Lecture 07 Reproductive Issues Flashcards Preview

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Flashcards in Lecture 07 Reproductive Issues Deck (41):

KNOW: Primary amenorrhea definition:

absence of menses by age 14 w/o secondary sexual development or age 16 with normal development NEVER HAD period


KNOW: Primary Amenorrhea etiology? (8)

1. Extreme weight loss/gain 2. Stress 3. Eating disorders 4. Cushing's disease 5. Congenital gyn abnorm 6. Polycystic ovarian syndrome 7. Hypothyroidism 8. Ovarian/adrenal tumors


KNOW: Secondary amenorrhea def:

Absence of menses x3 months after regular mensturation


KNOW: Secondary amenorrhea etiology? (10)

1. Pregnancy 2. Breastfeeding 3. Emotional stress 4. Pituitary/ovarian/adrenal tumors 5. Depression 6. Hyper/hypothyroidism 7. Malnutrition 8. Vigorous exercise 9. Early menopause 10. High prolactin levels


What hormone releases prolactin? What does prolactin do?

Anterior pituitary hormone; stimulates breast milk secretion (lactogenic activity)


When does prolactin increase? (9)

1. pregnancy 2. breastfeeding 3. Too little or too much sleep 4. Breast stimulation in non lactating women 5. Stress 6. Use of opiates 7. Antipsychotics 8. Antidepressants 9. Pituitary tumors (Measured w/nipple discharge. No correlation with breast cancer)


How would you assess for amenorrhea? (8)

1. Pregnancy test 2. Thyroid Func test 3. Prolactin level 4. Head CT 5. FSH level 6. (FSH level> 24 may mean menopause) 7. Laparoscropy 8. U/S to detect ovarian cysts


How would you treat amenorrhea? (6)

1. Cyclic progesterone 2. Thyroid replacement hormones 3. Bromocriptine 4. OCP's 5. Nutrition counseling 6. Lifestyle changes


KNOW: Def of primary dysmenorrhea?

Dysmenorrhea is painful menstrual cycle. Primary dysmenorrhea: increased prostaglandin produc by the endometrium. Causes contractions of the uterus. Levels highest days 1~2 of menses.


KNOW: Secondary dysmenorrhea:

pelvic/uterine pathology. Causes: Endometriosis fibroid tumors PID IUD cervical stenosis


What's the dif between secondary and primary diseases?

Secondary is it was a cause of something. Primary was there first.


What's the most common cause of secondary dysmenorrhea?

Endometriosis: when endometrium grows beyond the uterus. Ectopic implantation of endometrial tissue in other parts of the pelvis. Often ovaries, fallopian tubes, bowel, pelvic wall


Endometriosis are most common in what age?

30's and 40's


Endometriosis is associated with what?

Pain beyond menstruation, dyspareunia & infertility


Why is endometriosis so uncomfortable?

The tissue (that's in places outside the uterus) still responds to hormones during menstrual cycle, just like endometrial tissue


What are other disorders associated with endometriosis?

1. Chronic fatigue syndrome 2. fibromyalgia 3. autoimmune 5. endocrine disorders


What are some clinical manifestations of endometriosis? (8)

  1. Infertility (blocked tubes)
  2. Pelvic pain before and during menses
  3. Dyspareunia
  4. Painful urination
  5. Heavy menstrual bleeding
  6. Pelvic adhesions
  7. Irregular, more frequent menses
  8. Premenstrual vaginal spotting


Endometriosis treatment (6)

1. Anything to suppress levels of estrogen & progesterone

2.Surgical interventions

3. Medical interventions

4. Lifestyle changes

5. Clinical trials

6. Support Groups


What are some assessments in dysmenorrhea? (10)

  1. •Detailed physical/sexual history
  2. •Exam done during nonmenstrual phase of cycle
  3. •CBC to r/o anemia
  4. •UA to r/o bladder infection
  5. •Pregnancy test
  6. •Cervical cultures
  7. •Sed rate to r/o inflammatory process
  8. •Stool guaiac
  9. •Transvaginal ultrasound
  10. •Diagnostic laparoscopy


Treatments of dysmenorrhea?(9)

  1. NSAIDs
  2. COX-2Inhibitors
  3. Low dose OCPs
  4. Lifestyle changes
  5. Daily exercise (yoga and pilates to stretch and strengthen core.  Prevents organs from sticking together)
  6. Limit salty foods
  7. Weight loss
  8. Smoking cessation
  9. Stress management


What is dysfunctional Uterine Bleeding? (DUB)

When is it common?

What' is the relation between this and anovulation?

•Irregular, abnormal bleeding not caused by tumor, pregnancy or infection

•Common during perimenopause/menopause

•Anovulation  = no hormone progesterone produced. Endometrial grows and outgrows estrogen supply. Result = sloughing of endometrium and irregular bleeding.


 Dysfunctional Uterine Bleeding assessment consist of: (7)


  1. Must first assess where the uterus is, there's 5 total positions. Endometrial Bx (biopsy)
  2. •CBC – r/o anemia
  3. •PTT – r/o blood dyscrasias
  4. •Pregnancy test
  5. •TSH level – r/o hypothyroidism
  6. •Transvaginal ultrasound
  7. •Diagnostic D & C


What are Dysfunctional Uterine Bleeding treatments? (6)

Depends on the cause, if unknown, treat the Sx.


