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6. Women's Health > 1- Menstrual Disorders > Flashcards

1- Menstrual Disorders Flashcards

1
Q

What gives rise to male reproductive structures?

A

Wolffian ducts (Mullerian ducts regress)

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2
Q

What gives rise to female reproductive structures?

A

Mullerian ducts (Wolffian ducts become nonfunctional)

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3
Q

What hormone is responsible for breast development and growth of the skeleton in early puberty?

A

Estradiol

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4
Q

What leads to ovulation and menstrual cycle later in puberty?

A

FSH/ LH/ estradiol

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5
Q

What is the average age of menarche?

A

12-13 yrs

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6
Q

What is the average age of menopause?

A

51 yrs

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7
Q

How long is the average adult menstrual cycle?

A

24-38 days (1st day bleeding through next cycle of bleeding)

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8
Q

What is the duration of bleeding in a normal menstrual cycle?

A

≤ 8 days (average 4.5 days)

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9
Q

How much is blood lost in a normal menstrual cycle?

A

5-80mL

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10
Q

What is required for regular and spontaneous menstruation?

A

Functional HPO axis, competent endometrium (uterus) that responds to hormones stimulation, an intact outflow tract from internal to external genitalia

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11
Q

What is primary amenorrhea?

A

Failure to reach menarche

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12
Q

What is secondary amenorrhea?

A

Cessation of menses

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13
Q

How do you identify amenorrhea?

A

Absence of menses by age 15 w/ normal growth and secondary sex characteristics OR absence of menses by age 13 w/o secondary sexual development

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14
Q

What is secondary amenorrhea?

A

Cessation of menses

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15
Q

How do you idenitify secondary amenorrhea?

A

Absence of menses for more than 3 cycle intervals OR 6 consecuative months in women that were previously menstruating

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16
Q

Primary amenorrhea is usually due to genetic or anatomic abnormality, what is the most common cause?

A

Gonadal dysgenesis (others: PCOS, disruption of hypothalamic/ pituitary function, anatomic defects in outflow tract, receptor abnormality/ enzyme deficiency)

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17
Q

What does dysgenesis result in?

A

Hypergonadotrophic hypogonadism (high FSH)

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18
Q

In what condition are ovaries unable to respond to gonadotropins and has premature depletion of oocytes and follicles?

A

Turner Syndrome (45, XO)

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19
Q

What is one of the most common causes of premature ovarian insufficiency?

A

Turner Syndrome (45, XO)

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20
Q

In what condition is a fibrous streak gonad unable to secrete anti-Mullerian hormone/ T, and aka “vanishing testes”?

A

46, XY gonadal dysgenesis

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21
Q

Pt presents with short stature, shield chest and webbed neck. What would you expect to see on US of ovaries?

A

Streak ovaries (Turner syndrome)

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22
Q

What condition is defined as 46, XY gonadal dysgenesis, a mutation of the SRY gene, and leads to failure of indifferent gonads to differentiate into testes?

A

Swyer syndrome

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23
Q

What is the internal and external genitalia of a pt w/ swyer syndrome?

A

Female internal & external genitalia (due to lack of AMH, T and DHT)

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24
Q

Will pt w/ swyer syndrome develope secondary sex characteristics at puberty?

A

No

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25
Q

Is PCOS more common in primary or secondary ammenorrhea?

A

Secondary

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26
Q

In what condition does a pt have ovulatory dysfunction, anovulation and sxs of hyperandrogenism (acne, hisutism) in the presence of pubertal development?

A

PCOS (as a cause of primary amenorrhea)

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27
Q

HPO axis suppression due to an energy deficiency from stress, weight loss, excessive exercise or disordered eating will result in what?

A

Functional hypothalamic amenorrhea

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28
Q

What is the female athlete triad?

A

Insufficient calorie intake w/w/o eating d/o, amenorrhea, and low bone density/ osteoporosis

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29
Q

In pt w/ functional hypothalamic amenorrhea, what are their FSH, LH, and estradiol levels?

A

FSH = normal, LH = low, (LH surge is absent), Estradiol = low

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30
Q

What syndrome results from congenital GnRH deficiency?

A

Idiopathic hypogonadotropic hypogonadism

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31
Q

If a pt with idiopathic hypogonadotropic hypogonadism also has anosmia, what is it called?

A

Kallmann syndrome

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32
Q

What are the 2 more common pituitary causes of primary amenorrhea?

