Menstrual Disorders Flashcards Preview

Q4 Women's Health > Menstrual Disorders > Flashcards

Flashcards in Menstrual Disorders Deck (43):
1

Primary Amenorrhea is? (2)

1) No period by 15 e/t 2° characteristics N
2) No period by 13 and no 2° characteristics

2

Primary Amenorrhea caused by? (5)

1) Gonadal dysgenesis from chromosome abnormality
2) Hypothalamic hypogonadism
3) No mullerian duct as embryo, no women parts
4) Transverse vag septum, imperf hymen
5) Pituitary dz

3

Primary Amenorrhea: Hypothalmic/Pituitary Disorders caused by? (4)

1) Functional: Low GnRH secretion due to low nutrition, excess exercise, stress

2) Congenital: Low GnRH from hypogonad

3) Hyperprolactinemia

4) Infiltrate/tumors

4

Kallmann's Synd is?

hypogonadotropic hypogonadism with loss of sense of smell (anosmia)

5

Primary Amenorrhea: Ovarian Disorders caused by? (2)

1) Gonadal dysgenesis (e.g. Turner's)

2) Polycystic Ovary Synd (U causes 2° amenor)

6

Primary Amenorrhea: Receptor Abnormalities/Enzyme Deficiencies?

Androgen Insensitivity Synd:
Male w/ outer vagina,
no uterus/fallop tubes,
high testosterone

7

Primary Amenorrhea: Initiate eval when? (3)

1) 15yo w/o bleeding
2) 13yo w/o breast development (thelarche)
3) 13yo w/o bleed within 2 yrs of breasts

8

Primary Amenorrhea: Hx questions? (11)

1) Timeline of puberty
2) FHx age of menarche
3) Height compared to family
4) Neonate/childhood health
5) Sxs of virilization (male char)
6) Stress, wgt ∆, diet, exercise, illness
7) Galactorrhea
8) Anosmia
9) HA, visual ∆, fatigue, polyuria/dipsia
10) Hx of head trauma
11) Sex activity

9

Primary Amenorrhea: Physical exam should always include?

Cardiac, pulmonary, pelvic, breasts

Along w/ vitals, general, skin

10

Primary Amenorrhea: Labs? (6)

hCG (ALWAYS)
FSH/LH
Karotype
Prolactin
TSH
Testost

11

High FSH indicates?

Low/N FSH indicates?

gonadal dysgenesis

hypo/hypogonadism

12

Primary Amenorrhea: Possible Imaging?

Pelvic sonogram
CT or MRI (pituitary)

13

2° Amenorrhea is?

Previous menstruaters w/ no period for 3 cycles or 6 consecutive months

14

2° Amenorrhea: Caused by? (5)

1) PREGNANCY
2) Ovarian dysf
3) Hypothalamic dysf
4) Pituitary dysf
5) Uterine dysf

15

2° Amenorrhea: Hypothalamic/Pituitary Disorders caused by?

1) Fxn'l hypothalamic (same as w/ primary, celiac)
2) Puititary dz
3) Hyperprolactinemia

16

2° Amenorrhea: Hx questions? (11)

1) Bleed hx
2) Pregnancies
3) Meds
4) PMH/recent illness
5) Weight ∆
6) Exercise
7) Skin ∆s (oil, acne, hair)
8) Galactorrhea
9) E2 deficiency sxs
10) Endocrine ROS
11) Asherman sxs (intrauterine adhesions)

17

2° Amenorrhea: Physical exam should include?

same as primary
+ HEENT (parotid swelling, enamel erosion

18

2° Amenorrhea: Labs?

same
+ progestin challenge if other labs are N

19

Progestin challenge test is?

Assess E2:

pt takes medroxyprogestone x 10 d,
if E2 levels are N, pt will bleed w/ withdrawl of med

if no bleed = hypoE2, pregnancy, uterine defects

20

2° Amenorrhea: Imaging?

Pelvic sonogram
CT adrenal gland
CT/MRI pituitary

21

Polymenorrhea is?

frequent bleeds <24 days apart

22

Menorrhagia is?

heavy or prolonged at N intervals

23

Menometrorrhagia is?

heavy and irregular

24

Metrorrhagia is?

irregular

25

Abnormal Uterine Bleeding (AUB) caused by?

PALM COEIN

Polyp
Adenomyosis
Leiomyosis
Malig/Hyperplasia

Coagulopathy
Ovulatory dysf
Endometrial
Iatrogenic (caused by tx)
Not classified

26

Dysfunctional Uterine Bleeding is?

Dx of exclusion
Use when all other P causes are r/o

27

AUB initial eval includes? (3)

1) confirm blood from uterus
2) confirm pre- or postmenopausal
3) exclude pregnancy

28

AUB 2° eval includes? (5)

1) Determine bleeding pattern
2) Is endometrial sample needed?
3) Is coag eval needed?
4) Bleeding related to contraception method?
5) Concurrent factors to bleeding?

29

AUB hx questions? (9)

1) Age of menarche
2) Bleed hx
3) Bleed pattern/amount
4) Molimina sxs (premenstrual sxs)
5) Birthcontrol
6) Meds
7) Hx/FHx of bleed dis
8) Weight ∆
9) Anemia sxs

30

AUB physical exam purpose?

r/o all possible causes for bleeding

31

AUB labs? (4) and (4 possibles)

hCG
CBC
Fe
Pap/Cx

(P)
coag
TSH
LFT
FSH

32

AUG imaging/studies? (2)

pelvic sonogram
endometrial bx

33

AUG management?

E2
endometr ablation
hysterectomy

34

Dysmenorrhea: Primary is?

2° is?

no identifiable cause

organic pelvic dz

35

Primary Dysmenorrhea: Begins?

Pain description?

Pain location?

Assoc sxs?

Pelvic exam results?

at onset of menst, lasts 12-72 hrs

intermitt cramping

low abd, (P) low back/up thighs

N/V/D, HA, fatigue

N pelvic

36

Primary Dysmenorrhea: Tx for resistant cases?

CCB (nifedipine)

37

2° Dysmenorrhea: Management?

Treat cause
COC help in most cases

38

PMS is?

physical, mood, behavioral ∆s that occur in relationship to LUTEAL PHASE, resolve w/ menses

39

Premenstrual Dysmorphic Dis (PMDD) is?

PMS w/ severe emotional sxs

40

PMS diagnostic criteria?

1) 1 or more somatic and affective sxs 5 days before menses

2) sxs resolve w/i 4 days of meses

3) not caused by meds

4) dysfxn in social or economic life

41

PMDD diagnostic criteria?

slide 62

42

Non pharm mgmt for PMSs?

↓ salt, caffeine, EtOH
↑ exercise
↑ Ca2+/Mg

43

Pharm mgmt for PMSs?

NSAIDs
Spironolactone (bloating)
SSRI
(P) ovulation suppression