03a: Amenorrhea Flashcards
Top three causes of secondary amenorrhea
- Pregnancy
- PCOS (30-35%)
- Hypothalamic (20-25%)
List some less common causes (10% or less) of secondary amenorrhea
- Premature ovarian insufficiency (early menopause)
- Hyperprolactinemia
- Asherman’s syndrome (uterine adhesions)
- Hypothyroid/endocrine
Hypothalamic amenorrhea: (high/low) FSH, (high/low) LH, (high/low) E.
All low
PCOS: (high/low) FSH, (high/low) LH, high (E/T).
normal, high, Testosterone
PCOS is often the result of (X) resistance. What’s the mechanism/pathogenesis behind this?
X = insulin
High insulin causes high IGF to bind ovary theca cells, resulting in high androstenedione (and high testosterone)
Criteria for PCOS:
2/3 of:
- Oligo/an-ovulation
- Clinical OR biochem hyperandrogenism
- Polycystic ovary, 1 or both (and exclusion of other etiologies)
T/F: Insulin resistance appears in up to 70% of obese and non-obese PCOS women.
True (so check HbA1c if suspecting PCOS); 5-10% have DMII
Infertility is defined as inability to conceive after (X) (days/months/years) of regular, unprotected intercourse.
X = 1y
Of couples with female under 30 yo, (X)% are infertile.
X = 10
Of couples with female between 40-44 yo, (X)% are infertile.
X = 30-40
Window of time in menstrual cycle that’s considered “high risk” for pregnancy is (X) day(s) before and (Y) day(s) after ovulation.
4-5 day window
X = 3
Y = 1
Rx for unexplained/minor causes of infertility:
- Intrauterine insemination of washed/concentrated sperm with female on fertility drug (Letrozole, clomid)
- IVF
One milestone related to teratogens is the increase in incidence of phocomelia, aka (X), linked to (Y) exposure.
X = flipper limb Y = thalidomide (prescribed for morning sickness in europe)
FDA Lettering Classification of Benefit/Risk of drugs in pregnancy: fetal risk, but acceptable benefit/risk
D
FDA Lettering Classification of Benefit/Risk of drugs in pregnancy: no fetal risk, based on human studies
A
FDA Lettering Classification of Benefit/Risk of drugs in pregnancy: fetal risk outweighs benefits
X
T/F: Effect of maternal smoking on fetus is dose-dependent.
True
List some abnormalities that occur as result of maternal smoking during pregnancy
- Low birth weight (fetal growth retardation in trim 3 and increased risk of pre-term delivery)
- Teratogenic effects (heart defects)
T/F: About 2% of smokers among women are giving birth, according to 2014 data.
False - 8.4%!
T/F: Effect of maternal ethanol consumption on fetus is dose-dependent.
True
Pre-term infant has microcephaly and some abnormal facial features (low nasal bridge, indistinct philtrum, thin upper lip). This is characteristic of (X). What other issues are you worried this infant might have?
X = fetal alcohol syndrome
Neurodevelopment disorders
FDA restriction on fish consumption during pregnancy is due to:
teratogenic effects of mercury
List some examples of teratogenic meds.
- ACEi/ARBs
- Statins
- Anti-seizure (valproate, phenytoin)
- Retinoids
- Chemo
- Warfarin
ACEi/ARBs have teratogenic effects primarily in (X) trimester(s), by causing which abnormalities?
X = 2nd, 3rd
Renal dysgenesis/failure (fetal/neonatal death)
Valproate is considered Category (X) for teratogenicity.
X = D (benefit of drug may outweigh risk of teratogenicity since seizures are dangerous for mom and baby)
Valproate has teratogenic effects primarily in (X) trimester(s), by causing which abnormalities?
X = 1st
NTD (spina bifida)
Statins is considered Category (X) for teratogenicity.
X = X
Why are certain vitamin A analogues (tertinoin) relatively less teratogenic than others (isotretinoin, etretinate)?
Depends on administration route (topical v. po)
