Gyn 2 Flashcards
(37 cards)
What is amenorrhea, what is the most common type, what needs to be ruled out and what do you need to be sure of to properly assess, amenorrhea?
defined as pathological absence of menstruation (usually endocrine dysfunction)
There are primary and secondary subtypes, secondary is most common (menses ceases >3-6 months & other symptoms are ruled out: pregnancy, lactation, menopause)
MAKE SURE the female has had her first menses!!! REALLY IMPORTANT QUESTION TO ASK
etiology of amenorrhea can be divided into two categories: ___ and ___? which is most common?
anovulatory (MOST COMMON)- ovulation and menses absent - generally functional cause, mild decrease in E or ovulatory (LESS COMMON)- no menses, normal hormone function
There are 4 broad aspect causes of anovulatory amenorrhea - what are they?
- Hypothalamic Dysfunction - Anorexia nervosa, Severe stress
- Pituitary Dysfunction -
Galactorrhea, Benign Pituitary Tumor - Ovarian Failure/Dysfxn -
Autoimmune disorders, Addison’s dz, DM - Other Endocrine Dys - Hyperthyroidism (shuts down menstruation), Hypothyroidism (elevated prolactin), Obesity
what tests would you order for amenorrhea?
pregnancy test (-)
**FFT (free T3, free T4, TSH) & prolactin
FSH and estradiol levels
TVUS
if virilzation (PCOS, Cushing's, androgen secreting tumor) - Free testosterone and DHEA
What additional questions should be asked in diagnosing amenorrhea?
Hx of: Endometriosis, Uterine Surgery, Celiac Disease
Medication - antidepressents (drug-induced virilization), antipsychotic drugs, phenothiazines, anti-HTN, opioids
What are key features of Cushing’s disease
moon facies
truncal obesity
abdominal striae
thin extremities
what are key features of hirsutism, what causes this?
male pattern hair growth in women (face, chest, back)
-excess androgens, testosterone.
What are red flags of amenorrhea?
delated puberty (r/o genetic disorder) virilization (PCOS, Cushing's, androgen secreting tumor) visual field defects (prolactinoma)
what are the most common causes of secondary amenorrhea?
Pregnancy!!!!!
PCOS
Obesity
Thyroid Dysfunction
Dysfunctional Uterine Bleeding (DUB) is defined as? What periods of life does it occur? How it it diagnosed?
DUS - abnormal uterine bleeding in the absence of clinical or US evidence of structural Abnormalities (fibroids, polyps , cancer, hyperplasia)
occurs in anovulatory states (puberty, >45 y/o)
PCOS is also a common cause of involution
Diagnosis of Exclusion
There are two types of DUB, Anovulatory and Ovulatory - what are the differences?
Anovulatory - unopposed estrogen. No progesterone. excessive proliferation of the endometrium
Ovulatory - prolonged progesterone secretion - most likely due to LOW ESTROGEN levels
What tests would you order to help diagnose DUB?
Pregnancy
CBC & ferritin
TVUS - r/o structural abn
Serum salivary progesterone - day 21 - if <3 ng/mL= anovulation
What increases in the uterus that contributes to primary dysmenorrhea?
too much prostaglandin - it causes constriction of blood vessels which causes cramping.
This is the MOST COMMON form of dysmenorrhea
What are the most common causes of secondary dysmenorrhea?
secondary is due to underlying pelvic abnormalities
- endometriosis is most common
- adenomyosis
- Fibroids
compare and contrast primary and secondary dysmenorrhea
both have pain at or around time of menses
primary has - normal pelvic exam, symptoms occurring when ovulatory cycles begin, peaks in the late teens, early 20s, with response to medical therapy
secondary - pelvic exam is abnormal, more likely to require surgical intervention
what are red flags for dysmenorrhea
new or sudden onset pain
unremitting pain
fever
vaginal d/c
What are common ssx of PMS
weight gain breast swelling and pain bloating anxiety anger
What is diagnostic criteria for PMDD?
must have > 5 of the following most of the week before menses with at least one being from the first 4 in this list:
- feelings of sadness, hopelessness, self-depreciation
- tense (on edge) feeling or anxiety
- emotional liability with frequent tearfulness
- irritability or anger leading to interpersonal conflicts
- loss of interest in daily activities
- decreased concentration
- fatigue, lethargy, lack of energy
- change in eating habits (binging)
What 3 symptoms need to have 2/3 to be present for PCOS diagnosis?
hyperandrogenism
anovulation
polycystic ovaries (TVUS)
what metabolic abnormalities are observed in PCOS?
“the pivotal underlying issue is the woman’s inability to process insulin in the liver and muscles due to a probable genetic susceptibility that causes hyperinsulinemia”
hyperinsulinemia - glucose issues
abn lipid
obesity
metabolic syndrome
what labs/imaging needs to be ordered for diagnosis of PCOS?
salivary/serum E,P,T,DHEA,cortisol Thyroid Prolactin Fasting Glucose/insulin TVUS
** women meeting the criteria need serum cortisol to rule out Cushing’s syndrome **
what is premature ovarian failure and what do we need to make sure to tell our patients?
premature ovarian failure is when ovaries do not produce enough estrogen despite high gonadotropin hormones in women <40
** Women need to know, when diagnosed with this condition, 10% of women STILL CONCEIVE WITHOUT MEDICAL INTERVENTION!!! **
what is diagnostic of premature ovarian failure?
serum FSH, estradiol - IF FSH is >20 IU/mL and E < 20 pg/mL
repeat in 1 month
If the same? DIAGNOSTIC
always rule out pregnancy.
what is the hallmark of perimenopause?
change in menses, change in bleeding pattern - if she’s consistent normally - it’s a change in the cycle
usually begins in the 40s