A

Micro/ macroadenoma and hyperprolactinemia

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33
Q

What is a common sx of hyperprolactinemia?

A

Glactorrhea

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34
Q

A less common pituitary cause of primary amenorrhea is infiltrative disease and/ or cranial tumors that cause what?

A

Pituitary stalk compression

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35
Q

What uterine outflow tract disorder can cause primary amenorrhea?

A

Mullerian agenesis

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36
Q

In Mullerian agenesis (46 XX), there is a congenital absence of what?

A

Oviducts, uterus, upper vagina

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37
Q

What vaginal outflow tract disorders can cause primary amenorrhea?

A

Imperforate hymen or transverse vaginal septum

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38
Q

Pt presents with cyclic pelvic pain. a perirectal mass, and hx of amenorrhea. What should you be concerned about?

A

Vaginal outflow tract disorder (imperforate hymen or transverse vaginal septum)

39
Q

Mullerian agenesis (46 XX), do you have normal gonadal function?

A

Yes (estrogen = breast development)

40
Q

Although rare, what are the 3 receptor/ enzyme abnormality causes of primary amenorrhea?

A

Androgen Insensitivity Syndrome (AIS), 5-alpha reductase deficiency, and 17-alpha-hydroxylase deficiency (CYP17 gene)

41
Q

F pt presents w/ “testicular feminization”. What is her genotype and T levels?

A

46 XY, high serum testosterone (AIS)

42
Q

If a pt with AIS has testes that remain intra-abdominal or partially descended, what is the management?

A

Should be removed due to increased risk of testicular CA

43
Q

Pt presents with breast development, absence of acne/ voice changes at puberty, absent axillary/ pubic hair. On pelvic US you note absent upper vagina, uterus and fallopian tubes. What are you concerned for?

A

Androgen Insensitivity Syndrome (AIS) (possible cause of primary amenorrhea)

44
Q

In a pt w/ AIS, what hormones are produced and what hormones is the body unresponsive to?

A

Testes make T and AMH, but are unresponsive to T or DHT

45
Q

Baby is born w/ amgiuous genitalia. What enzyme deficiency are you concerned about?

A

5-alpha reductase deficiency (46, XY)

46
Q

In pt undergoing puberty w/ 5-alpha reductase deficiency what will not occur?

A

No enlargement of external genitalia or prostate

47
Q

Pt presents with HTN and lack of pubertal development. Labs show decreased cortisol levels, lack of sex steroids, and high ACTH. What should you be concerned for?

A

17-alpha-hydroxylase deficiency (CYP17 gene) (possible cause of primary amenorrhea)

48
Q

Pt with amenorrhea presents with breast development, and a uterus is present. What is a possible cause?

A

Outflow tract obstruction

49
Q

Pt with amenorrhea presents with breast development and a uterus is NOT present. What are possible causes?

A

AIS (46, XY) OR Mullerian agenesis (46, XX)

50
Q

Pt with amenorrhea presents with NO breast development and normal/ low FSH (indicating hypogonadotropic hypogonadism). What are possible causes?

A

Kallman Syndrome OR Functional hypothalamic amenorrhea

51
Q

Pt with amenorrhea presents with NO breast development and high FSH (indicating hypergonadotropic hypogonadism). What are possible causes?

A

Turner syndrome, Swyer syndrome (46, XY gonadal dysgenesis), OR primary ovarian insufficiency

52
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy!

53
Q

F pt w/ prior hx of menstruation presents w/ amenorrhea, acne and hirsutism. Labs find elevated total T. What are you concerned about?

A

PCOS

54
Q

On US of ovaries you see “string of pearls”. What is this concerning for?

A

Polycystic ovaries

55
Q

PCOS is usually associated w/ what hormone resistance?

A

Insulin

56
Q

What is primary ovarian insufficiency?

A

Depletion of oocytes before age of 40 (clinical menopause)

57
Q

Hyperandrogenism, due to adrenal or ovarian tumors, will result in what in a F?

A

Pronounced virilization (male like characteristics)

58
Q

What are the most common hypothalamic and pituitary causes of secondary amenorrhea?

A

Functional hypothalamic amenorrhea and pituitary disease

59
Q

What are the most common causes of pituitary disease leading to secondary amenorrhea?

A

Hyperprolactinemia, Sheehan syndrome, iron deposition, primary hypothyroidism

60
Q

Hypopituitarism caused by ischemic necrosis due to severe hemorrhage and hypotension during/ after childbirth is known as what?

