Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Women's Health Theory > Bleeding Across the Lifespan > Flashcards

Bleeding Across the Lifespan Flashcards

1
Q

Definition: normogonodotropic

A

normal amounts of gonadotropic hormones (GnRH, FSH, LH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What produces GnRH?
What produces FSH/LH

A
  1. Hypothalamus produces GnRH
  2. Anterior pituitary produces FSH/LH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define: Hypergonadotropic

A

higher than normal amounts of gonadotropic hormones produces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define: Hypogonadotropic

A

lower than normal amounts of gonadotropic hormones produces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define: Hypogonadism

A

lower than normal amounts of gonadal hormones (estrogen, progesterone, testosterone) produced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define: Hyperprolactinemia

A

higher than normal amount of prolactin produced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is more common primary or secondary ammenorrhea?

A

Secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common causes secondary amenorrhea

A

1) pregnancy
2) PCOS
3) hypothalamic amenorrhea
Other: hyperprolactinemia, POI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk factors of hypothalamic amenorrhea

A

a. low/poor nutrition
b. Excessive exercise (female athlete triad)
c. Severe stress (cortisol connection)
d. Thyroid disease
e. Medication induced (dopaminergic)
f. Chronic illness (celiac disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RF hyperprolactinemia

A

i. Tumors
ii. Empty sella syndrome (ESS)
iii. Cushing’s disease
iv. Sheehan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF POI

A

i. Genetics
ii. Autoimmune
iii. Chemo/radiation
iv. Environment
v. Galactosemia (galactose deficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Outflow disorders: primary amenorrhea

A

imperforate hymen, labial agglutination, transverse vaginal septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

General s/s outflow disorder

A

Cyclical abdominal pain arising from accumulated menstrual blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

S/s Mullerian anomalies & agensis (i.e. uterine anomalies)

A

i. Ovulation usually occurs when ovaries present
ii. Secondary sex characteristics are present
iii. Potential for painful intercourse/sexual activity d/t vaginal deviations, absence of cervix (decreased mucous)
iv. Normal steroid hormone production
v. Difficulty getting pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outflow disorder: secondary amenorrhea cuases

A

Asherman’s syndrome (scarring from procedure, hemorrhage, or infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Genetic conditions that cause primary amenorrhea

A

-Androgen insensitivity syndrome (AIS)
-Turner syndrome
-Pure gonadal dysgenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Do pituitary adenomas cause primary or secondary amenorrhea?

A

Both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is POI?

A

depletion of oocytes before age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

S/S POI

A

-high FSH
-irregular menses
-VMS
-Estradiol in menopausal level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

consequences of female athlete triad?

A

early low bone density increases the risk of osteoporosis later in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sequelae of POI

A

i. Vasomotor symptoms: hot flashes, vaginal dryness
ii. Urogenital atrophy
iii. Osteoporosis and fracture
iv. Increase in CV disease (estrogen is cardio-protective)
v. Increase in all-cause mortality  consider estrogen supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Parameters of primary amenorrhea

A
  1. no menses by age 15 with normal growth and development of secondary sexual characteristics
  2. No menses 3 years past breast development
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Parameters of secondary amenorrhea

A

Absence of menses for 3 cycle intervals or 6 months in a woman who has previously menstruated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ROS for amenorrhea

