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EOR Women's Health > menstruation > Flashcards

menstruation Flashcards

(112 cards)

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1
Q

steady GnRH used for what?

A
  • suppress FSH, LH, estrogen
  • adjuvant for estrogen-receptive breast cancer
  • delay precocious puberty
  • Tx endometriosis & uterine fibroids
  • hormone suppression in transsexual females

USE IN ESTROGEN DEPENDENT DISEASES

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2
Q

pulsatile GnRH used for what?

A

hypogonadotropic hypogonadism

  • low GnRH
  • induce normal puberty, menses development, reproductive cycle
  • fertility Tx
  • preserve reproductive capacity in chemo

RESTORE NORMAL FUNCTION

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3
Q

things that decr GnRH

A
  • mild incr E
  • progesterone
  • endorphins, opioids (heavy exercise)
  • Corticotropin Releasing Hormone (stress, incr cortisol, Cushings)
  • prolactin
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4
Q

things that incr GnRH

A
  • rapidly incr E

- Kisspeptin (adipose tissue)

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5
Q

FSH

A

granulosa cells, androgens to estrogen, inhibin & activin

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6
Q

LH

A
  • theca cells, production of androgens
  • ovulation
  • convert residual follicle to corpeus luteum
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7
Q

dominant follicle maturation dependent on what?

A

FSH

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8
Q

what causes release of oocyte?

A

LH surge

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9
Q

as dominant cell prepares for ovulation, what level increases?

A

high estrogen

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10
Q

what hormone converts residual follicle to corpeus luteum?

A

LH

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11
Q

corpeus luteum produces what?

A

progesterone

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12
Q

progesterone roles

A
  • menses

- implantation

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13
Q

no fertilization…

A

corpus luteum–> corpus albicans–> gone

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14
Q

fertilization…

A

HCG from zygote

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15
Q

role of HCG initially

A

sustain corpus luteum, progesterone secretion for implantation

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16
Q

estrogen effect on lipids, cardiovascular?

A

decr LDL, incr HDL
vasodilation
lower CAD

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17
Q

estrogen and skin?

A

thick skin, elasticity, collagen incr, incr melanocytes

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18
Q

estrogen & bone?

