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Menstrual disorders Flashcards

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1
Q

PMDD differs from PMS how

A

PMDD more severe and usually mood sxs

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2
Q

how to treat PMS

A 
pain mngmt 
OCP
diet- low Na low Caffeine, 
exercise
 NSAIDS,
SSRI for mood sxs
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3
Q

ddx for PMS

A

hypothyroidism
depression
PMDD
anemia

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4
Q

labs for momma with PMS depression sxs

A 
UPT
CBC
TSH
CHEM7
HROMONES
SX chart
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5
Q

tx options for depression exacerbated by menses

A

SSRI
continuous therapy
counseling
behavioral, exercise, rest

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6
Q

tests for irregular menses in 15 yo

A 
CBC-
factor V
PTT
von willibrands 
testosterone  (PCOS)
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7
Q

irregular menses 15 yo ddx

A 
anovulatory cycles 
PCOS
thyroid
pregnancy
thyroid disorder
bleeding disorder
pituitary or adrenal disorder
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8
Q

labs for irregular menses

A

CBC
TSH, PROLACTIN, DHEA-S, INSULIN
CHEM 7
PT/PTT, additional coag tests if indicated

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9
Q

tx for anovulatory cycle

A

can do really low dose bc pill if don’t need contraception

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10
Q

what tests would you run for a pt with migraines associated with recent BC

A

cbc
tsh
chem7

need to check BP (if increasing and hx of CVD not a good idea to be taking estrogen)

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11
Q

what causes migraines associated with hormones

A

withdrawl of estrogen

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12
Q

Fatigue and HA assoc with menses ddx

A

hypothyroid
anemia
neuro

UPREG

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13
Q

32 yo c/o PMS

fatigue
sad lonely irritable

A

Rule out thyroid disorders, anemia, blood sugar, etc.

Rule out thyroid disorders, anemia, blood sugar, etc.

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14
Q

the best screening test if you suspect premature ovarian failure

A

. Serum FSH

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15
Q

when would you not check hormone levels in a pt complaining of PMS

A

Do not check hormone levels if pt on OCP/HRT.

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16
Q

if having sxs all month long

A

dx is mild depression with exacerbation during menses

tx options
SSRI
therapy
bx therapy exercise rest

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17
Q

when do you follow up with SSRI

A

f/u in 4 weeks

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18
Q

if suspect perimenopausal want to get these tests

A

May do FSH, LH, estradiol if suspect perimenopausal

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19
Q

15 yo w/ irregular menses 3-4x normal cycles and now heavy bleeding or spotting

A

need to know how heavy is heavy bleeding

is she sexually active

Anovulatory cycles
PCOS
Pregnancy 
Thyroid disorder
Bleeding disorder
Pituitary or adrenal disorder
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20
Q

screening for bleeding disorders

A

PT & PTT as screening for bleeding disorders

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21
Q

. Often bleeding disorders in females present

A

. Often bleeding disorders in females present

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22
Q

LABS with irregular 15yo

A 
CBC
TSH
prolactin
DHEA-S, insulin (if indicated)
Chem 7 panel (fasting)
PT / PTT, additional coag tests if indicated
UPT
GC/Chlamydia?  Other sti testing
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23
Q

