Menstrual Disorders- Paulson

Question 1

When does puberty start?

Answer 1

Age 8-13

Question 2

increase in androgens before the onset of puberty

Answer 2

Adrenarche

Question 3

breast development

Answer 3

Thelarche

Question 4

pubic hair development

Answer 4

Pubarche

Question 5

What is precocious puberty?

Answer 5

pubertal development before age 8 in girls and age 9 in boys

Question 6

Avg age to start menstruation?

Answer 6

12-13 years old

Question 7

How long should periods last?

Answer 7

4-6 days

Question 8

Regular interval between periods, excessive flow and duration

Answer 8

Menorrhagia

Question 9

Decreased flow during normal duration of regular period

Answer 9

Hypomenorrhea

Question 10

Irregular intervals of menses

Answer 10

Metorrhagia

Question 11

shortened interval between periods , < 19-21 day interval

Answer 11

Polymenorrhea

Question 12

Irregular or excessive bleeding during periods and between

Answer 12

Menometorrhagia periods

Question 13

Lengthened interval between periods, > 35 days intervals

Answer 13

Oligomenorrhea

Question 14

Bleeding following coitus

Answer 14

Post-Coital Bleeding

Question 15

Absent period

Answer 15

Amenorrhea

Question 16

What is primary vs secondary amenorrhea?

Answer 16

Primary- absence of spontaneous menstruation by 13 without normal growth and with secondary sex characterics
Secondary-absence of menses after 3 months of previous menses and after 6 months if irregular menses

Question 17

Turner syndrome

Answer 17

congenital developmental disorder of the reproductive system. Does not develop properly – underdeveloped and malfunctioning.

Question 18

Turner syndrome and hypothalamic pituitary insufficiency result in lifelong absence of menses whereas outflow obstruction: imperforate hymen does/does not result in lifelong absence of menses?

Answer 18

Does not result in lifelong (just needs to be surgically opened)

Question 19

If a patient has primary amenorrhea and presence of secondary sex characteristics, with uterus present, what is the most likely cause?

Answer 19

Outflow tract obstruction

Question 20

If a patient has primary amenorrhea and NO presence of secondary sex characteristics what is the most likely cause?

Answer 20

Karotype analysis should be done because could be genetic

Question 21

What are common causes of secondary amenorrhea?

Answer 21

• ***Pregnancy
• PCOS
• Medications (IUD, birth control)
• Diabetes
• Hyperthyroidism/Hypothyroidism
• Surgery

Question 22

What is the first thing you should work up a patient with secondary amenorrhea?

Answer 22

CHECK A PREGNANCY TEST

Question 23

What is the progesterone challenge test?

Answer 23

Done by giving progesterone medication to a woman with absent or irregular periods to INDUCE a period (once progresterone withdrawn, the bleeding stops)

• *A + test = patient had period so just anovulation
• *A - test indicates low estrogen or outflow tract is blocked

Question 24

A patient presents with irregular periods, overweight, hirtuism. What is the most likely dx? What imaging is helpful?

Answer 24

PCOS

Pelvic U/S to determine if ovaries are cystic

Question 25

Treatment for acne in PCOS?

Answer 25

OCP or combo estrogen and progesterone pill

Question 26

Treatment for hyperglycemia and/or weight loss for PCOS?

Answer 26

Metformin

Question 27

What is the female athlete triad?

Answer 27

1. Eating disorder 2. Amenorrhea 3. Low bone mineral density

Question 28

What is mittleschmerz?

Answer 28

Pain w/ ovulation that occurs in the middle of menstrual cycle

Question 29

How should you treat mittleschmerz?

Answer 29

NSAIDs

Question 30

painful menstruation

Answer 30

Dysmenorrhea Dysmenorrhea is reserved for women whose pain prevents normal activity and requires medication (OTC or prescription)

Question 31

Difference between primary dysmenorrhea and secondary dysmenorrhea?

Answer 31

Primary is caused by excessive prostaglandins leading to cramping whereas secondary is due to pathologic cause like endometriosis or IUD or soemthing (pain that lasts longer than a normal period)

Question 32

What is the #1 RF for dysmenorrhea?

Answer 32

Heavy periods

Question 33

First line treatment for dysmenorrhea?

Answer 33

NSAID (Ibuprofen)

Question 34

Menstrual flow outside of normal volume, duration, regularity, or frequency

Answer 34

Abnormal uterine bleeding

Question 35

Best imaging to do for abnormal uterine bleeding?

Answer 35

Transvaginal U/S

Question 36

Best tx for non-emergent AUB?

Answer 36

IUD or combo OCPs

Question 37

Best tx for acute AUB?

Answer 37

IV estrogen

Question 38

What is the treatment for premenstrual dysphoric disorder?

Answer 38

SSRIs are first line (fluoxetine, sertraline)