Flashcards in Abnormal Uterine Bleeding 2 Deck (17)
What conditions are ovarian failure, chronic anovulation w estrogen absent and w estrogen present?
failure = hyper hypo
absent = hypo hypo
present = eugonadotropic eugonadism
Which chromosomal disorders can cause amenorrhea?
Turners or 46 XX or 46 XY gonadal dysgenesis
What is fragile X syndrome?
X linked dominant CGG unstable repeat that expands over generations
55-200 repeats = premutation, >200 = full
correlation w POF
What iatrogenic or infectious causes are there for POF?
surgery, radiation, chemo
When should autoimmunity be considered as a cause of POF?
when no other source found - screen for other autoimmune disorders
What are more minor causes of POF?
galactosemia (AR, 85% get POF)
enzymatic (17alpha hydroxylase def)
What are the etiologies of chronic anovulation with estrogen low or absent (hypo hypo)?
inherited hypothalamic-pituitary abnormalities - Kallman's syndrome (no sense of smell), idiopathic hypo hypo
Will women with hypo hypo experience withdrawal bleeding after progesterone treatment?
no - endometrium thin b/c no estrogen stimulation
What are the etiologies of chronic anovulation with estrogen present?
tumors (ovarian or adrenal) - production of excess estrogen or androgens can interfere w axis
chronic illness - ESKD, malignancy, malabsorption
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
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
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!
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
intraovarian androgens rise and androgen dominant follicles fail to develop
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
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
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