A
  1. Constitutional: hot flashes, night sweats
  2. Skin hair nails: lanugo  anorexia; hirsutism & acne  hyperandrogenism
  3. Eyes: visual changes
  4. Breasts: tenderness, galactorrhea
  5. Thyroid problems
  6. Cyclic pelvic pains?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Tanner staging review (primary amenorrhea) starting with Tanner 2 - 5
Tanner 2 breast budding Tanner 3 areola is becoming darker Tanner 4 nipples and areolas are elevated and form an edge towards the breast Tanner 5 fully formed
26
Findings of Turner syndrome
Short stature, neck webbing, pigeon chest
27
Labs for amenorrhea
Pregnancy test Serum prolactin FSH/LH TSH estradiol --> for POI
28
Amenorrhea with low FHS/LH - what do you start to think
functional hypothalamic amenorrhea
29
Amenorrhea with normal FHS/LH - what do you start to think
Consider outflow track obstruction
30
Amenorrhea with elevated FSH/LH - what do you start thinking
POI
31
Physiologic causes of amenorrhea
-pregnancy -breastfeeding -contraception -peri/menopause
32
outflow tract disorders that cause primary amenorrhea
1. Asherman’s  acquired scarring 2. Transverse vaginal septum 3. Imperforate hymen 4. Cervical stenosis 5. Labial agglutination (low estrogen stage) 6. Congenital anomalies (mullerian anomalies & agenesis) 7. Androgen insensitivity syndrome
33
HPO axis disorders that cause amnorrhea
Hypothalamic: eating disorders, weight loss, stress, THBI Pituitary: hyperprolactinemia, prolactinoma, ESS, medications
34
Endocrine gland disorders that can cause amenorrhea other than hypothalamus or pituitary
adrenal disease delay of puberty cushing syndrome PCOS thyroid disease
35
What happens in functional hypothalamic amenorrhea?
2. There is decreased GnRH secretion  therefore no LH surge from anterior pituitary -- anovulation a. See low serum estradiol
36
What comprises the female athlete triad
3 components: low energy, menstrual dysfunction, low bone density
37
What is a normal prolactin level?
<30
38
what happens with pituitary amenorrhea? (prolactin, GnRH, LH/FSH, estrogen)
Increased prolactin inhibits GnRH  which means no LH/FSH  anovulation (low estrogen)
39
What can cause elevation of prolactin?
breastfeeding/stimulation, altered metabolism d/t liver or kidney failure, ectopic production, medications [OCs, antipsychotics, antidepressants, anti-HTN, opiates, steroids]
40
What is considered hyperprolactinemia
> 100
41
Ovarian causes of amenorrhea
1) PCOS 2) POI 3) gonadal dysgenesis (most commonly seen with Turner's sydrome)
42
When do you perform a progestin challenge?
FSH/LH normal and no identifiable cause of amenorrhea
43
How does a progestin challenge work?
- PO progestin 7-10 days (or IM 1 dose) - Stimulates the endometrium to cause a withdrawal bleed - WDB occurs 2-7 days after completion of progestin
44
+ WDB means
patent outflow tract AND endogenous estrogen present
45
(-) WDB means
outflow tract abnormality and/or inadequate estrogen production
46
What do you do after a failed progestin challenge?
Estrogen & progestin challenge
47
How is an estrogen/progestin challenge performed?
PO administration of COC for 21 days OR can do PO estrogen for 21 days followed by PO progestin 7-10 days
48
+ E/P WDB means
failure in the HPO axis -recheck FSH/LH o < 5  MRI for possible tumor o WNL: hypothalamus or pituitary problem, PCOS o Elevated FSH or LH  POI
49
(-) E/P WDB means
outflow track obstruction
50
Tx for outflow tract disorders (partial imperforate hymen or labial agglutination)
estrogen cream and aquaphor
51
Tx pituitary adenoma (pharmacologic)
prolactinomas: dopamine agonist (bromocriptine)
52
Tx: POI
Estrogen supplementation
53
When do you see surgical interventions?
1) Asherman's syndrome 2) pituitary adenomas
54
Define: AUB
alteration in the volume, pattern and or duration of menstrual flow – arising from the uterus
55
What is the most common reason for gyn referrals?
AUB!
56
Define: Menorrhagia
heavy or prolonged bleeding at REGULAR intervals
57
Define: metrorrhagia
irregular intervals or bleeding between menses
58
Define: menometrorrhagia
irregular intervals AND heavy/prolonged flow
59
Oligomenorrhea
greater than normal intervals (>35 d)
60
Age group 13-18: most common cause of AUB
Immature HPO axis iatrogenic d/t BC Pregnancy
61
Age group 19-39: most common cause of AUB
Pregnancy Structural lesion: fibroid/polyp adenomyosis PCOS
62
Age group 40+ - menopause: most common cause of AUB
Anovulation d/t menopause endometrial hyperplasia endometrial atrophy endometrial CA
63
Age group post-menopausal: most common cause of AUB
malignancy iatrogenic (d/t hormone therapy) atrophy
64
Leiomyoma RF
black smokers nulliparous long menstrual cycle
65
Malignancy RF
age obesity unopposed estrogen tamoxifen use early menarche/late menopause nulliparity PCOS chronic anovulation infertility Fhx colon cancer/lynch syndrome, cowden syndrome Fhx endometrial, breast or ovarian CA, prior diagnosis of endometrial hyperplasia
66
Iatrogenic RF
