Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

OBGYN rotation review > dysmenorrhea and amenorrhea > Flashcards

dysmenorrhea and amenorrhea Flashcards

(78 cards)

Start Studying
1
Q

why are women w/ PMDD emotional

A

decreased serotonin in the progesterone dominant luteal phase

progestone increases MAO ⇒ reduces serotonin availability​

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

pharmacologic treamtent options for PMDD

A

*** SSRIs ***

oral contraceptives

NSAIDs (helps dysmenorrhea, mastodynia, leg edema)

spironolactone (decreases bloating)

GnRH agonists (refractory)

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

No secondary sex characteristics and high FSH

A

hyper gonadotropic hypogonadism

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

secondary amenorrhea initial lab workup

A

urine/ serum hCG

FSH

prolactin

TSH

total testosterone (if hyperandrogenism)

pevlic US

pituitary MRI (if suspect pituitary etiology)

adrenal CT (if virilization + high T)

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

when evaluating primary amenorrhea, what are you looking for in the thyroid exam

A

goiter

abnormal DTR’s

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

molimina symptoms

A

breast tenderness

ovulatory pain

bloating

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

46 XX F

+

menopause before 40

A

Primary Ovarian Insufficiency

presents as secondary > primary amenorrhea

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

scarring of the endometrial lining

(secondary to postpartm hemorrhage/ uterine instrumentation such as D and C)

A

Ashermans Syndrome

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

pain not as much related to the first day of menses, not limited to menses

dyspareunia, infertility, AUB

30-40 y/o

A

secondary dysmenorrhea

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

how do you tx a hemodynamically unstable pt w/ acute AUB

A

admit

IV estrogen

+/- D and C

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

AUB is defined as menstrual bleeding of abnormal

  • quantity =
  • schedule=
  • duration =
A

AUB is defined as menstrual bleeding of abnormal

  • quantity= more than 80 mL
  • schedule= cycle <24 or >38 days
  • duration = more than 8 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cyclic pain/ menstrual cramps

primary amenorrhea

hematometra/ hematocolpos

no uterus

A

outflow obstruction:

transverse septum (inside vagina)

or

imperforate hymen

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

premenstural symptoms affects __% of women

PMS affects __% of women

PMDD affects __% of women

A

premenstural symptoms affects 75% of women

PMS affects 3-8% of women

PMDD affects 2% of women

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

hematometra

A

blood sequestered in uterus

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

AUB and you suspect anovulatory bleeding…

what labs/ screening

A

CBC

+/- TSH, prolactin, fasting glucose w/ fasting insulin

screen for eating disorder, stress, female athlete triad

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

leiomyomas =

A

uterine fibroids

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

how do you tx a pt w/ chronic AUB

A

hormone therapy- mirena IUD/ depo/ estrogen-progestin OCP

tranexamic acid- 3x daily up to 5 days during menses

NSAIDs for the entirety of menses

endometrial ablation

hysterectomy (extreme cases)

endometrial artery embolization/ myomectomy (leiomyomas)

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

how do you treat a stable pt w/ acute AUB

A

hormonal treatents

  • combo oral contraceptives
    • monophasic tab w/ 35 mcg ethinyl estradiol (3 tabs Q daily x 7 days)
  • medroxyprogesterone PO
  • HD estrogen PO w/ anti-emetic

non-hormonal treatment

  • tranexamic acid IV or oral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

for a pt of reproductive age, what are the etiologies of

intermenstrual bleeding

A

cervical infection

cervical dysplasia

IUD

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

what are the common causes of AUB in a 13-18 y/o patient

A
  • ​immature HPO axis ⇒ anovulation
  • oral contraceptives
  • pelvic infection
  • coagulopathy ⇒ menorrhagia
  • tumor
  • primary amenorrhea etiologies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the pituitary causes of amenorrhea

A

adenomas (cushings disease/ prolacinomas/ thyrotropinomas)

isolated hyperprolactinemia w/ galactorrhea (more commonly secondary amenorrhea cuased by hypothyroidism/ meds)

infiltrative dz and or tumors that compress the pituitary stalk

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

when evaluating a pt for AUB, what systemic disease do you need to r/o

A

anemia

(pallor, weakness, parethesias, bruising, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PMS is related to what phase

