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EOR - Women's Health > Menstruation: Amenorrhea, Dysfunctional uterine bleeding, Dysmenorrhea, Menopause > Flashcards

Menstruation: Amenorrhea, Dysfunctional uterine bleeding, Dysmenorrhea, Menopause Flashcards

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1
Q

2 types of amenorrhea

A

primary
secondary

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2
Q

mc cause of secondary amenorrhea

A

intrauterine pregnancy

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3
Q

first step in work up for amenorrhea

A

pregnancy test

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4
Q

primary amenorrhea is the failure of menses to occur by __ yo

A

15 yo (according to AAPA Blueprint)
but apparently some sources say 16 yo

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5
Q

in order for primary amenorrhea dx, amenorrhea must occur in the presence of (2)

A

normal growth
secondary sexual characteristics

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6
Q

primary eval of amenorrhea should occur at age 13 if there is

A

complete absence of secondary sexual characteristics

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7
Q

6 causes of primary amenorrhea

A

turner’s syndrome
hypothalamic-pituitary insufficiency
androgen insensitivity
imperforate hymen
anorexia
mullerian agenesis

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8
Q

XO karyotype
webbed neck
broad chest
elevated FSH

A

turner’s syndrome

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9
Q

46 XX
elevated testosterone
breast development only

A

hypothalamic-pituitary insufficiency

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10
Q

46 xy
cyclic pelvic pain
diagnosis via speculum exam

A

imperforate hymen

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11
Q

46 xx
very low weight

A

anorexia

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12
Q

secondary sex characteristics present
no uterus

A

mullerian agenesis

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13
Q

secondary amenorrhea is absence of menses for _ months
in a woman w. previously normal menstruation
OR
_ months in a woman w. a hx of irregular cycles

A

3
6

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14
Q

4 causes of secondary amenorrhea

A

pregnancy
weight changes
hypothyroid
prolactinoma

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15
Q

lab work up for secondary amenorrhea

A

beta HCG
TSH
prolactin

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16
Q

work up for secondary amenorrhea should include what challenge test

A

progesterone challenge test

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17
Q

what is the progesterone challenge test

A

medroxyprogesterone/progestogen x 7-10 days - if bleeding occurs = anovulatory cycles

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18
Q

what do you think when you see a 35 yo woman w. heavy and irregular menstrual periods x 1 year - she is in a stable/monogamous relationship, no hx of abnormal paps, and no hx STI’s - elevated BMI, normal vitals and pelvic exam

A

dysfunctional uterine bleeding

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19
Q

excessive uterine bleeding and prolonged menses that is NOT caused by pregnancy or miscarriage

A

dysfunctional uterine bleeding/AUB

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20
Q

6 types of dysfunctional uterine/AUB

A

polymenorrhea
hemorrhagic/hypermenorrhea
menorrhagia
metorrhagia
menomethorrhagia
oligomenorrhea

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21
Q

menses that occur more frequently (< 21 days apart)

