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Flashcards in Menstrual Disorders Deck (61)
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1
Q

How is primary amnorrhea defined?

A

Absence of menarche by age 15

2
Q

How is secondary amenorrhea defined?

A

Absence of menses for 6 months or greater in a woman previously menstruating

3
Q

What is the most common chromosomal cause of primary amenorrhea?

A

Turner’s Syndrome

4
Q

What are the FOUR most common manifestations of Turner’s Syndrome?

A

Short Stature
Infertility
Primary Gonadal Failure
Osteoporosis

5
Q

What are THREE structural causes of primary amenorrhea?

A

Absence of uterus, cervix, vagina
Transverse vaginal septum
Imperforate Hymen

6
Q

The absence of a uterus, cervix, or vagina would result from __________ (mullerian/wolffian) abnormalities

A

Mullerian

7
Q

What is another name for the syndrome that results in mullerian agenesis?

A

Mayer-Rokitansky-Kuster-Hauser Syndrome

8
Q

Transverse vaginal septums occur from _______ (agenesis/apoptosis) of the vaginal plate

A

Apoptosis

9
Q

Which is more common…..

Imperforate Hymen or Mullerian Abnormalities

A

Imperforate Hymen

10
Q

How are sturctural causes of primary amenorrhea managed?

A

Resection (Imperforate Hymen, Vaginal Septums)
Hysterectomy (Absent Cervix)
Creation of a Neovagina

11
Q

What are FOUR ‘conditions’ that may lead to hypothalamic malfunction that results in amenorrhea?

A
  1. Eating Disorders (Anorexia)
  2. Vigorous Exercise
  3. Low Body Fat
  4. High Stress
12
Q

_________ Syndrome is described as a congenital GnRH deficiency classically associated anosmia

A

Kallmann Syndrome

13
Q

What are TWO causes of ovarian caused primary amenorrhea?

A

PCOS

Premature Ovarian Failure

14
Q

What is the name of the syndrome that results in primary amenorrhea in females and often is associated with the presence of testis in the labia?

A

Androgen Insensitivity Syndrome

46 XY with non functional androgen receptors

15
Q

When working up primary amenorrhea what labs should you order if a uterus is present?

Absent Uterus?

A

Present: B-Hcg, FSH, FSH, Prolactin

Absent: Karotype, Serum Testosterone

16
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

17
Q

What ALWAYS needs to be ruled out when working up secondary amenorrhea?

A

Pregnancy

18
Q

What are the THREE most common ‘sources’ for secondary amenorrhea?

A

Hypothalamic
Pituitary
Ovarian

19
Q

T/F: Secondary amenorrhea cannot be iatrogenic

A

False

It can be

(ex: OCPs, Metocloparmide, Antipsychotics)

20
Q

How does functional hypothalamic amenorrhea occur?

A

Decreased GnRH secretion commonly due to anorexia, low body fat, or excessive exercise

21
Q

T/F: Celiac disease can impact hypthalamic function leading to secondary amenorrhea

A

True

22
Q

What is the most common pituitary adenoma?

A

Prolactinomas

23
Q

Can secondary amenorrhea result from hypothyroidism or hyperthyroidism?

A

Both!

24
Q

PCOS is the cause of about __% of amenorrhea

A

20%

25
Q

What ovarian disroder is classified as a depletion of functional oocytes before the age of 40?

A

Premature Ovarian Failure

26
Q

What is Asherman;s Syndrome?

A

Acquired scarring of the endometrial lining from prior surgery or infection

27
Q

What is the first lab always ordered when working up amenorrhea?

A

Beta-Hcg

28
Q

If a patient underwent the progestin withdrawal test for secondary amenorrhea and no bleeding occurred what would it indicate?

A

Asherman’s Syndrome

29
Q

When working up secondary amenorrhea, why are the following ordered……

MRI?

Karyotype?

A

MRI: Pituitary Adenoma

Karyotype: If FSH elevated to r/o partial chromosome deletion

30
Q

What is the mainstay of treatment for hypothalamic causes of secondary amenorrhea?

A

Lifestyle Changes

31
Q

What is the mainstay of management for secondary amenorrhea due to hyperprolactinemia?

A

Dopamine Agonists (Bromocriptine, Cabergoline)

Surgery is large, unresponsive to medication

32
Q

What is the mainstay of management for secondary amenorrhea due to premature ovarian failure?

