Amenorrhea and endometriosis/infertility Flashcards Preview

Year2 Repro exam II > Amenorrhea and endometriosis/infertility > Flashcards

Flashcards in Amenorrhea and endometriosis/infertility Deck (49):
1

labs to order for primary amenorrhea

serum pregnancy test
CBC
US
FSH/LH
E2
karyotype

2

whats telarche

onset of female breast development

3

what is pubarche

appearance of sexual hair

4

what is adrenarch

growth of axillary hair

5

what is primary amenorrhea

failure to menstruate by age 16

6

what is secondary amenorrhea

absence of menstruation for 3 cycles> 6 mo

7

common causes primary amenorrhea

constitutional delay
45XO, 46XY
pituitary tumor
congenital adrenal hyperplasia
genital tract anomaly

8

signs pituitary tumor

headaches, blurry vision

9

Dx steps primary amenorrhea

height weight BP
evaluate secondary sexual characteristics
look for signs androgen excess
visual fields
chromosomes
FSH LH E2
androgens TSH and PRL

10

common causes secondary ammenorrhea

stress
weight loss/gain
post pill and depo provera
PCOS
premature menopause or premature ovarian failure
hyperPRL
pituitary adenoma
drug induced
PREGNANCY

11

what is sheehans

post partum hemorrhage, infarct pituitary
stop menstruating

12

uncommon causes secondary amenorrhea

kallmans
sheehans
cushings
ashermans
thyroid disease
post encephalitis
androgen producing tumors
cervical stenosis

13

clincal evaluation for secondary amenorrhea

life events, weight exercise, pregnancy
visual fields, secondary sexual characteristics

14

primary labs for secondary amenorrhea

FSH LH E2 TSH PRL
androgens
US
visual fields

15

secondary tests secondary amenorrhea

CT pituitary
DXM suppression
hydroxyPROG
hysteroscopy

16

labs for primary infertility

FSH LH Progesterone, semen analysis
HSG
diagnostic laparoscopy

17

when is progesterone done

day 21

18

hemosiderin laden macrophages in spots found on ligaments on uterus

endometriosis

19

endometriosis

ectopic endometrium

20

how to Dx endometriosis

laparoscopy +/- Bx

21

Sx endometriosis

dysmenorrhea
dyspareunia
infertility

pre-menstrual staining
pain with defection during menstruation
intermenstrual pain
disordered cycles

22

most important in Dx of endometriosis

careful Hx

23

gold standard for endometriosis Dx

laparoscopy

24

differenctial Dx for endometriosis

primary dysmenorrhea
IBS
ovulation pain
PID

25

theories that cause endometrium

retrograde menstruation
peritoneal metaplasia

26

predisposing factors endometriosis

familial
disordered immunity
environmental toxins
recurrent ovulation
infertile partner
obstructed menstrual flow

27

hwo to mange endometriosis

if pain use medical Rx
if infertility then surgery
no problem, don't need to tx

28

what type of medical Rx would you use in endometriosis

progestins: OCP, provera or norethisterone, mirena IUD

29

benefits of laparoscopy with diathermy in endometriosis

dec pain
dec infertility

30

what is infertility

12 mo of regular sex without contraception

31

principal causes of infertility

ovulation
sperm
tubal
cervical factor
endometriosis

32

how to test ovulation

check body temperature- progesterone
check progesterone at day 21
LH surge in urine

33

how to test if tubes are still open

hysterosalpingogram
laparoscopy with dye studies
(both can open tube up if mild obstructin)

34

testing cervix

around day 12 or 13
sample mucous after intercourse
can also use this to look at sperm

35

what is semen analysis

48-72 hours
collect whole sample
examined 1-2 hours at room temp
look at count, motility and morphology
if abnormal- repeat.

36

labs if suspec tmenopause

CBC
FSH LH
TSH
Pregnancy
endometrial Bx and pap

37

Tx for menopause with Sx

HRT

38

perimenopause

time leading up to menopause, time when ocarian function and hormone production are declining

39

premature menopause

before age 40

40

menopause Sx

vasomotor Sx
sleep changes
mood changes
UG Sx, dryness and atrophy
sexual well being, libido
skin changes

41

decreased E can lead to

vasomotor Sx, urogenital disorders, CHD risk factors, skin changes
CV disease
bone loss/osteoporosis

42

decreased P can cause

irregular periods
PMS

43

decreased androgen Sx

decrease mood, energy
msucle weakness
dec libido
osteopenia

44

what is better HT at time of menopause or after menopause

HT does not increase CHD if started within 5 years of onset
does increase risk CHD if initiated late

45

when is risk of VTE with HT occur

1st year of use

46

When should E be taken to prevent dementia of menopause

perimenopause or very onset menopause

47

when do we give P as well as E for HRT

still have uterus because protects against uterine CA

48

Tx for menopausal patients with mild vasomotor Sx

lifestyle changes
dietary isoflavones
black cohosh
Vit E

49

Tx for mod-severe vasomotor Sx

HT "gold standard"
SSRIs and gabapentin
Progestogens