen or androgens can interfere w axis
chronic illness - ESKD, malignancy, malabsorption

10

What are the Rotterdam criteria for diagnosing PCOS?

affected individuals must have two out of following three:
oligo- or anovulation (12 cysts of 10 ml) - only needs to be in 1

11

What are the long-term health risks associated with PCOS?

oligo-anovulation: menstrual irregularities, infertility, endometrial hyperplasia/cancer
metabolic disorders: insulin resistance/diabetes, dyslipidemia/CV dz
pregnancy complications
depression, anxiety
sleep apnea
NAFLD

12

What kinds of menstrual abnormalities are seen in pts with PCOS and oligo-anovulation?

pts can have long periods w no bleeding followed by severe menorrhagia at unpredictable intervals = estrogen withdrawal bleeding
ovarian androgens converted to estrogens resulting in negative feedback and endometrial thickening
bleeding does not equal ovulation!

13

What are the features of hyperandrogenism in PCOS leading to hirsutism and acne?

LH:FSH = 2:1 or 3:1 - LH drives androgen production, abnormal feedback
not virilism!
intraovarian androgens rise and androgen dominant follicles fail to develop

14

What factors can affect androgen action in PCOS?

end organ sensitivity
genetic differences in concentration of hair follicles or 5alpha reductase activity, androgen metabolism or receptor activity
reduced SHBG levels can elevate free testosterone levels and lead to normal total testosterone

15

What pregnancy complications are pts with PCOS at risk for?

miscarriage (2X normal rate) - maybe increase in circulating insulin
gestational diabetes, pregnancy induced HTN, pre-ecclampsia

16

How does the progesterone challenge test help distinguish between different causes of amenorrhea?

withdrawal bleed positive = estrogen present (PCOS)
withdrawal bleed negative = estrogen absent, check FSH

17

What are the basic approaches to treatment of hormonal causes of abnormal menstrual bleeding?

treat underlying dz (dopamine agonist or TH replacement)
if not making estrogen, give it to protect against osteoporosis
if making or receiving estrogen, also need progesterone to control endometrial hyperplasia (OCPs)
ovulation induction if want to be pregnant
weight reduction if overweight
control insulin resistance and lipid abnormalities (metformin common)