amphetamines, anticoagulants, aspirin, antipsychotics, SSRIs, NSAIDs, neuroleptics, marijuana alcohol, corticosteroids (prednisone), tamoxifen, herbs/supplements, LNG-IUD, covid vaccine (can cause shift in menstrual cycle)
67
S/s: Polyps
Bright red painless Bleeding/spotting
68
S/s: malignancy
AUB PMB
69
S/s: coagulopathy
bruise easily frequent nose bleeds hx PP hemorrhage bleeding with sx or dental work Fhx
70
S/s: ovulatory dysfunction
no moliminal signs irregular heavy menses
71
S/s: endometrial dysfunction
HPO intact menses/ovulation occur regularly normal steroid hormones (estrogen, progesterone, testosterone)
72
S/s: endometritis (chronic/acute)
Chronic: PID, uterine and cervical motion tenderness Acute: postpartum or post-abortion
73
S/s: anovulation
unpredictable cycle length bleeding patterns frequent spotting frequent/unpredictable heavy bleeding monophasic basal body temperature no moliminal signs
74
When do you consider removing polyps?
When individuals are older because there is a chance of malignancy
75
What can leiomyomas impact?
fertility
76
Pertinent history for abnormal genital/uterine bleeding
i. LMP: normal for the patient? How were your past menstrual periods? ii. Menarche – age? Menopausal symptoms? iii. Cycle length – regular? iv. Duration (# flow days), amount – estimate the blood loss and severity v. Dysmenorrhea? vi. Moliminal symptoms? vii. Medications? Including contraception *helps to clue in if ovulating viii. Other sign/symptoms of hemostatic disorder
77
Leiomyoma PE - what to look for?
pelvic exam -- give us an idea if the uterus is enlarged Need US to confirm
78
When would you perform an EmBx?
-malignancy -AUB
79
When would you perform an TVUS?
-polyps -leiomyoma -malignancy (post menopausal lining cut off is 4 mm) First line diagnostic for: ovarian mass, uterine fibroids and polyps
80
When would you perform a saline infusion sonohystogram (SIS)?
polyps visualization
81
When would you perform an hysteroscopy?
-polyps -when embx is insufficient to r/o malignancy
82
When would you perform a dilation and curettage?
-malignancy -AUB: when embx not sufficient
83
When would you perform an MRI?
adenomyosis - might see asymmetric thickening of the mymetrium
84
What labs do you order for coagulopathy?
[Pt, Ptt, platelets, +/- fibrinogen, thrombin time] also potentially consider BUN, Cr
85
What labs do you order for AUB
urinalysis, pregnancy test, TSH, STI, Wet mount, Pap
86
Differentials: bleeding from vulva/vagina
a. Genitourinary syndrome of menopause (GSM) – loss of ruggae b. Vaginitis: yeast, atrophy, trich, BV c. Trauma d. Vaginal carcinoma e. Foreign body
87
Differentials: bleeding from cervix
a. Infection (cervicitis) b. Polyps c. Cancer d. Condyloma
88
Differentials: bleeding from fallopian tubes
a. Salpingitis/PID b. Tumors
89
Differentials: bleeding related to ovaries
a. Benign/malignant tumors b. Ruptured follicular or corpus luteum (CL) cysts c. Adnexal torsion (so much pain!!)
90
Differentials: obstetric related bleeding
a. Ectopic pregnancy b. Spontaneous abortion c. Implantation bleeding d. Subchorionic hematoma e. Gestational trophoblastic disease/molar pregnancy f. Post-abortion/postpartum endometritis (infection/inflammation of endometrium) g. Hyperemia of cervix/post-coital spotting h. Unexplained!
91
PALM COEIN
- PALM = visualizable structural sources of bleeding - Polyps, adenomyosis, leiomyomas, malignancy - COEI = unrelated to structural abnormalities - Systemic disease, iatrogenic causes, disorders of the HPO axis - Coagulopathy [von Willebrand {most common}, thrombocytopenia, leukemia, liver disease/renal disease] Ovulatory dysfunction, Endometrial, Iatrogenic - N – “not yet classified”
92
Management: adenomyosis
-IUD -Progesterone
93
Management: HMB (heavy menstrual bleeding) -stabilize lining -acute bleeding -cycle the endometrium -before period
-stabilize lining: pill, patch, ring -acute bleeding: IV estrogen -cycle the endometrium: (any combination of estrogen, progestin) w/ COCPs, patch, ring; suppress endometrium with continuous progestin, extended use COCPs, danazol & GnRH agonists -before period: NSAIDs 24 hours before expected menses
94
Heavy and prolonged menstrual bleeding -initial treatment -maintenance therapy
1) aygestin taper (1 pill q 4 hrs for 24 hours and then taper) 2) "cascade" COCP Maintenance: -extended cycle COCP -IUD (52 mg) -medroxyprogesterone acetate and norethindrone ***still need birth control
95
How to definitively diagnose adenomyosis
hysterectomy with histologic exam
96
Procedures for HMB?
-ablation -hysterectomy -aspiration
97
Patient education for HMB
1. Avoid use of aspirin/aspirin containing products during week prior to menses 2. Avoid increased heavy activity during the days of heaviest flow 3. Hot tubs can increase flow 4. Use pads vs tampons if possible 5. Change tampons frequently 6. Increase Fe in diet/take supplemental

Women's Health Theory (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions