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OBGYN > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

The absence of menstruation

A

Amenorrhea

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2
Q

Menarche has never occurred but the patient is 16 years old or older

A

Primary amenorrhea

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3
Q

loss of menstruation for 3 consecutive months or more in a patient who was previously menstruating

A

Secondary amenorrhea

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4
Q

painful menstruation

A

dysmenorrhea

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5
Q

painful menstruation that is from normal menstruation and not another cause

A

primary dysmenorrhea

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6
Q

painful menstruation that is caused by another source other than normal menstruation

A

Secondary dysmenorrhea

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7
Q

a recurring set of physical and emotional symptoms that develop several days before menses and subside when menses begin

A

Premenstrual Syndrome (PMS)

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8
Q

A severe form of PMS that results in functional impairment

A

Premenstrual Dysphoric Disorder (PDD)

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9
Q

This is a general term used to describe an abnormal menstrual cycle

A

Abnormal Uterine Bleeding

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10
Q

Refers to heavy menstruation, either excessive flow or duration(>7 days)

A

Menorrhagia

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11
Q

menstrual cycles that occur with irregular frequencies

A

metrorrhagia

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12
Q

excessive and irregular menstruation

A

menometrorrhagia

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13
Q

Infrequent menstruation (menses is > 35 days apart)

A

Oligomenorrhea

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14
Q

when no pathologic cause can be identified for abnormal uterine bleeding

A

Dysfunctional Uterine Bleeding (DUB)

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15
Q

Primary amenorrhea is usually the result of …

A

Ovarian Insufficiency (genetic irregularity) or Anatomical abnormality

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16
Q

The most common cause of ovarian insufficiency.

A

Turner Syndrome

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17
Q

Genotype is a single X chromosome. Underdeveloped breasts, shield chest, genital hypoplasia, webbed neck, cardiovascular abnormalities, short statue…

A

Turner syndrome

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18
Q

Failure of the uterus, fallopian tubes and vagina to develop. Ovaries are normal, so secondary sexual characteristics develop normally. Confirmed by ultrasound

A

Mullerian agenesis

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19
Q

Menses occurs but the outflow tract is blocked, so bleeding cannot be observed and appears absent.

A

Imperforate hymen and Transverse vaginal septum

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20
Q

Secondary amenorrhea is most commonly caused by…

A

Pregnancy

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21
Q

Other causes of secondary amenorrhea

A

hypothalamic disorders, hyperprolactinemia, primary ovarian insufficiency/failure, polycystic ovarian syndrome, anatomic abnormalities (from adhesions or scarring)

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22
Q

Hypothalamic dysfunction can be caused by…

A

being under excessive stress, loss of excessive weight, eating disorders

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23
Q

Hypothalamic dysfunction leads to what hormonal imbalances?

A

Low FSH, LH, and estrogen

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24
Q

Female athlete triad:

A

Insufficient caloric intake, Amenorrhea, Low bone density/osteoporosis.

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25
Q

What is the treatment for amenorrhea caused by the female athlete triad?

A

nutritional counseling, stress or exercise reduction. Calcium and vit D supplements for bone loss

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26
Q

Hyperprolactinemia can be a side effect of…

A

Dopamine-lowering drugs, pituitary tumor, hypothyroidism

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27
Q

What labs should you order in secondary amenorrhea?

A

TSH and prolactin levels.
TSH high= treat thyroid
Prolactin high = order MRI

28
Q

What are the causes of Premature ovarian failure/primary ovarian insufficiency?

A

usually idiopathic.

radiation, chemo, infection, autoimmune

29
Q

Are premature ovarian failure/primary ovarian insufficient patients infertile?

A

No. Sometimes they can still ovulate randomly

30
Q

How do you confirm ovarian failure in a younger patient?

A

FSH levels of > 40 on 2 occasions (also can confirm menopause in older adults)

31
Q

How to treat ovarian failure?

A

With hormones until normal age of menopause.

32
Q

What are the Rotterdam Criteria for PCOS?

A

Pt must have 2 of the 3:
Clinical or Lab hyperandrogenism (testosterone test)
Oligo-ovulation or anovulation
Polycystic ovaries
(must always rule out all other possible causes)

33
Q

What conditions may fall under clinical hyperandrogenism?

A

hirsutism, alopecia, acne

34
Q

How is laboratory hyperandrogenism evident?

A

Free testosterone test, or total testosterone (will also rule out androgen-secreting tumor)

35
Q

What Total testosterone levels are diagnostic for PCOS?

A

> 50, but >200 suggests an androgen-secreting tumor

36
Q

How are oligo-ovulation and anovulation usually evident?

A

Erratic menstrual patterns, often no menses for 3-4 mo followed by a heavy period (from lack of progesterone)

37
Q

How are polycystic ovaries identified radiologically?

