Module 5 Practice Questions Flashcards
List some common causes of anovulation.
-physiological alterations in the HPO axis at the extremes of reproductive ages
-thyroid disorder ( the thyroid is the body’s regulator for many systems. It eventually affects menstruation when either too little or too much active (free) thyroxine is circulating.)
-PCOS (one of the hallmarks of PCOS is irregular ovulation (often called oligo-ovulation)— that may stretch out into long enough time periods that we call it anovulation.)
T/F: Amenorrhea, having no period at all, may be primary or secondary.
True!
Primary amenorrhea means never having a period. It’s often caused by congenital absence of the uterus or other conditions present from birth. Secondary amenorrhea means menstruation ceasing after being present in the past. The most common cause is, of course, pregnancy–but there are many others we will explore in this module.
T/F: Excessive uterine bleeding may be a sign of endometrial hyperplasia or cancer.
True!
Although rare, long periods of anovulation in the presence of estrogen (“unopposed” estrogen) can predispose a woman to developing endometrial cancer. Hyperplasia, where a thick lining persists over time, can set the stage for point mutations in the cells of the lining that can become cancerous. We must always consider hyperplasia or cancer as a possible cause of heavy or irregular uterine bleeding, especially when a woman has been anovulatory for long periods of time.
T/F: Ruling out endometrial cancer always requires a biopsy.
False!
A thin endometrium on transvaginal ultrasound can rule out endometrial cancer less invasively. In recent years, many clinicians start with TVUS and move to biopsy only if imaging findings are equivocal or suspicious. Timing of the ultrasound is important to avoid false positives.
What is the typical age of onset of endometriosis?
adolescence or early adulthood
What is the typical age of onset of POCS?
adolescence or early adulthood
What is the typical age of onset of adenomyosis?
middle to later reproductive years
What is the typical age of onset of PMS?
middle to later reproductive years
What is the typical age of onset of ovarian cancer?
post-menopause
What is the typical age of onset of breast cancer?
post-menopause
A patient presents with intense itching of the vuvla. What may it be associated with?
-lichen sclerosis (this condition can cause intense itching and excoriations of vulvar skin along with its typical “keyhole” or “figure 8” whitened skin presentation.)
-contact dermatitis
-yeast vaginitis
T/F: Most chronic pelvic pain has a GYN origin.
False: About 2/3 of chronic pelvic pain has a GI or GU origin.
Which of the following may COMMONLY cause secondary amenorrhea? (check ALL that apply)
-outflow tract obstruction
-regular ovulation
-prolonged anovulation with low or no estrogen
-prolonged anovulation with normal or high estrogen
-prolonged anovulation with low or no estrogen
-prolonged anovulation with normal or high estrogen
In one pathway to secondary amenorrhea, a pituitary tumor causes ——– to rise, which suppresses ——–, resulting in very low levels of ——–.
1: Prolactin
2: GnRH
3: Estrogen
List reasons that could cause an increase in prolactin.
-a benign pituitary tumor called a prolactinoma
-medications (including mood stabilizers)
-breast feeding
-frequent breast stimulation
What is the hormonal status associated with PCOS?
normal to high estrogen
What is the hormonal status associated with anorexia?
low estrogen
What is the hormonal status associated with chronic disease
low estrogen
What is the hormonal status associated with excess adipose tissue?
normal to high estrogen
What is the hormonal status associated with prolactinoma?
low estrogen
