Menstruation

Question 1

Primary amenorrhea

Answer 1

Failure to begin menstruating

Question 2

Secondary amenorrhea

Answer 2

Absence of menses for 6 months in a previously menstruating patient

Question 3

Etiology of primary amenorrhea

Answer 3

Ovarian insufficiency due to genetics

Question 4

Etiology of secondary amenorrhea

Answer 4

Pregnancy
PCOS
Pituitary disease

Question 5

Sheehan’s syndrome

Answer 5

Postpartum pituitary necrosis

Question 6

Mullerian dysgenesis

Answer 6

Congenital absence of uterus and upper 2/3 of vagina

Question 7

Asherman’s syndrome

Answer 7

Uterine adhesions

Question 8

Primary amenorrhea with low FSH and LH

Answer 8

Issue with the HPO axis
- Get an MRI

Question 9

Primary amenorrhea with high FSH

Answer 9

Ovarian failure
- Check karyotype for genetic issues

Question 10

Treatment of amenorrhea if desiring pregnancy

Answer 10

Ovulation induction with Clomid or Letrozole

Question 11

Treatment of amenorrhea if not desiring pregnancy

Answer 11

Estrogen/progesterone

Question 12

Dysmenorrhea

Answer 12

Painful menstruation

Question 13

Treatment of dysmenorrhea

Answer 13

NSAIDs
Hormonal contraceptives

Question 14

S/S of PMS and PMDD

Answer 14

HA
Fatigue
Breast tenderness
Bloating
Abdominal pain
Mood swings
Irritability

Question 15

PMS vs PMDD

Answer 15

PMDD: clear functional impairment with predominant psych symptoms

Question 16

Treatment of PMS/PMDD

Answer 16

Mild: behavioral modifications and symptomatic tx
Severe: SSRIs and OCPs

Question 17

Menorrhagia

Answer 17

Heavy bleeding

Question 18

Hypomenorrhea

Answer 18

Light bleeding

Question 19

Metrorrhagia

Answer 19

Bleeding between normal menses

Question 20

Polymenorrhea

Answer 20

Menses occurring too frequently

Question 21

Menometrorrhagia

Answer 21

Bleeding with irregular intervals and amount

Question 22

Oligomenorrhea

Answer 22

Menses occurring too infrequently

Question 23

Evaluation of dysfunctional uterine bleeding (DUB)

Answer 23

Pelvic US
Endometrial biopsy
Hysteroscopy

Question 24

Treatment of premenopausal DUB

Answer 24

Observation
Hormone therapy

Question 25

Treatment of postmenopausal DUB

Answer 25

Hormones US Hysteroscopy

Question 26

Menopause

Answer 26

No period for 12 months

Question 27

Hormone levels in menopause

Answer 27

Low inhibin Increased FSH and LH Decreased estrogen Decreased progesterone

Question 28

S/S of menopause

Answer 28

Hot flashes Mood swings Vaginal dryness Hair loss

Question 29

Treatment of menopause

Answer 29

Vaginal moisturizer Estrogens

Question 30

Known risks of hormone replacement

Answer 30

Endometrial cancer Breast cancer Clots

Question 31

1st line tx for vasomotor menopause sx

Answer 31

Transdermal hormones

Question 32

Pros and cons of combination hormone therapy

Answer 32

Pro: adding progesterone to estrogen decreases risk of endometrial cancer rather than just unopposed estrogen Con: addition of progesterone to estrogen increases risk of breast cancer

Question 33

If patient has intact uterus ___

Answer 33

Must do combo estrogen and progesterone

Question 34

Actions of estrogen

Answer 34

Endometrial proliferation Development of secondary sex characteristics Increased vaginal lubrication

Question 35

Actions of progesterone

Answer 35

Decrease uterine contractility Promotes breast development Falling levels trigger menses and lactation

Question 36

Major hormone of pregnancy

Answer 36

Progesterone

Question 37

What hormone leads to ovulation

Answer 37

LH surge/peak

Question 38

Mittelschmerz

Answer 38

Mid-cycle pain

Question 39

Pre-ovulatory phase of ovarian cycle

Answer 39

Varying length Several follicles enlarge until one becomes dominant and grows rapidly and the others regress

Question 40

Mid-ovarian cycle

Answer 40

Mature follicle ruptures

Question 41

Post-ovulatory phase of ovarian cycle

Answer 41

Always 14 days Corpus luteum makes progesterone and estrogen If pregnancy does not occur, LH and FSH decline and corpus luteum atrophies Decreased progesterone leads to shedding of uterine lining

Question 42

Why does progesterone trigger menses?

Answer 42

Progesterone controls blood supply to endometrium, so when it drops, the endometrium sheds

Question 43

Days 1-5 of uterine cycle

Answer 43

Menstrual phase

Question 44

Proliferative phase of uterine cycle

Answer 44

Estrogen rises causing endometrium to regenerate Uterine glands lengthen

Question 45

Secretory phase of uterine cycle

Answer 45

Progesterone causes endometrium to mature Corpus luteum regresses leading to decreased estrogen and progesterone

Question 46

Hormone effect on cervical mucus

Answer 46

Estrogen: thins and creates fern-like pattern Progesterone: thickens

Question 47

When is cervical mucus thinnest and thickest?

Answer 47

Thinnest: ovulation Thickest: following ovulation and pregnancy