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Repro > Lecture 4: Menstrual Disorders > Flashcards

Lecture 4: Menstrual Disorders Flashcards

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1
Q

What is menarche?

How long after 1st menarches is first ovulation?

A

onset of menses (period)

1st ovulation = 6-9 months after 1st menses

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2
Q

What 2 hormones dominate the follicular phase (day 0-14)?

which is more dominant day 0-5?

What causes ovulation on day 14?

What hormone predominates during luteal/secretory phase (day 14-28)

A

follicular = Estrogen and FSH

Estrogen = day 0-5

ovulation: d/t LH surge

luteal phase = progesterone

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3
Q

3 possible definitions of primary amenorrhea:

What is a marker of ovarian fxn?

A

Absence of menses:
1. before age 16 in presence of norm pubertal development

  1. before age 14 in ABSENCE of norm pub. development
  2. 2 yrs after sexual maturity

breast exam = marker of ovarian fxn

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4
Q

pt has low/normal FSH, what type of problem do they have? Where is problem if FSH is high?

A

low FSH –> hypothal or pituitary problem

high FSH –> ovarian problem

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5
Q

3 major classification of primary amenorrhea

A
  1. Ovarian failure
  2. Outflow Tract (Uterus problem)
  3. Obstruction
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6
Q

Ovarian Failure:

  1. what labs seen?
  2. what is present/absent?
  3. What is MC cause of ovarian failure?
A

Ovarian Failure:

  1. Labs - high FSH/LH, LOW estradiol
  2. what is present/absent?
    - no breasts but + uterus
  3. What is MC cause of ovarian failure?
    - Gonadal Dysgenesis
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7
Q

Infertile patient presents w/webbed neck, short stature, heart defects and learning disabilities…Dx?

What is this d/o assoc w/?

A

Turner Syndrome (45, X0)

Congenital cause of Gonadal Dysgenesis

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8
Q

Turner Syndrome:

  1. What is it?
  2. What does no ovaries lead to?
  3. How to Dx?
  4. Tx ?
A
  1. partial or complete loss of X chrom
  2. no ovaries –> “gonadal streak” (fibrous tissue)
  3. Dx = karotype
  4. replace estrogen + give progesterone to induce menses/shed lining
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9
Q

Outflow tract problem:

What is Mullerian agenesis? Result of this?

A

Mullerian agenesis = congenital malformation of mullerian duct (forms vagina, uterus, etc) –> NO uterus + shortened vagina

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10
Q

How does Mullerian Agenesis differ from Turner’s?

what is the Tx for Mullerian Agenesis

A

Mullerian Agenesis

  • breasts present
  • NO uterus
  • normal karyotype
  • norm hormone levels
  • Tx = surgical reconstruction of vag

Turner’s

  • NO breasts
  • Uterus present
  • abn karyotype
  • abn hormone levels
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11
Q

2 types of obstruction for primary amenorrhea?

are breasts and a uterus present? hormone levels?

What are the Sxs?
Tx?

A
  1. Imperforate Hymen
  2. Transverse vaginal septum

both breasts and uterus are present; hormone levels normal

Sxs = retention –> cyclic abd pain, bloating/ distended abd

Tx = surgery

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12
Q

How does imperforate hymen and transverse vaginal septum cause obstruction?

A

imperforate hymen
- hymen doest perf during dev –> blocks vagina

transverse vaginal septum
- wall of tissue blocking the vagina

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13
Q

definition of secondary amenorrhea?

MC cause?

A

absence of menstruation:

  • > 3 months (cycles) in pts w/prev prior reg cycles or..
  • 6 mo in pts w/irreg cycles

MC cause = preg

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14
Q

Pt presents w/ body habitus (thin), hirustism/acne, galactorrhea, dry/atrophic vagina and dyspareunia. But uterus present/normal size.

What type of d/o does she have?

A

secondary amenorrhea

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15
Q

Progestin Withdrawal test:

  1. what does it determine?
  2. how performed?

What is a + withdrawal bleed

  • what does this indicate
  • Tx?

What 2 things are a/w (-) withdrawal bleed

A
  1. determine if estrogen defic or ovulation prob
  2. Give pt Provera (medroxyprogesterone) for 10 days–> look for withdrawal bleed

+ withdrawal bleed = bleeding 2-7 days after complete provera

  • ovarian problem –> pt not ovulating
  • Tx = OCPs

(-) withdrawal bleed = estrogen defic or outflow problem

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16
Q

What is the hypothalamus d/o related to 2ndary amenorrhea?

A

Functional Hypothalmic Amenorrhea

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17
Q

Pt has low FSH, LH, and estradiol; norm PRL. She has admitted to wt loss d/t excessive exercising lately. You find out she has already been Dx w/AN. What is Tx?

A

Tx = nutrition, OCPs (estrogen)

Dx = Functional Hypothalmic Amenorrhea

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18
Q

What is the female athlete triad?

Study These Flashcards
A
  1. eating d/o (AN)
  2. amenorrhea
  3. Osteopenia
19
Q

What are the 2 pituitary d/o related to 2ndary amenorrhea?