  1. •IV Estrogen if severe and Hgb < 8g/100ml –vasospasm of uterine arteries to slow bleeding
  2. •OCPs - cycle regulation
  3. •NSAIDs – inhibit prostaglandins
  4. •levonorgestrel-releasing IUD (Mirena)- suppress endometrial growth

  5. •Iron replacement

  6. •Surgical intervention

    •D & C

    •Endometrial ablation alternative to hysterectomy using thermal balloon. (Catherized the whole area, prob can't have kids)


KNOW: A range of sx occurs before menses, during which part of the cycle?

During the last half of the cycle


What are possible etiologies of PMS? (5)

  1. —? Excess/abnormal prostaglandin activity
  2. —? Estrogen-progesterone imbalance
  3. —? Premenstrual fall in endogenous endorphins
  4. —? Hyperprolactinemia
  5. —? Hypoglycemia


PMS affects what percentage of women?

85% of mensturating women




Affective sx:

Somatic Sx:

Affective sx: depression, anger, irritability, anxiety

Somatic sx: breast tenderness, abd bloating, edema, headache


What is PMDD?

It's a more severe variant of PMS (5~10% of menstruating women)


It interferes with ADLs


What's the main sx of PMDD?

Mood disorders


PMDD: 5 sx of the following must be presented for diagnosis of PMDD

  1. •Affective lability: depression & crying        
  2. •Severe Anxiety & Tension
  3. •Persistent anger/irritability
  4. •Difficulty concentrating
  5. •Insomnia
  6. •Increased/decreased appetite
  7. •Increased/decreased sexual desire
  8. •Chronic fatigue
  9. •Constipation or diarrhea
  10. •Severe breast swelling/pain


What are possible treatments of PMS?

  1. •Eliminating menstrual cycle fluctuations: OCP’s
  2. •Reducing prostaglandin levels: NSAID’s
  3. •SSRIs (Prozac, Zoloft, Paxil, Celexa)
  4. •Diet (natural diuretics) & daily exercise
  5. •Diuretic therapy as a last resort (spironolactone)
  6. •No “quick fix”
  7. •Treatment of PMS is treatment of symptoms
  8.  Mastodynia - pain in the breasts (called also mastalgia)
  9.  Avoidance of coffee/tea/chocolate/cola
    •Mild diuretic Rx
    Vitamin E 1200 – 1800 U daily


What is Primary Infertility?

inability to conceive after one year of regular sexual intercourse unprotected by contraception


What is secondary infertility?

 inability to conceive after a previous pregnancy

•Both affect about 10% reproductive age population

•Increasing incidence of secondary infertility

•1 in 6 couples in US experience difficulty conceiving in one year

•Apparent increase since 1999


What are some contributions to infertility? (5)

  1. •Delayed childbearing/age-related decline in fertility
    •Men most fertile/sperm most viable ages 18 – 24
    •Women most fertile ages 24 - 29; sharp decline after age 35
  2. •Choice of prior contraception (older IUDs)
  3. •Increased number of sexual partners/greater potential for exposure to STI’s
  4. •Increasing obesity in population
  5. •Increasing treated/untreated STIs


How is a pap smear done?

 A procedure to obtain cells from the cervix for cytology screening, done at annual GYN visit


What is the goal of a pap smear?

 Goal:  Screening test to detect precancerous lesions of the cervix before they develop into cancer


What is the methodology of a pap testing?

Thin-Prep – cervical specimen is placed in liquid preservative, rather than glass slide. Allows for HPV-DNA Typing (Hybrid Capture) – identify high risk HPV types


What is colposcopy?

 Colposcopy is the direct magnified inspection of the surface of a woman’s genital area, including the cervix, vagina, and vulva, using a light source and a binocular microscope.

•Diagnostic biopsies


What are the following treatments for cervical lesions?




LSIL: If no treatment 50~70% of lesions spontaneously resolve.

Cryotherapy: Liquid nitrogen freezes the lesion and destroys it and the surrounding tissue

LLETZ/LEEP: thin wire loop through which an electrical current it passed. Advantage of visualization of lesion while it is being excised and tissue bx can be done. Local anesthesia.


What are the following treatments for cervical lesions?

Laser ablation:

Cold knife conizaton (Cold cone bx)

Total hysterectomy

Laser Ablation: for lesions extending into the cervical canal

Cold knife conization (cold cone bx): scalpel to remove portion of the cervix with abnormal cells. Requires general anesthesia

Total Hysterectomy: may still need to get screening years after, if there was lesions presented before hysterectomy


How common is cervical cancer?

What are two types of cervical cancers?

I'ts the 3rd most common reproductive cancer.

The two types:

Squamous cell: Majority of cervical cancers. Occurs in transformation zone of the cervix. Originates from precurso lesions called cervical intraepithelial neoplasia (CIN)

Adenocarcinoma: More common in younger women. Arises from the mucus producing gland cells. More difficult to treat. Associated with the presence of HPV. More aggresive.