A

luteal

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

AUB classification

A

PALM COEIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
AUB stands for
abnormal uterine bleeding
26
adenomyosis
ectopic endometrial tissue within the myometrium
27
when does primary dysmenorrhea occur
during ovulatory cycles age 17-22
28
for a pt of reproductive age, what are the etiologies of oligomenorrhea (infrequent)
long follicular phase
29
for a pt of reproductive age, what are the etiologies of menorrhagia
structural lesions coagulopathy liver failure renal failure
30
what are the causes of pituitary disease that lead to amenorrhea
hyperprolactinemia (from prolactinoma/ meds) sheehans syndrome iron deposition primary hypothyroidism
31
how would PCOS present
amenorrhea hyperandrogenism acne
32
what are the common causes of AUB in a 19-38 y/o patient
**pregnancy** structural lesions (leiomyoma, polyp) anovulatory cycles (PCOS) oral contraceptives endometrial hyperplasia endometrial CA
33
at what age and under what circumstances do you need to evaluate primary amenorrhea
under 15 with no menarche or no menarche w/in 3 years of thelarche or under 13 with no menarche/ thelarche
34
how would 17 alpha reductase deficiency present
46 XX F female w/ HTN and primary amenorrhea
35
46 XY M ambiguous genitalia at birth at puberty ⇒ virilization (male hair growth, acne, increased muscle mass, deeper voice) but no genital enlargement + treatment?
5 alpha reductase deficiency can't change T ⇒ DHT don't undergo DHT dependent masculinization as a fetus * treatment: counseling to decide on gender identity * male ⇒ DHT therapy * female ⇒ estrogen therapy
36
PALM COIEN: **What does PALM stand for?** (AUB classification)
* Structural causes of AUB * Polyp * Adenomyosis- endometrial tissue grows into uterine wall * Leio-myoma- non cancer uterine growth * Malignancy and endometrial hyperplasia
37
amenorrhea + hyperandrogenism what's next?
US ⇒ PCOS
38
what specific history questions should you ask when evaluating secondary amenorrhea
* exercise habits/ weight change * skin abnormalities/ changes * sxs of estrogen deficiency * vag dryness, hot flashes, poor sleep, decreased libido * galactorrhea * HA/ visual field defects
39
first line tx for PMDD
SSRIs
40
for a pt of reproductive age, what are the etiologies of polymenorrhea (short intervals)
luteal phase disorder short follicular phase
41
how would Tuners Syndrome present
45 XO primary amenorrhea streak ovaries sexual infantilism shield chest broad webbed neck short hypergonadotropic (high FSH) hypogonadism
42
hematocolpos
blood sequestered in vagina
43
patient presents with primary amenorrhea + secondary sexual characteristics .... what do you do next?
**Ultrasound!** * uterus present ⇒ * imperforate hyman and transverse septum (outflow obstruction) * no uterus ⇒ karyotype * 46XX = muellerian agenesis (no upper vagina/ oviducts/ uterus) * 46 XY = androgen insensitivity syndrome (boobs + internal testes)
44
ovaries don't respond to gonadotropins ⇒ premature depletion of ooctyes and follicles streak ovaries sexual infantilism hypergonadotropic (high FSH) hypogonadism
Turners
45
what are the common causes of AUB in a 40+ y/o patient
anovulatory bleeding endometrial hyperplasia/ carcinomas endometrial atrophy leiomyoma
46
46 XX F female w/ HTN and primary amenorrhea + treatment?
**17 alpha hydroxylase deficiency** no adrenal or sex hormone synthesis so all the precursors get shunted to making mineralocorticoids (aldosterone precursors) ⇒ hypernatremia + hypokalemia + HTN * hydrocortisone/dexamethosone (normalize BP) * spironolactone (to counter excess aldosterone precursors) * LD estrogen (induce development of secondary sex characteristics)
47
1st day of period onset and lasts 12-72 hours: cramp like, intermittent, lower abdominal pain, radiates to lower back/upper thighs N/V/D HA hypotension fatigue
primary dysmenorrhea (clinical diagnosis)
48
for a pt of perimenopausal age, what are the etiologies of AUB
very common declining number of ovarian follicles ⇒ anovulation ⇒ longer intermenstrual periods, skipped cycles, and episodes of amenorrhea
49
postpartum amenorrhea severe hemorrhage hypotension
sheehans syndrome | (secondary amenorrhea)
50
46 XX w/ no fallopian tubes/ uterus/ upper vagina (short vagina) ovaries develop normally ⇒ normal estrogen and progesterone ⇒ normal breast development and FSH what's the treatment?
muellerian agenesis * treatment * counseling * sx to create vagina + vaginal dilation * Assisted Reproduction Techniques * egg harvesting * IVF * surrogate pregnancy * uterine transplant
51
how do transverse septum/ imperforate hymen present
cyclic pain/ menstrual cramps primary amenorrhea hematometra/ hematocolpos no uterus
52
46XY M SRY gene is mutated ⇒ gonads don't differentiate into testes ⇒ **no** testosterone/ DHT/ AMH = **no** secondary sex characteristics female internal and external genitalia hypergonadotrophic hypogonadism
