Amenorrhea/Dys/PCOS

Question 1

Amenorrhea

Answer 1

PCOS: Treated until menopause
Functional Hypothalamic Amenorrhea: Small, stressed, over exercising; treat w/lifestyle before hormones
Hyperprolactinemia Treatment: Withdrawal of medications, pituitary resection, dopamine agonists

Question 2

Estradiol

Answer 2

IND: Hypogonadism, metastatic breast cancer, hypoestrogenism, osteoporosis prevention, prostate cancer, vasomotor s/s, vaginal atrophy
MOA: Acts as endogenous estrogen
BOX: Endometrial cancer; increased risk of unopposed estrogen (no progestin)
CV DZ
Breast cancer: Increased risk
Dementia: Not for prevention
CON: UnDx genital bleeding, thromboembolic dz, breast cancer, estrogen-dependent tumors, hepatic dz, pregnancy
ADR: Breast pain, vaginal bleeding, m/s pain, edema

Question 3

Progesterone

Answer 3

IND: Amenorrhea
MOA: Acts as Progestin. 10-12 days/month in addition to estradiol or estrogen.
BOX: CVD
Breast cancer
Dementia; doesn’t prevent
CON: Allergy to peanuts, bleeding/clotting disorders, tumors, breast cancer, hepatic dz, pregnancy
ADR: Breakthrough bleeding, weights, galactorrhea

Question 4

Dysmenorrhea

Answer 4

Abnormal/excessive menstrual pain
NSAIDs: mainstay
COC: second line or first if also desiring contraception
IUD/IM injections
Vit E: Non-NSAID if NSAIDs are contraindicated

Question 5

PMS/PMDD

Answer 5

Severe mood disorder present in the week before menses.
SSRI: First line/gold standard. Use provides benefits WITHIN HRS TO DAYS.
Effect is from ALLO increase within minutes
Continuous or intermittent therapy
Hormonal Therapy: Mixed research and effectiveness

Question 6

PCOS

Answer 6

Treatment depends on prevailing s/s
Infertility: Clomifene or Metformin
Hyperandrogensim: COCs, Spironolactone, Metformin