A

Ultrasound - string of pearls

38
Q

What are other common findings in pts with PCOS?

A

obesity, central adiposity, insulin resistance, acanthosis nigricans, skin tags, abnormal LH:FSH ratio (LH 2-3x FSH)

39
Q

What conditions are pts with PCOS at risk for developing?

A

DM, atherosclerosis, dyslipidemia, cardiovascular disease, infertility

40
Q

What is the treatment for PCOS?

A

If overweight, loose the weight (5-10% loss in 6 mo induces ovulation 50% of the time)
Oral contraceptives to reduce endometrial hyperplasia
Spironolactone - hirsutism
Metformin high does - insulin resistance, dylipidemia, hirsutism, infertility
Clomiphene citrate - if weight loss/metformin ineffective

41
Q

What are symptoms of primary dysmenorrhea?

A

generalized pelvic pain, nausea, vomiting and headache

42
Q

What is the primary treatment of primary dysmenorrhea?

A

NSAIDS

Contraceptives may also be helpful

43
Q

What may be some causes of secondary dysmenorrhea?

A

endometriosis, fibroids, PID…

44
Q

What are general symptoms of PMS/PDD

A

headache, bloating, breast tenderness, moodiness, restlessness, irritability, depression, loss of emotional control

45
Q

What is the treatment of PMS/PDD

A

SSRIs, SNRIs, Calcium, vit D/B6, Magnesium

46
Q

What are characteristics of menorrhagia?

A

menses that last >8 days.
gushing flow that soaks through 1 pad/tampon per 1-2 hours.
clots.

47
Q

What are common causes of menorrhagia?

A

fibroids, adenomyosis, endometrial hyperplasia, vW disease, thrombocytopenia

48
Q

What are characteristics of metrorrhagia?

A

Irregular (unreliable) menstrual cycles due to oligo-ovulation.
Regular menstrual cycles with spotting in between cycles

49
Q

What might cause spotting in metrorrhagia?

A

cervical polyps or cancer

Infection

50
Q

What are causes of Anovulatory AUB?

A

PCOS, Thyroid dysfunction, Hyperprolactinemia, Med SE, Uncontrolled DM, Hypothalamic dysfunction, Female athlete triad, year 1-2 after menarche or perimenopause, PREGNANCY

51
Q

What are causes of Ovulatory AUB?

A

Thyroid dysfunction, Coagulation defects/bleeding disorder, Fibroids, Polyps, Advanced Liver Disease (clotting factors)

52
Q

How is AUB treated?

A

varies according to underlying condition. Oral contraceptives, endometrial ablation. Prevent hyperplasia!

53
Q

Occurs when simple proliferation of endometrium advances to abnormal proliferation that involves glandular and stromal elements

A

Endometrial hyperplasia

54
Q

What is endometrial hyperplasia caused by?

A

continuous exposure to endogenous or exogenous estrogen, with the absence of progesterone

55
Q

Who might be at risk for endometrial hyperplasia?

A

Obese women, women receiving estrogen HRT without progesterone, HTN, DM

56
Q

What are different patterns of endometrial hyperplasia?

A

Involves the entire endometrium, or just focal patches.

57
Q

What are patients with endometrial hyperplasia at risk for?

A

endometrial carcinoma (may also exist with endometrial carcinoma)

58
Q

What is the clinical presentation of endometrial hyperplasia?

A

oligomenorrhea, amenorrhea followed by irregular or excessive uterine bleeding, pelvic exam unremarkable, obesity, acne hirsutism

59
Q

How do you approach uterine bleeding in postmenopausal women?

A

CA until proven otherwise

60
Q

How to evaluate an ultrasound of someone with endometrial hyperplasia?

A

Postmenopausal: 4mm or less endometrial stripe and not on HRT = low likelihood of hyperplasia or CA.
Premenopausal: No standards, but ranges from 4-14mm. Thinnest on day 4-6 of menstruation

61
Q

How can you better achieve visualization of endometrial hyperplasia?

A

sonohyterography

62
Q

If thickness appears global in endometrial hyperplasia, what is the method of choice for evaluation?

A

endometrial biopsy

63
Q

How is atypical complex hyperplasia generally treated?

A

hysterectomy

64
Q

What is a general treatment for all forms of endometrial hyperplasia?

A

Progestin therapy (but may relapse in atypical types after stopping)

65
Q

What is an optional treatment for patients without atypical endometrial hyperplasia?

A

Dilation and Curettage

66
Q

Who should be evaluated for endometrial hyperplasia or cancer?

A

Women > 45 with AUB
Women < 45 with AUB, anovulation, and obesity
Pt who fail to respond to AUB treatment
Some cervical cytology findings

OBGYN (4 decks)

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