swyer syndrome
53
how would Swyer Syndrome present
46 XY male with female internal and external genitalia
54
primary amenorrhea initial lab workup
urine/ serum HCG serum FSH prolactin TSH pelvic US
55
postpartum pituitary necrosis ⇒ secondary amenorrhea leads to severe hemorrhage hypotension
sheehans syndrome
56
when do you need to evaluate perimenopausal AUB further
if the bleeding is frequent, heavy, or prolonged ⇒ endometrial biopsy (EMB) to r/o hyperplasia and CA
57
how would hypothalamic amenorrhea present
amenorrhea (primary or secondary) **hypogonadotropic hypogonadism** hx of eating disorder, WL, stress, female athletes triad low GNRH ⇒ low/ no FSH and LH ⇒ low follicular development and estradiol
58
mullerian agenesis
46 XX w/ **no** fallopian tubes/ uterus/ upper vagina (short vagina) ovaries develop normally ⇒ normal estrogen and progesterone ⇒ normal breast development and FSH
59
patient presents with primary amenorrhea but NO secondary sexual characteristics .... what do you do next?
check FSH * low ⇒ hypogonadotropic hypogonadism * hypothalamic * pituitary * high ⇒ hypergonadotropic hypogonadism ⇒ karyotype * 46 XY = Swyer * 45 XO = Turners * 46 XX = Premature Ovarian Insufficiency
60
who should get an endometrial biopsy
**all** postmenopausal women w/ **any** uterine bleeding pts \> 45 w/ ovulatory AUB or bleeding is frequent/heavy/lasts more than 5 days pts \< 45 w/ AUB **plus** obese/ chronic anovulation/ PCOS/ persistent bleeding/ refractory
61
how would Primary Ovarian Insufficiency present
46 XX + menopause before 40
62
common causes of secondary dysmenorrhea
endometriosis adenomyosis adhesions PID leiomyomas inflammation/ infection IUD
63
when evaluating primary amenorrhea, what are you looking for in the skin exam
acne virilization/ hirsuitism (male hair pattern) axillary hair growth pubic hair growth
64
when evaluating primary amenorrhea, make sure to look at the development of
breasts external genitalia presence/ absence of uterus
65
what are the most common etiologies of AUB ## Footnote *(AUB accounts for 1/3 GYN visits)*
anovulation structural uterine pathology hemostasis disorders neoplasia
66
endometriosis
endometrial glands outside the uterus
67
No secondary sex characteristics and low FSH
hypogonadotropic hypogonadism * hypothalamic problem * female triad * Kallmans * pituitary problem * tumor
68
what specific history questions should you ask when evaluating primary amenorrhea
* timeline of other stages of puberty * neonatal and childhood health * time of menarche in mother/ sisters * height compared to other family members * sex activity/ stress/ WL/ diet/ exercise/ illness * sxs of virilization (male development) * galactorrhea * HA/ visual field defects * anosmia * hx of head trauma
69
PALM COIEN: **What does COIEN stand for?** (AUB classification)
* Non-structural causes of AUB * Coagulopathy * Ovulatory dysfunction * Endometrial * Iatrogenic (anticoags, hormonal contraceptives) * Not otherwise classified
70
for a pt of POSTmenopausal age, what are the etiologies of postmenopausal bleeding
**ABNORMAL!!!** endometrial carcinoma assess w/ pelvic US or endometrial biopsy (EMB)
71
intermenstrual bleeding, what extra diagnostic tests?
pap smear cervical cx
72
how would androgen insensitivity syndrome present
46 XY F female external genitalia + breasts + no acne + amenorrhea + elevated T US ⇒ **no** upper vagina/ uterus/ fallopian tubes **BUT has** un/partially descended testes
73
primary dysmenorrhea treatment options
heat, massage, exercise, yoga, increase dairy and vit B, smoking cessation NSAIDs (ibuprofen 400 mg, 1 tab PO Q 4-6 hours x 3-4 days) hormonal contraceptives laparoscopy/ GnRH analogue (refractory)
74
what drugs can cause secondary amenorrhea
**antipsychotics** (risperidone) antidepressants cimetidine (H2 blocker) anti-HTN (methyldopa, verapamil) metoclopropamide (reglan) *(cause hyperprolactinemia)*
75
how would Kallmans syndrome present
ansomia primary amenorrhea **hypogonadotropic hypogonadism**
76
46 XY F female external genitalia + breasts + no acne + amenorrhea + elevated T US ⇒ **no** upper vagina/ uterus/ fallopian tubes **BUT has** un/partially descended testes + treatment?
**androgen insensitivity syndrome** problem w/ androgen receptor ⇒ testes make testosterone and AMH but body doesn't respond to it * treatment * surgical removal of testes (CA risk) * counseling * vag surgery * vag dilation
77
what are some non-pharmacologic things that patients can do to manage menstrual cycle sxs
decrease salt, caffeine, ETOH aerobi exercise **Mg and Ca supplements** acupuncture, yoga
78
menorrhagia and you suspect ovulatory bleeding... what labs/ screening
**CBC** **pelvic US** (to r/o uterine fibroids) +/- LFTs, BUN/creatinine, coags +/- EMB (to r/o endometrial hyperplasia)

OBGYN rotation review (14 decks)

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