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Reproductive Medicine Exam 2 > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

(61 cards)

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1
Q

How is primary amnorrhea defined?

A

Absence of menarche by age 15

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2
Q

How is secondary amenorrhea defined?

A

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

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3
Q

What is the most common chromosomal cause of primary amenorrhea?

A

Turner’s Syndrome

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4
Q

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

A

Short Stature
Infertility
Primary Gonadal Failure
Osteoporosis

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5
Q

What are THREE structural causes of primary amenorrhea?

A

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

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6
Q

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

A

Mullerian

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7
Q

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

A

Mayer-Rokitansky-Kuster-Hauser Syndrome

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8
Q

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

A

Apoptosis

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9
Q

Which is more common…..

Imperforate Hymen or Mullerian Abnormalities

A

Imperforate Hymen

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10
Q

How are sturctural causes of primary amenorrhea managed?

A

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

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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
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12
Q

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

A

Kallmann Syndrome

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13
Q

What are TWO causes of ovarian caused primary amenorrhea?

A

PCOS

Premature Ovarian Failure

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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

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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

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16
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

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17
Q

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

A

Pregnancy

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18
Q

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

A

Hypothalamic
Pituitary
Ovarian

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19
Q

T/F: Secondary amenorrhea cannot be iatrogenic

A

False

It can be

(ex: OCPs, Metocloparmide, Antipsychotics)

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20
Q

How does functional hypothalamic amenorrhea occur?

A

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

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21
Q

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

A

True

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22
Q

What is the most common pituitary adenoma?

A

Prolactinomas

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23
Q

Can secondary amenorrhea result from hypothyroidism or hyperthyroidism?

A

Both!

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24
Q

PCOS is the cause of about __% of amenorrhea

A

20%

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25
What ovarian disroder is classified as a depletion of functional oocytes before the age of 40?
Premature Ovarian Failure
26
What is Asherman;s Syndrome?
Acquired scarring of the endometrial lining from prior surgery or infection
27
What is the first lab always ordered when working up amenorrhea?
Beta-Hcg
28
If a patient underwent the progestin withdrawal test for secondary amenorrhea and no bleeding occurred what would it indicate?
Asherman's Syndrome
29
When working up secondary amenorrhea, why are the following ordered...... MRI? Karyotype?
MRI: Pituitary Adenoma Karyotype: If FSH elevated to r/o partial chromosome deletion
30
What is the mainstay of treatment for hypothalamic causes of secondary amenorrhea?
Lifestyle Changes
31
What is the mainstay of management for secondary amenorrhea due to hyperprolactinemia?
Dopamine Agonists (Bromocriptine, Cabergoline) | Surgery is large, unresponsive to medication
32
What is the mainstay of management for secondary amenorrhea due to premature ovarian failure?
Estrogen/Progestin Therapy to prevent bone loss and manage menopause symptoms
33
What is the mainstay of management for secondary amenorrhea due to Asherman's Syndrome?
Hyterscopic lysis of adhesions | Long-term Estrogen supplementation
34
_________ (primary/secondary) dymenorrhea is described as pelvic pain that occurs during menstruation in the absence of pelvic pathology
Primary Dysmenorrhea
35
_________ (primary/secondary) dysmenorrhea is described as pain with menses that results from pathologic changes in the pelvic viscera
Secondary Dysmenorrhea
36
When do symptoms (cramping, nausea, emesis) of primary dysmenorrhea onset?
Just prior to flow onset and last for a few days
37
Primary dysmenorrhea is present in __% of teens
60%
38
Primary dysmenorrhea is due to what?
Excess production of endometrial prostaglandins
39
What are TWO indications for doing a pelvic examination when working up primary dysmenorrhea?
Severe Sx | Pt is sexually active
40
T/F: A pelvic examination can be omitted if the patient is not sexually active
True
41
What is the first step in managing primary dysmenorrhea?
NSAIDs | may need to start 1-2 days prior to menses
42
If NSAIDs are not successful in managing primary dysmenorrhea, what can be started next?
Combination OCPs | *If the patient is sexually active this should be strongly considered
43
If treatment of primary dysmenorrhea fails what needs to be considered?
Secondary Dysmenorrhea
44
What are FIVE red flags of primary dysmenorrhea?
``` 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
What are some of the many causes of secondary amenorrhea?
``` Endometriosis Adenomyosis Uterine leiomyomata Ovarian cysts Pelvic adhesions Chronic PID Obstructive uterovaginal anomalies Cervical stenosis Copper IUD IBS Inflammatory bowel disease Interstitial cystitis ```
46
The prevalence of secondary dysmenorrhea __________ (increases/decreases) with age while the prevalence of primary dysmenorrhea _________ (increase/decreases) with age.
Secondary: Increases with age Primary: Decreases with age
47
Would you expect dyspareunia with secondary or primary dysmenorrhea?
Secondary Dysmenorrhea
48
What are examples of pelvic examination findings in secondary dysmenorrhea?
``` Purulent cervical discharge Cervical motion and/or adnexal tenderness Nodularity of uterosacral ligaments Uterine enlargement or irregularity Adnexal mass ```
49
What are THREE management options for secondary dysmenorrhea?
1. NSAIDs / Analgesics 2. OCPs / IUDs 3. Treat underlying disease
50
How is menorrhagia defined?
Menstrual blood loss greater than 80 mL
51
_______ menses is defined as menses for longer than 7 days
Prolonged menses
52
What is metorrhagia
Irregular bleeding between menses
53
___________ is defined ass excessive and irregular uterine bleeding
Menometorrhagia
54
How is dysfunctional uterine bleeding defined?
Abnormal bleeding not from an anatomic abnormality
55
A menstrual cycle that lasts less than 24 days is defined as what?
Polymenorrhea
56
T/F: Coagulation testing should be considered when working up menorrhagia
True
57
Why should a CBC be ordered when working up menorrhagia?
rule out anemia
58
What THREE 'procedures' should be considered when working up menorrhagia?
``` Endometrial Biopsy (r/o hyperplasia) Pelivc US (Polyps, Fibrosis) Hysteroscopy (Lesions) ```
59
What are THREE management options for menorrhagia due to anovulation?
1. Cycling with combined OCPs 2. Scheduled progestin withdrawal bleeds 3. Medicated IUD
60
What are management options for menorrhagia due to anatomic abnormality?
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
How is anemia from menorrhagia corrected?
Iron Supplementation

Reproductive Medicine Exam 2 (7 decks)

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