A

Estrogen/Progestin Therapy to prevent bone loss and manage menopause symptoms

33
Q

What is the mainstay of management for secondary amenorrhea due to Asherman’s Syndrome?

A

Hyterscopic lysis of adhesions

Long-term Estrogen supplementation

34
Q

_________ (primary/secondary) dymenorrhea is described as pelvic pain that occurs during menstruation in the absence of pelvic pathology

A

Primary Dysmenorrhea

35
Q

_________ (primary/secondary) dysmenorrhea is described as pain with menses that results from pathologic changes in the pelvic viscera

A

Secondary Dysmenorrhea

36
Q

When do symptoms (cramping, nausea, emesis) of primary dysmenorrhea onset?

A

Just prior to flow onset and last for a few days

37
Q

Primary dysmenorrhea is present in __% of teens

A

60%

38
Q

Primary dysmenorrhea is due to what?

A

Excess production of endometrial prostaglandins

39
Q

What are TWO indications for doing a pelvic examination when working up primary dysmenorrhea?

A

Severe Sx

Pt is sexually active

40
Q

T/F: A pelvic examination can be omitted if the patient is not sexually active

A

True

41
Q

What is the first step in managing primary dysmenorrhea?

A

NSAIDs

may need to start 1-2 days prior to menses

42
Q

If NSAIDs are not successful in managing primary dysmenorrhea, what can be started next?

A

Combination OCPs

*If the patient is sexually active this should be strongly considered

43
Q

If treatment of primary dysmenorrhea fails what needs to be considered?

A

Secondary Dysmenorrhea

44
Q

What are FIVE red flags of primary dysmenorrhea?

A
Failure to improve with NSAIDs + OCs
Symptoms that worsen on treatment
Onset of sxs with menarche (rather than 1-2 y later)
Pelvic pain outside of menses
History of STI
45
Q

What are some of the many causes of secondary amenorrhea?

A
Endometriosis
Adenomyosis
Uterine leiomyomata
Ovarian cysts
Pelvic adhesions
Chronic PID
Obstructive uterovaginal anomalies 
Cervical stenosis
Copper IUD
IBS
Inflammatory bowel disease
Interstitial cystitis
46
Q

The prevalence of secondary dysmenorrhea __________ (increases/decreases) with age while the prevalence of primary dysmenorrhea _________ (increase/decreases) with age.

A

Secondary: Increases with age

Primary: Decreases with age

47
Q

Would you expect dyspareunia with secondary or primary dysmenorrhea?

A

Secondary Dysmenorrhea

48
Q

What are examples of pelvic examination findings in secondary dysmenorrhea?

A
Purulent cervical discharge
Cervical motion and/or adnexal tenderness
Nodularity of uterosacral ligaments
Uterine enlargement or irregularity
Adnexal mass
49
Q

What are THREE management options for secondary dysmenorrhea?

A
  1. NSAIDs / Analgesics
  2. OCPs / IUDs
  3. Treat underlying disease
50
Q

How is menorrhagia defined?

A

Menstrual blood loss greater than 80 mL

51
Q

_______ menses is defined as menses for longer than 7 days

A

Prolonged menses

52
Q

What is metorrhagia

A

Irregular bleeding between menses

53
Q

___________ is defined ass excessive and irregular uterine bleeding

A

Menometorrhagia

54
Q

How is dysfunctional uterine bleeding defined?

A

Abnormal bleeding not from an anatomic abnormality

55
Q

A menstrual cycle that lasts less than 24 days is defined as what?

A

Polymenorrhea

56
Q

T/F: Coagulation testing should be considered when working up menorrhagia

A

True

57
Q

Why should a CBC be ordered when working up menorrhagia?

A

rule out anemia

58
Q

What THREE ‘procedures’ should be considered when working up menorrhagia?

A
Endometrial Biopsy (r/o hyperplasia) 
Pelivc US (Polyps, Fibrosis)
Hysteroscopy (Lesions)
59
Q

What are THREE management options for menorrhagia due to anovulation?

A
  1. Cycling with combined OCPs
  2. Scheduled progestin withdrawal bleeds
  3. Medicated IUD
60
Q

What are management options for menorrhagia due to anatomic abnormality?

A

Hysteroscopic resection of endometrial polyps, submucous myomas
OCs and medicated IUD may have some efficacy at controlling heavy bleeding from myomas and adenomyosis
Endometrial ablation
Myomectomy
Hysterectomy

61
Q

How is anemia from menorrhagia corrected?

A

Iron Supplementation