Dysmenorrhea or Amenorrhea

Question 1

Why should copper IUD not be used for dysmenorrhea?

Answer 1

Can lead to even heavier bleeding; is only used for contraception

Question 2

How do OCPs relieve dysmenorrhea?

Answer 2

Progestin –> endometrial atrophy –> decreased prostaglandin production –> improved dysmenorrhea

Question 3

Risks of depo medroxyprogesterone acetate

Answer 3

Gaining weight
Depression

Question 4

What are causes of secondary dymenorrhea?

Answer 4

Endometriosis
Adenomyosis
Fibroids
Pelvic inflammatory disease from STIs (e.g. Chlamydia) or adhesions
Ovarian cysts

Question 5

in whom are oral contraceptive pills contraindicated?

Answer 5

Smokers
>age 35

Question 6

What demographic more likely has adenomyosis?

Answer 6

Older multiparous women

Question 7

Women >45 yo (late reproductive years and older) with abnormal uterine bleeding should receive what?

Answer 7

Endometrial biopsy - to rule out endometrial hyperplasia or cancer

Question 8

How would pathology show endometriosis?

Answer 8

Endometrial glands/stroma and hemosiderin-laden macrophages outside the uterine cavity

Question 9

What is indicated by well-circumscribed, non-encapsulated myometrium?

Answer 9

Fibroids

Question 10

What fibroid location is less likely to cause pain with menstruation?

Answer 10

Subserosal

Question 11

Endometrial polyps are most common in which women, and how do they present?

Answer 11

Age 40-50; increased menstrual flow with increased cramping, as well as intermenstrual spotting

Question 12

What is red/carneous degeneration?

Answer 12

Fibroid growth in pregnancy that may become symptomatic due to hemorrhagic changes associated with rapid growth

Question 13

In whom might myotectomy be preferred over hysterectomy?

Answer 13

Younger patients with fibroids who want to preserve fertility

Question 14

How long after GnRH agonist cessation do things return?

Answer 14

Hot flashes end by 1-2 months after
Myoma and uterine size return to pretreatment levels in 3-4 months

Question 15

When does fibroid degeneration happen?

Answer 15

When it outgrows its blood supply and is independent of the use of GnRH agonist

Question 16

What hormone labs in workup for hyperandrogenism?

Answer 16

DHEAS (for adrenal tumor)
17-OH progesterone (for late-onset 21-hydroxylase deficiency)
Testosterone (androgen secreting tumor)

Question 17

What are symptoms of premature ovarian failure?

Answer 17

Hot flashes
Insertional dyspareunia

Hypergonadotropic amenorrhea could be due to ovarian failure or follicular resistance to gonadotropins

Question 18

What types of patients typically have hypothalamic amenorrhea?

Answer 18

Female athlete triad
Nutritional deficiency

Question 19

What is the definition of oligomenorrhea?

Answer 19

Periods occur >35 days apart
Periods <9 per year

Question 20

What test if suspect Cushing’s syndrome?

Answer 20

Overnight dexamethasone suppression test for measuring cortisol

Question 21

What tests if suspect PCOS?

Answer 21

Pelvic ultrasound
Insulin
Testosterone (to rule out androgen secreting tumor)

Question 22

Rotterdam criteria for PCOS

Answer 22

2 of 3:
1. Chronic anovulation
2. Hyperandrogenism (clinical/biologic)
3. Polycystic ovaries on US

Need testosterone to rule out androgen secreting tumor if diagnosing without US

Question 23

Why can patients have hair loss postpartum?

Answer 23

High estrogen during pregnancy increases synchrony of hair growth; postpartum telogen effluvium may occur

Question 24

What drug can be added to OCPs to help with hirsutism?

Answer 24

Spironolactone

Question 25

How does a ruptured ectopic pregnancy cause fecal urgency?

Answer 25

Blood pools in posterior cul-de-sac, increasing rectal pressure and resulting in urge to defecate

Question 26

What is pelvic congestion syndrome?

Answer 26

Dull, ill-defined pelvic pain from long standing or intercourse that is present before and relieved by menses

Question 27

Accelerated follicle depletion can be seen in women with what family history?

Answer 27

Fragile X syndrome - premutation carriers overexpress FMR1, with cytotoxic effect on follicles