Test 1 Flashcards by Nicholas Berglund

Amenorrhea

Absence or abnormal cessation of the menses for more than 3 months

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Oligomenorrhea

Scanty menstruation; menstrual periods occur at intervals of greater than 35 days, with only 4-9 periods in a year.

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Polymenorrhea

Occurrence of menstrual cycles of greater than usual frequency.

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Menorrhagia

Excessively prolonged or profuse menses

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Metrorrhagia

Any irregular, acyclic bleeding from the uterus between periods

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Menometrorrhagia:

Irregular or excessive bleeding during menstruation and between menstrual periods

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Dysmenorrhea

Painful menses

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Mittelschmerz

One sided lower abdominal pain that occurs in women at or around the time of ovulation

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Tool for: Magnification and viewing of cervix, vulva, vagina, and perianal

Colposcopy

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Indication for Endometrial Biopsy (EMB)=

Abnormal vaginal bleeding

Postmenopausal bleeding

Fertility Issues

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Waht does a Hysteroscopy view?

Direct Intrauterine viewing (camera through cervix)

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What are indications for Hysteroscopy?

Abnormal bleeding

Intrauterine Mass (fibroid/CA)

Pelvic Pain

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What is a hysterosalpingogram?

Radiopaque dye outlines interior of uterus and fallopian tubes.

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Indications for Laparoscopy?

Pelvic masses-uterus, ovaries, tibes

Pelvic pain PID, endometriosis, fibroids

Fertility issues

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What is a Laparotomy?

When is it used?

Open abdominal surgery

Hysterectomy, Pelvic cancers, Pelvic masses, C-section.

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When is are of menarche?

12-13

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% of women with infertility=

20%

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What does normal menses require?

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Normal hypothalamic pituitary ovarian (HPO axis)

Responsive Endometrium

Unobstructed outflow tract

Effects of Estrogen

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Endometrial proliferation
Myometrial cell growth
Vaginal cornification
Reduced vaginal pH
Increased cervical mucus

Estrogen in excess Sx

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Dysmenorrhea
Nausea
Edema
Enlarged uterus
Fibroids
Fibrocystic Breasts
Menorrhagia

Estrogen Deficiency Sx

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Scant menses

Mid cycle spotting

Progesterone effects

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Endometrial secretory changes
Decrease pH of cervical mucus
Help maintain pregnancy
Breast, uterine, tubal mm activity
Thermogenic effects

Progesterone in excess Sxs

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Edema
Bloating
Headache
Depression
Weight gain
Fatigue
Hypertension
Vericose Veins
(Sxs of pregnancy)

Progesterone Deficiency Sxs

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Prolonged menses
Heavy menses
Severe cramps
Luteal spotting

Normal cycle length= Flow= Amount=

Cycle=21-45 days Flow= 7 days (3-5 ave) Amount= 80ml (16tsp)

Estradiol is highest in what phase? Progesterone is highest in what phase?

Estrogen= Follicular Progesterone= Luteal

Causes of primary amenorrhea (0.3% prevalence)

-CNS hypothalamic pituitary disorder -Membranous blockage of vagina (hyman) -Drastic weight loss/malnutrition -Hypoglycemia -Extreme obesity -Thyroid disease -Anemia Congenital

Causes of Secondary Amenorrhea

- Pregnancy - Weight reduction/gain - Stress/depression - Hypothyroidism - PCOS - Obesity - Increased prolactin (inhibit GnRH) - Early menopause - Drugs

Medications that may cause Amenorrhea

``` Hormonal contraception Antipsychotics Antidepressants Cardiovascular meds Marijuana ```

Risks of long term amenorrhea: If Hypoestrogenic Amenorrhea= If Hyperestrogenic Amenorrhea=

Hypo= - Bone mineral density loss Hyper= - Abnormal lipid levels - DM - Obesity - Breast Cancer

Initial labs to check diagnose reason for amenorrhea=

B-hCG (Pregnancy) TSH (Thyroid) PRL (Inhibits GnRH) Estrogen/ Progesterone challenge test

HPO axis and Amenorrhea: If FSH >30 or LH>40= If >45y= If <40yo= Low FSH/LH=

If FSH >30 or LH>40= ovarian failure If >45y= menopause If <40yo= premature ovarian failure Low FSH/LH= pituitary or hypothalamic dysfunction

Exercise induced Amenorrhea can be cause by:

Body fat <15-18% BMI <18 Nutritional deficient state: energy output exceeds input. Exercise alone does not lead to amenorrhea

Causes of Premature Ovarian Failure (early menopause <40)

``` Autoimune Chemo/radiation Family Hx Surgical removal/damage Chromosomal (fragile X/Turners) ```

Management of Premature Ovarian Failure (estrogen deficiency symptoms)

1) Hormone Replacement 2) SSRIs 3) Botanicals (black cohosh, red clover) 4) Diet, Exercise, Stress Mgmt

What diseases do you need to watch out for with Premature Ovarian Failure Management?

Osteoporosis - DEXA, Cal/mag/D, Exercise, Meds CAD - Monitor BP, Lipids Estrogen Deficiency - Vaginal Atrophy, Libido, Insomnia, mood swings

What diseases do you need to watch out for with Premature Ovarian Failure Management?

Osteoporosis - DEXA, Cal/mag/D, Exercise, Meds CAD - Monitor BP, Lipids Estrogen Deficiency - Vaginal Atrophy, Libido, Insomnia, mood swings

3 criteria for PCOS

1) Oligo-menorrhea 2) Hyperandrogenism 3) Exclusion of other disorder * Polycystic varies are NOT required for diagnosis*

What % of women have full blown clinical picture of PCOS? What is full blow?

1/3 Amenorrhea (50%) Hirsutism (50%) Obesity (40%) Infertility (20%)

What do woment with PCOS usually seek medical care for?

``` Menstrual cycle Irregularities & infertility Metabolic issues: - Hypoglycemia - Insulin resistance - Hyperlipidemia -Hypertension ```

PCOS increases your risk for what 4 diseases?

Infertility DM CVD Endometrial cancer

Making the diagnosis of PCOS. Symptoms= Tests=

Symptoms= hirsutism, anovulation, irregular menses Tests= Free testosterone/DHEA, & Fasting glucose/insulin Pelvic ultrasound NOT NECESSARY

How do you manage PCOS?

Treat disease and symptoms associated with it. - Insulin resistance - Androgen excess - Fertility - Diabetes, cancer, CVD, obesity.

Treating PCOS Meds= Supplements= Lifestyle=

Meds= - Progesterone for E:P - Spironolocatone for androgens - Metformin for BS Supplements= -SHBH (soy, flax, nettles, green tea) -Decrease androgens: Saw palmetto, green tea - Improve Insulin Resistance: Vit C, Chromium Increase Ovulation: Vitex, Rhodiola Lifestyle= - High protein, low carm, low bad fats. - EXERCISE

Test 1 Flashcards

(44 cards)