Labs seen? (what is incr/result)

Study These Flashcards
A
  1. Sheehan Syndrome
  2. Pituitary adenoma

decr FSH, LH and estradiol

INCR PRL –> galactorrhea

20
Q

What is Sheehan syndrome d/t, who occur in and result?

How to Dx/Tx?

Study These Flashcards
A

Hemorrhage in postpartum pt –> HotN and infarct/necrosis of pituitary gland

Dx = MRI

Tx = replace pituitary hormones

21
Q

What are the 2 ovary d/o related to 2ndary amenorrhea?

Study These Flashcards
A
  1. Premature Ovarian failure

2. PCOS (polycystic ovarian syndrome)

22
Q

Premature Ovarian failure:

  • what is it? age?
  • Presentation (what are Sxs similar to)
  • Hallmark?
  • how to Tx?
Study These Flashcards
A

early menopause (< 40)

  • Sxs = similar to menopause (hot flashes, atrophic/dry vag, etc)
  • hallmark = incr FSH
  • Tx = HRT (estro + progest), Vit D and Ca
23
Q

What are the 4 main signs of PCOS?

Study These Flashcards
A
  1. hyperandrogenism
  2. obesity
  3. Irreg pds (oligo/amenorrhea)
  4. Anovulatary bleeding
24
Q

How to Dx/what seen and how to Tx PCOS?

Study These Flashcards
A

US –> polycystic ovaries

Tx = OCPs, metformin

25
Main uterine d/o a/w 2ndary amenorrhea?
Ashermann Syndrome
26
What is Ashermann Syndrome? | - MC cause?
intrauterine adhesions/fibroids MC caused by D&Cs
27
What can be used to Dx AND Tx of Ashermann Syn? - what see on Pelvic US other Tx?
Dx + Tx = Hysteroscopy - can use it to remove adhesions - pelvis US --> no norm uterine stripe Other Tx = estrogen --> endometrial regen
28
Definition of dysmenorrhea?
pain w/menstrual cycle (cyclic)
29
Difference b/t primary dysmenorrhea and secondary? what are each d/t?
Primary - no pelvic pathology (d/t incr PGs) - pain is during 1st 2-3 days of cycle Secondary - pathology (MC = endometriosis) - new onset pain
30
Mainstay of Tx for dysmenorrhea? Other 2 Tx options? - what no given? other 2 supportive Tx options?
1. NSAIDs + OCPs Others - IUDs (NOT COPPER--> more pain) - Depo Provera Supportive Tx - heat, Vit E
31
What NSAIDs given for dysmenorrhea? When should they be given? How do they work to decr pain a/w dysmenorrhea?
1. Ibuprofen 2. Naproxen Sodium Start 1-2 days before menses and continue for 2-3 days decr PGs --> less inflam--> less pain
32
Definition of endometriosis? result? MC sites? Theory for pathogenesis?
growth of endometrial tissue outside the uterine cavity (ectopic) --> inflammatory response (pain) MC = ovary (and ant/post cul-de-sac) retrograde menstruation --> backflow of cells thru fallopian tubes to peritoneal cavity
33
Classic triad a/w endometriosis? 3 other signs:
"PAIN" 1. Cyclic pelvic pain 2. Dysmenorrhea 3. Dyspareunia others 1. dyschezia 2. infertility 3. urinary Sxs
34
2 Signs on PE indicating endometriosis? Gold std = for Dx? - see raised patches of thickened, discolored, scarred or powder burned implants of tissue
1. Tender nodularity (cul-de sace and uterine ligaments) 2. Fixed/immobile uterus gold std for dx = laparascopy
35
Mainstays of Tx for endometriosis? | Why?
1. NSAIDs + continous hormonal therapy | - continous hormonal therapy--> decr ovulation --> less pain
36
What are the 3 infreq used methods for Tx endometriosis?
1. GnRH agonists (leuprolide) 2. Danazol 3. Aromatase inhib
37
Definition of PMS (premenstrual syndrome) When does it resolve?
Physical, behav and mood changes that occur repetitively in 2n half of menstrual cycle (luteal phase) & 1st few days of menses resolves w/onset of menses (criteria discussed later is more spp)
38
What is PMS possibly d/t?
ovarian hormonal fluctuations and NT disturbances (serotonin)
39
2 mai requirements for Dx of PMS?
1. 1 or more behavioral/emot or somatic Sxs 5 days before menses in last 3 menstrual cycles 2. Sxs relieved w/in 4 days of menses --> cant recur til at least day 13 (7 days of no sxs in follicular phase)
40
How does PMDD differ from PMS?
PMDD = more severe
41
Dx criteria for PMDD requires 5+ Sxs during most cycles in last year AND 1 of Sx must be (4 options)
1. Depressed mood 2. Anxiety/tension 3. Lability 4. Angry/irritable
42
what 3 other things must be present to make Dx of PMDD?
1. Markedly interferes w/life 2. Not exacerbation of another d/o 3. Confirmed by prospective daily ratings in 2 consec cycles w/Sxs
43
Tx for PMS AND PMDD: 1. what is tx for mild Sxs? 2. what is tx for mod-severe Sxs?
1. Mild Sxs --> lifestyle modifications | 2. mod-severe Sxs --> SSRIs
44
What 2 SSRIs used for PMS and PMDD
1. Fluoextine | 2. Sertraline

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