pill warning sign

A

ACHES

abdominal -blood clot, vomiting, cramping, weakness

chest pain-blood clot in lung or heart
hear attack

HA-stoke

eye problems-stoke

leg pain -inflammartion

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24
Q

Tx for 16 yo that can be on bc

A

Can out on birth control to normalize cycle

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25
21 yo Returns for refill and states she has been getting more migraines than before starting the pill. H/o migraines, but they seem to be worse recently.
``` Menstrual migraines Tension ha Depression/anxiety Anemia Cerebrovascular complication of OCP ```
26
DX testing
``` Diary of migraines Consider labs if indicated by h&p Cbc Tsh Chem 7 (fasting) ```
27
TX for menstrual migraines
``` Discontinue or change OCP Consider alternative birth control method NSAID Triptan-day before off week Supportive therapy ```
28
menstrual migraines is the result of
Estrogen withraw
29
37 yo with amenorrhea x2mos w/ 8 mos of irregularity ddx
pregnancy Anovulatory cycles Premature ovarian failure / perimenopause Hypothyroidism Prolactinoma Pcos endometriosis
30
dx tests
upt Tsh, prl, fsh, testosterone/dhea-s (if indicated) Chem 7 (fasting) Cbc
31
DUB is a dx of exclusion, can be caused by
fibroids, polyps, hormone imbalance, uterine cancer, etc
32
49 yo woman with hx of breast cancer and hot flashes
was her breast cancer estrogen receptive?
33
what are non hormonal therapy for menopausal sxs
Ssri/snri Clonidine Pregabalin Cbt, hypnosis
34
______ cells of corpus luteum begin producing progesterone
Granulosa cells --> progesterone
35
oligomenorrhea
1. Irregular cycles lasting longer than 34 days
36
polymenorrhea
<25 days
37
when should you measure serum progesterone
Measurement of the serum progesterone concentration in the mid-luteal phase, 18-24 days after menses or 7 days before next menses is expected
38
when should you measure FSH
Measurement of an early follicular phase serum FSH level on Day 3 of the menstrual cycle is used as a marker for ovarian reserve in older or infertile women
39
highest probability of conception is with
Highest probability of conception is with intercourse 1-2 days prior to ovulation
40
when does a rise LH occur
Rise in LH occurs about 36 hours prior to ovulation
41
most common etiology of primary amenorrhea
Chromosomal abnormalities causing gonadal dysgenesis (50%)
42
other causes of primary amenorrhea
Hypothalamic hypogonadism including functional hypothalamic amenorrhea (20%) Absence of the uterus, cervix and/or vagina, müllerian agenesis (15%) Transverse vaginal septum / imperforate hymen (5%) Pituitary disease (5%)
43
evaluation of primary menorrhea dx tests
a. Presence or absence of breast development (Tanner staging) b. Presence or absence of the vagina, uterus, cervix, and ovaries c. FSH serum level
44
MCC if
pregnancy #1 ``` Ovarian disease (40%) Hypothalamic dysfunction (35%) ``` . Pituitary disease (19%) . Uterine disease (5%)
45
High FSH, LH: Dx = Ovarian Failure
i. ≥40 yrs: Menopause ii. <40 yrs: Premature menopause 1. Karyotype if <30 yrs
46
if you have a low FSH and LH
Normal/Low FSH, LH: Dx = Central Failure Evaluate pituitary: MRI brain Rx estrogen replacement If pregnancy desired, induce ovulation
47
elevated DHEAS
adrenal tumor PCOS
48
Elevated testosterone
PCOS ovarian tumor
49
progesterone challenge in a patient with amenorrhea
Withdrawal bleed: anovulation No withdrawal bleed: check FSH, LH
50
when do menstrual migraines occur
2 days prior to 3 days after onset of menses
51
prometherin
progesterone
52
premarin
estrogen
53
theory behind menstraul migraines
: estrogen stimulates nitric oxide release which affects the vasculature leading to migraine Progesterone concentration has no significant effect
54
NSAID recommendation for menstrual migraines
1. Taken 5-7 days prior to onset of menses, continue until 1-2 days after onset
55
triptan recommendation for menstrual migraines
1. Taken 2-3 days prior to anticipated onset of migraine
56
Mastodynia occurs when, relieved with what
Occurs in luteal phase; relieved with menses Most often assoc with fibrocystic changes of breast.
57
mastodonia is the result of.... | what is the Tx 1st and 2nd line
Due to high gonadotropin levels there fore is relieved with danazol androgen inhibitor of GnRH OCP MOST useful and commonly Tamoxifen, bromocriptine may be used off-label and with caution
58
PMS sxs must occur during this phase of the menstrual cycle
Symptoms must occur in the luteal phase May be related to decreased levels of prostaglandins
59
menstrual migraine tx
1 - using monophasic pills (or monophasic ethinyl estradiol doses) only one inactive pill week a few times a year, rather than monthly (ie. “Seasonale”) main problem is breakthrough bleeding 2 - using OCP for BCM uses approx 20 mcg of EE in OCP day 1-21, then day 22-28 use 0.9 mg conjugated estrogens (Premarin) 3 - using low dose estrogen during the time when HA would normally occur also GnRH agonists - but not FDA approved and high cost and side effects
60
OTC FOR MILD PMS
Mild diurectic Analgesics Prostaglandin inhibitors Antihistamines
61
The only diuretic that has been shown in studies to alleviate fluid retention and breast tenderness associated with PMS
spironolactone
62
RX for pMS SSRI
Sarafem (fluoxetine) 20mg po qd Zoloft 25-50mg po qd Celexa 20mg po qd
63
when would you administer SSRI for PMS
Tx during last 2 weeks of cycle or given few days before anticipated start of symptoms. Efficacy for intermittent tx similar to continuous tx
64
conditions that may worsen with the menstrual cycle
``` Migraine Depression Seizures Irritable Bowel Syndrome Asthma Chronic Fatigue Syndrome Allergies ```

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