A

inhibits osteoclasts

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19
Q

menopause estrogen

A

estrone

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20
Q

most potent estrogen

A

estradiol

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21
Q

pregnancy estrogen

A

estriol

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22
Q

reproductive years estrogen

A

estradiol

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23
Q

extra-ovarian production of estrogen

A

adrenal glands, adipose tissue

breasts, liver

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24
Q

menses E & P

A

LOW

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25
in follicular phase, pituitary secretes FSH. what is the result?
- ovaries up-regulate FSH receptors (granulosa cells) - produce E from androgens - rapid incr E stimulates GnRH - GnRH causes LH surge
26
mittelschmerz
feel ovulation pain
27
luteal phase follicle transformed into what?
corpus luteum
28
luteal phase progesterone causes what?
neg feedback on LH and FSH
29
endometrial lining conditioning by what?
PROGESTERONE and E
30
corpus luteum lifespan
9-11 days
31
E effects on endometrium
build up
32
P effects on endometrium
differentiation of components
33
E & P if no fertilization
major drop E & P, endometrium sloughs
34
normal menses blood loss, length
20-60 mL | 3-7 days
35
in order for P to be produced in menses, what must occur?
ovulation
36
if no ovulation
E unchecked (no P), no secretory phase, abnorm bleeding (sloughing irregular)
37
breast tenderness when?
luteal phase
38
mucus with E & P
E: thin, P: thick
39
hypothalmic cause of irreg menses, anovulation. what to order next?
LH
40
menorrhagia
prolonged bleeding > 7 days
41
metrorrhagia
bleeding b/t menstrual periods
42
secondary amenorrhea
no menses 3-6 mo in previously menstruating female
43
primary amenorrhea
- 13 y/o no menstruation, no secondary sexual characteristics - 15 y/o no menstruation, yes secondary sexual characteristics
44
MCC amenorrhea
pregnancy
45
#2 cause amenorrhea
anovulation
46
female athlete triad
- anorexia - amenorrhea (b/c decr adipose tissue, excessive exercise) - osteoporosis (stress Fx)
47
hypothalmic amenorrhea
anorexia (kisspeptin), excessive exercise (endorphins), stress (cortisol), opioids
48
MCC pituitary amenorrhea
hyperprolactinemia (decr GnRH)
49
hypothyroidism causes what?
incr TRH = incr TSH, prolactin
50
ovary amenorrhea
PCOS, premature ovarian failure
51
asherman syndrome
uterus scarring, no proliferation, no shedding | = amenorrhea (cause: procedures)
52
MCC hirsutism
PCOS
53
DHEA produced where
adrenals
54
androstenedione produced where
adrenals, ovaries
55
testosterone produced where
adrenals, ovaries, adipose tissue
56
DHT produced where
hair, genitals
57
most potent androgen
DHT
58
adipose only CONVERTS androstenedione to what?
T and estrone
59
ovary androgen prod
androstenedione, T, estradiol
60
adrenals androgen prod
cortisol, androgens
61
adipose androgen prod
converts to T, estrone
62
Stein-Leventhal syndr
PCOS
63
Sx PCOS
-anovulation -hyperandrogenism (hirsutism, T) -polycystic ovaries (string of pearls) (obesity, infertility, miscarriage, metab syndr)
64
labs PCOS
high LH, low FSH (>2.5-3 LH:FSH) high free T high androstenedione
65
metabolic syndr
- central obesity - incr TG - incr BP - decr HDL - hyperglycemia (> 100 fasting)
66
HAIR-AN syndr, assoc with what?
HyperAndrogenism, Insulin Resistance, Acanthosis Nigricans | -PCOS
67
PCOS pt- no hyperglycemia with blood glucose test. next step?
GTT
68
impaired GTT (fasting glucose, 2hr GTT, HbA1C)
- fasting glucose: 126 - 2hr GTT: 200 - HbA1C: 6.5
69
Tx PCOS
wt loss provera (progesterone) OCP (desogen, modicon, ortho-cyclen) Tx infertility: clomid Tx hyperandrogenism: spironolactone, Vaniqa (topical hair removal) Tx insulin resistance: metformin
70
Tx hyperandrogenism (in PCOS)
spironolactone, Vaniqa (topical hair removal)
71
specific tests to evaluate amenorrhea
P challenge, E-P challenge, FSH levels
72
provera given, withdrawn. pt bleeds. what does this mean?
PCOS anovulation -enough E for endometrium build up, just anovulation
73
provera given, withdrawn. pt doesn't bleed. what does this mean? what to do next?
E deficient | E-P challenge next.
74
premarin given, then provera, withrawn. pt bleeds. what to do next?
FSH in 2 wks
75
premarin given, then provera, withrawn. pt doesn't bleed. what does this mean?
anatomic problem - Asherman (scarred uterus)- can't build up - cervical stenosis- can't expel
76
E-P challenge. pt bleeds. FSH high. what does this mean?
menopause | -ovaries not responding to FSH
77
E-P challenge. pt bleeds. FSH low. what does this mean?
anorexia, exercise, opioids, stress, pituitary adenoma | -inappropriate release of FSH, LH (hypothalamus, pituitary problems)
78
follicles become resistant to FSH (no follicle stimulation). what is this?
menopause
79
menopausal FSH levels
> 30
80
premature menopause
before 30 y/o
81
menopause definition
menses cessation x 1 yr
82
factors that have no effect on menopause
lactation, menarche age, # of pregnancies, OCP, race
83
hormones of menopause
testosterone, estrone
84
Sx of menopause
sleep disturbance, genital atrophy (cystocele, uterine prolapse, vaginitis, mood changes, osteoporosis, incr LDL, decr HDL, thin skin, hirsutism, hot flashes, nightsweats
85
DEXA -1.0 to -2.5
osteopenia
86
DEXA < -2.5
osteoporosis
87
when to start routine bone density scanning
65 y/o
88
osteoporosis RF
white, incr age, Fx, smoking, dementia, low body wt, estrogen def, alcoholism, chronic corticosteroids, sedentary
89
osteoporosis Tx
- calcium - vit D - bisphosphonates - SERM: raloxifene - estrogen replacement - calcitonin - progesterone
90
calcium requirement in menopause
1200-1500 mg/day
91
vitamin D supplementation in menopause
800-2000 Units/day
92
active form Vit D
vit D3
93
how to measure vit D
25-OH Vit D
94
ADR bisphosphonates
osteonecrosis of jaw, esophageal erosions | -holiday after 5 yrs of use
95
main management of Sx related to menopause
estrogen replacement | Premarin
96
estrogen ADR
melasma, gallstones, endometrial CA, incr CAD/stroke/DVT/breast CA/dementia menstrual Sx
97
progesterone
Provera, levonorgestrel, norethindron, drospirendone
98
combined menopause Tx
cyclic: E days 1-25, medroxyprogesterone acetate days 16-25 continuous: together
99
absolute contraindications to hormonal therapy
unDx vaginal bleeding, thrombophlebitis, cerebral vascular disease, pregnancy, CAD, smoker >35 y/o, impaired liver, breast CA, hyperlipidemia
100
incr risk of what diseases in hormonal therapy?
MI, thromboembolism, stroke, breast CA | not colorectal CA
101
monophasic, biphasic, triphasic OCP
- mono: same doses, both, all month - bi: same E dose, incr progestin dose second 1/2 - tri: varying dose both
102
progestin only/mini pill 2 indications (take at SAME TIME every day)
> 40 y/o | lactating
103
break through bleeding with progestin
resolves in 3 mo
104
depo medroxyprogesterone acetate (Depo-Provera) affects what?
``` suppress LH (ovulation), no effect on FSH thicken mucus ```
105
Depo shot ADR
osteoporosis
106
PMS, PMDD- what phase ONLY?
luteal phase | P makes women mean!
107
PMDD
core Sx: depressed, anxiety/tension, sad/tearul/sensitive, irritable/angry anhedonia, lethargy, insomnia
108
main contraceptive effect of pill attributed to?
E
109
spotting on pill, what should you do?
wait 3 months, will go away
110
PMS
5 days before menses! in 3 menstrual cycles! gone in 4 days of LMP! no drugs! depression, angry, irritable, confusion, social withdrawal, breast tender, bloating, HA
111
Tx PMS
- less carbs, caffeine, fat, EtOH - exercise - NSAIDs - SSRI: fluoxetine, sertraline - calcium, Mg (danazol)
112
Tx PMDD
SSRI (GOLD STANDARD) fluoxetine, sertraline, paroxetine -14 days before menses

EOR Women's Health (4 decks)

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