Menstrual Disorders

Question 1

What is primary amenorrhea?

Answer 1

13 y.o. without secondary sex characteristics

15 y.o. with secondary sex characteristics

Question 2

Number one cause of amenorrhea?

Answer 2

Pregnancy

Question 3

What is secondary amenorrhea?

Answer 3

3-6 months or more than 3 menstrual cycles missed

Question 4

What is Oligomenorrhea

Answer 4

Cycles > 40 days

Question 5

Abnormal levels for prolactin?

Answer 5

Greater than 20-200

Question 6

Primary- no uterus, no breast cause

Answer 6

agondaism, XY genotype androgen insensitivity syndrome

Question 7

Primary- yes uterus, yes breast

Answer 7

hyperprolacenemia, structural defects

Question 8

Primary- No uterus, yes breast

Answer 8

congential absence of uterus, androgen insensitivity syndrome

Question 9

Primary- Yes uterus, no breast

Answer 9

Hypothalmic or pituitary dysfunction, gonadal dysgensis

Question 10

Labs- normal E2, FSH, LH

Answer 10

PCOS

Question 11

Labs- Decreased E2 and FSH

Answer 11

Pituitary problem

Question 12

Labs- decreased E2 elevated FSH

Answer 12

Gonadal dysgenesis or POF

Question 13

Labs- elevated DHEA

Answer 13

Adrenal tumor

Question 14

Labs- elevated 17-hdyroxyprogesterone

Answer 14

Congenital adrenal hyperplasia

Question 15

What does progesterone test tell you?

Answer 15

If there’s a structural abnormality. If it’s a deficit of estrogen, just check the E2 level

Question 16

Causes of outflow tract obstruction

Answer 16

Imporfate hyman, transverse septum
Mullarian agenesis
Complete androgen insensitivity (XY genotype)
Asherman Syndrome (D/C and infection)
Cervical Stenosis

Question 17

Causes of ovarian failure

Answer 17

Gonadal Dysgenesis (do karyotype)
Turner Syndrome
FSH and LH receptor mutations
POF

Question 18

Causes of Hypothalamic Dysfunction

Answer 18

Stress, weightless, illness, exercise
Kallman Syndrome (ansomnia)
Congenital GnRH deficiency
GnRH receptor deficiency
Craniopharyngioma- most common, visual defecits

Question 19

Causes of Pituitary Dysfunction

Answer 19

Prolacenmoa
Sheehan Syndrome
Hemochromocytosis
Isolated FSH/LH deficency

Question 20

Causes of non gonadotropic amenorrhea

Answer 20

PCOS, congenital adrenal hyperplasia, cushing syndrome, hyperprolacinoma, thyroid disease

Question 21

What is 17-hydroxyprogesterone associated with and why does it cause amenorrhea?

Answer 21

Associated with congenital adrenal hyperplasia. Causes amenorrhea because it activates progesterone receptors (decreasing release of FSH and LH)

Question 22

Why does DHEAS cause amenorrhea?

Answer 22

Don’t know

Question 23

What is irregular bleeding refer to as?

Answer 23

Anovulatory bleeding

Question 24

What must be present for anovulatory bleeding?

Answer 24

Estrogen

Question 25

What are the three factors for irregular bleeding?

Answer 25

1. irregular 2. Not predictable 3. not associated with ovulatory cycles

Question 26

What is mid cycle spotting associated with?

Answer 26

Rapidly dropping estrogen. Is normal

Question 27

What is the luteal phase defect?

Answer 27

corpus luteum does not produce adequate progesterone

Question 28

What are structural causes? PALM

Answer 28

Polyp, adenomyosis, leiomyoma, malignancy and hyperplacsia

Question 29

What are non structural causes?Coein

Answer 29

Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

Question 30

What happens to unopposed estrogen?

Answer 30

Endometrial hyperplasia and risk for endometrial cancer

Question 31

What is goal in treatment of anovulatory bleeding?

Answer 31

Give oral contraceptives to shed endometrium or suppress endometrial growth.

Question 32

What is metrorrhagia and menorrhagia

Answer 32

Metrorrhagia- irregular bleeding | Menorrhagia- heavy bleeding

Question 33

What to check for in perimenopausal bleeding?

Answer 33

Anovulation, structural abnormality, malignancy, TSH, PRL, and FSH

Question 34

What to check forin post menopausal women?

Answer 34

Endometrial and vaginal atrophy. 7-10% have endometrial cancer

Question 35

What's the gold standard for evaluating endometrial cavity?

Answer 35

Hysteroscopy

Question 36

What's the first line test for >45 y.o.?

Answer 36

Endometrial sampling

Question 37

What to do for abnormal uterine bleeding and positive pregnancy test?

Answer 37

Evaluate for ectopic pregnancy, problem with fetus, or an abortion.

Question 38

What is dysfunctional uterine bleeding?

Answer 38

Diagnosis of exclusion with unopposed estrogen without progesterone

Question 39

What contraceptive should you give smokers?

Answer 39

Progesterone only

Question 40

What is screening test for coagulation problems associated with vWD?

Answer 40

Restoceitin factor only in those with problems beginning at menarche.

Question 41

What are drugs associated with dysfunctional uterine bleeding

Answer 41

digitalis, phenytoin, steroids | Dopamine antagonists.

Question 42

Normal FSH level?

Answer 42

5-30

Question 43

Normal LH Level?

Answer 43

5-20

Question 44

Normal Prolactin Level?

Answer 44

Less than 20

Question 45

Normal LH/FSH ratio?

Answer 45

Less than 2

Question 46

Normal testosterone Level?

Answer 46

70-120

Question 47

Abnormal DHEAS?

Answer 47

Greater than 400

Question 48

What are drugs associated with amenorrhea?

Answer 48

Phenothiazines, SSRIs, TCAs, antihypertensives, estrogen (COC), amphetamines, marijuana

Question 49

Criteria for PCOS?

Answer 49

Polycystic ovaries Anovulation or oligoovulation Serum or clinical signs of increased androgenism. Exclusion of other androgen disorder

Question 50

NSAIDS for dysfunctional uterine bleeding and dysmenorrhea

Answer 50

Mefanamic- 500 mg tid Naproxen 550 then 275 q 6 hours Ibuprofen 600 mg TID

Question 51

Physiologic causes of amenorrhea? x4

Answer 51

Pregnancy, menopause, post partum, breast feeding

Question 52

Drugs that cause amenorrhea?

Answer 52

SSRIs, TCAs, antihypertensives, estrogens, amphentamines, marijuana, phenothiazines

Question 53

What age is premature ovarian insufficiency diagnosed?

Answer 53

Before age 40

Question 54

First two tests to do in amenorrhea?

Answer 54

TSH and Prolactin

Question 55

What do you do if you don't get withdrawl bleeding from progesterone challenge?

Answer 55

Check FSH. could be POF/Menopause if FSH high. If low give E and P, if bleeding occurs, do pituitary work up. If it doesn't occur, refer

Question 56

Drugs for management of glactorea?

Answer 56

Parlodel (bromocriptine) and dostinex (cabergoline). These are dopamine agonists

Question 57

What is the cause of galactorrhea with normal prolactin?

Answer 57

Usually medications