A

polymenorrhea

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22
Q

menses that involve more blood loss (> 7 days OR > 80 mL) w. irregular intervals

A

hemorrhagic/hypermenorrhea

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23
Q

prolonged/heavy bleeding (> 7 days OR > 80 mL) w. regular intervals

A

menorrhagia

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24
Q

uterine bleeding that occurs frequently AND irregularly btw regular intervals

A

metrorrhagia

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25
more blood loss during menses AND frequent and irregular bleeding btw menses
menometrorrhagia
26
long intervals btw menses
oligomenorrhea
27
oligomenorrhea involves > _ days btw menses
35
28
AUB in the absence of an anatomic lesion caused by a problem w. the hypothalamic-pituitary-ovarian axis
polymenorrhea menorrhagia metrorrhagia
29
gs dx for abnormal uterine bleeding
uterine dilation and curettage
30
work up for AUB
r/o pregnancy labs progestin trial ovulation journal pap smear/pelvic exam endometrial bx HSG (hysterosalpingography)
31
tx for AUB
OCP NSAIDs
32
dull, throbbing cramping/lower abdominal pain during menses w. n/v - normal length and bleeding amount
dysmenorrhea
33
dysmenorrhea pain peaks _ days after the onset of menses and subsides after _ days
peaks: 24 hr subsides: 2-3 days
34
t/f: dysmenorrhea can be primary or secondary
t!
35
in order for dysmenorrhea dx, pain must (2)
prevent normal activity require medication (OTC vs rx)
36
t/f: dysmenorrhea pain can occur w. menses OR 2-3 days before onset
t!
37
work up for dysmenorrhea (2)
pregnancy test US
38
cause of primary dysmenorrhea
excessive PG's (not pinot grigio, which actually helps)
39
what PG is associated with dysmenorrhea
any from Sonoma County ... jk real talk: F2a
40
dysmenorrhea mc affects what age group
teens - early 20's *declines w. age*
41
rf for dysmenorrhea (5)
menarche before 12 yo nulliparity smoking fam hx obesity
42
how might primary dysmenorrhea pain be described
"labor-like" on days 1-3
43
dysmenorrhea may be associated by what symptoms (3)
n/v diarrhea HA
44
causes of secondary dysmenorrhea (lots!)
pathologic/clinically identifiable cause: endometriosis adenomyosis polyps fibroids PID IUD tumors adhesions cervical stenosis cervical lesions psych
45
how might secondary dysmenorrhea pain be described
begins mid-cycle increases in severity until the end
46
secondary dysmenorrhea is mc in what age group
20s-40s
47
dx of menopause is based on _ or more months of amenorrhea
12
48
mean age of menopause
51 (44-55 yo)
49
on average, women spend _ years in the postmenopausal state
30+
50
regular menstrual fxn that marks the transition btw reproductive capability and menopause
perimenopause
51
perimenopause lasts _ years
3-5
52
symptoms of menopause (6)
menstrual irregularity vasomotor sx sleep distrubances irritability mood disturbances vaginal dryness
53
what are vasomotor symptoms (2)
hot flashes night sweats
54
4 sx associated w. vaginal dryness
dyspareunia vaginal atrophy loss of urogenital integrity loss of skin elasticity
55
menopause onset before 40 yo
premature ovarian failure
56
hallmark labs for menopause
FSH > 30 decreased estradiol
57
tx for vasomotor sx
HRT - estrogen
58
HRT for women with a uterus
estrogen + progesterone
59
HRT for women with no uterus
ERT (estrogen replacement therapy)
60
unopposed estrogen HRT in women w. a uterus increases the risk of
endometrial ca
61
progestin HRT increases the risk of (2)
hot flashes breast ca
62
when should HRT be used for menopause
severe sx: hot flashes night sweats vaginal dryness
63
how should you dose HRT for menopause
smallest dose for shortest possible time annual review of decision to use HRT
64
t/f: HRT should be used to prevent CVD
f! dt increased risk of breast ca, CVD, DVT
65
effect of HRT on lipid profile
increases: HDL and TG decreases: LDL
66
contraindications for HRT (6)
elevated TG undiagnosed vaginal bleeding endometrial ca hx breast ca OR estrogen sensitive ca CVD hx DVT/PE
67
non hormonal tx for vasomotor sx of menopause (3)
SSRI's/SNRI's clonidine gabapentin
68
what SSRI is used for vasomotor sx of menopause
paroxetine
69
2 phases of the 28 day menstrual cycle
follicular (proliferative) luteal (secretory)
70
normal menstrual cycle can vary in duration from _ to _ days
20-35
71
each menstrual cycle begins on
the first day of ovulation
72
ovulation occurs _ days before teh first day of menstruation
14
73
chance of fertilization is highest btw days _ and _ of the menstrual cycle
11-15
74
days 0-14 of menstrual cycle
follicular (proliferative) phase
75
during the luteal phase, _ from the hypothalamus stimulates _ and _ to be released from the anterior pituitary
hypothalamus: GnRH anterior pituitary: FSH, LH
76
FSH and LH stimulate _ growth, which secretes _
follicle estrogen
77
increasing estrogen levels during the follicular phase cause _ feedback, which causes a surge in _ (2)
positive FSH, LH
78
what causes ovulation
LH spike (caused by increasing estrogen release from the follicle)
79
days 15-28 of the menstrual cycle
luteal (secretory) phase
80
after ovulation, the follicle become the _ which secretes _
corpus luteum progesterone
81
increased progesterone in the luteal/secretoy phase causes _ feedback and a decrease in _ (2)
negative LH/FSH
82
in the absence of fertilization during the luteal phase, the corpus luteum becomes the _
corpus albicans
83
the corpus luteum does not produce estrogen or progesterone, which leads to _
endometrial sloughing -> menses
84
after menses, _ secretion marks the beginning of a new follicular phase
GnRH
85
26 yo f c/o dpn and anxiety x 1 year just prior to menses - this interferes w. her relationships and work productivity - also c/o poor sleep, feeling overwhelmed, easily fatigued - PE and labs are normal
premenstrual dysphoric d.o
86
repeated episodes of significant dpn and related sx during the first week before menstruation
premenstrual dysphoric d.o (pmdd)
87
difference btw pmdd and pms
pmdd is a severe disabling extension of pms -> causes marked disruption in functioning
88
dsm 5 for pmdd
at least 5 sx in the final week before onset of menses, which improve/become absent a few days after onset of menses: affective lability/mood swings interpersonal conflict dpn anxiety decreased interest in activities difficulty concentrating lethargy change in appetite hypersomnia OR insomnia sense of being overwhelmed physical sx: ex breast tenderness, bloating, joint pain
89
tx for pmdd (3)
SSRIs: fluoxetine, sertraline SNRIs: venlafaxine OCP + diuretics
90
tx for severe/refractory pmdd (4)
GnRH TCAs benzos ovariectomy
91
25 yo c/o abd bloading, HA, irritability, dpn, poor sleep, breast tenderness 5 days before menses - sx greatly improve w.in 4 days of menses onset
premenstrual syndrome
92
when do sx of pms typically occur
btw ovulation and menses
93
what causes pms sx
-imbalance of estrogen and progresterone -excess PG's
94
what pms sx typically occur during the luteal phase (3)
bloating irritability pmdd
95
what criteria is used to for pms dx
ACOG: one of the following sx is present during the 5 days before menses and abates w.in 4 days of menses: -somatic: breast tenderness, abd bloating, HA, edema -affective: irritability, dpn, angry outbursts, anxiety, social w/d, confusion
96
tx for pms
exercise stress reduction SSRIs combined OCP
97
t/f: for pms, SSRI's can be dosed cyclically
t!
98
tx for resistant/severe PMS
GnRH oophrectomy

EOR - Women's Health (15 decks)

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