A

Sheehan syndrome (possible cause of secondary amenorrhea)

61
Q

How is Asherman syndrome acquired?

A

Scarring of the endometrial lining caused by uterine instrumentation duing OBGYN procedures

62
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of weight loss, stenuous exercise, or eating disorder. What are you concerned for?

A

Hypothalamic dysfunction

63
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of uterine surgical procedure or infection. What are you concerned for?

A

Asherman syndrome

64
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of HA and visual changes. What are you concerned for?

A

Infiltrating pituitary disease/ tumor

65
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of galactorrhea. What are you concerned for?

A

Sheehan syndrome

66
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of worsening acne, hirsutism, and weight gain. What are you concerned for?

A

PCOS or hypothyroidism

67
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of recent or recurrent medication use (oral contraceptives, progestins, danezol, antipsychotics). What are you concerned for?

A

Post pill amenorrhea/ amenorrhea due to DA or GnRH antagonists

68
Q

Pt presents with secondary amenorrhea. Pregnancy test is negative. Hx of other illness (renal failure, CA, infection, RA). What are you concerned for?

A

Amenorrhea due to systemic illness

69
Q

By what age should you evaluate for primary amenorrhea if uterine bleeding has not occurred?

A

Age 15

70
Q

By what age should you evaluate for primary amenorrhea if no menses or evidence of thelarche (breast development)?

A

Age 13

71
Q

What should you evaluate for if pt presents w/ no menarche w/i 3 yrs of thelarche?

A

Primary ammenorrhea

72
Q

What is the general order of sexual development for F?

A

Thelarche, pubarche, growth spurt, menarche (thelarche and menarche should occur w/in 3 years of each other)

73
Q

When evaluating for primary ammenorhea what are important history questions to ask?

A

Other stages of puberty? Age of menarche in mother/sisters? Height relative to family members?

74
Q

What sxs can be presents in both primary and secondary amenorrhea?

A

Glactorrhea, anosmia

75
Q

When evaluating for secondary ammenorhea what are important history questions to ask?

A

Previous mentrual hx? Breastfeeding? Recent d/c of OCP? Uterine OBGYN procedures? Sx of estrogen deficiency?

76
Q

Pt presents with amenorrhea. What are the most important vital signs to assess given the CC?

A

Weight, height, BMI

77
Q

What general things should be assessed on PE for a pt presenting with amenorrhea?

A

Signs of virilization, thyroid abns, features of Turner syndrome, breast exam, genital exam

78
Q

Pt presents with amenorrhea. What lab tests/ diagnostic studies should be ordered? (Both primary and secondary)

A

Urine/ serum HCG, FSH, TSH, prolactin, +/- pelvic US

79
Q

Aside from pregnancy test, FSH, TSH and prolactin, additional studies for eval of primary amenorrhea should be ordered based on what?

A

Signs/ sxs, PE findings and results of initial workup

80
Q

What imaging should be ordered if you suspect a pituitary pathology of secondary amenorrhea?

A

Pituitary MRI

81
Q

What imaging should be ordered if you are evaluating a pt with secondary amenorrhea and there is evidence of significant virilization and elevated T?

A

Adrenal CT

82
Q

Pt presents with primary amenorrhea. PE shows NO breast development and labs show low/ N FSH. Repeat FSH/LH are very low. What pathology should you consider?

A

Congenital GnRH deficiency or constitutional delay of puberty (“late bloomer”)

83
Q

Pt presents with secondary amenorrhea and pituitary MRI shows a lesion. What is the next step?

A

Refer to endo

84
Q

Pt presents with secondary amenorrhea, normal prolactin and there is no evidence of a lesion on pituitary MRI. What is the next step?

A

Transferrin saturation (hemochromatosis screen) and progesterone challenge

85
Q

Pt presents with secondary amenorrhea, normal prolactin and there is no evidence of a lesion on pituitary MRI. Progesterone challenge results in NO withdrawal bleed. What should you be concerned for?

A

Functional hypothalamic amenorrhea (no estrogen, low FSH)

86
Q

Pt presents with secondary amenorrhea, normal prolactin and there is no evidence of a lesion on pituitary MRI. Progesterone challenge results in + withdrawal bleed. What should you be concerned for?

A

Eval for PCOS (unopposed estrogen, high LH to FSH ratio)

87
Q

What is the goal of tx for amenorrhea?

A

TX underlying cause, restore ovulatory cycles and preserve fertility, reduce risk of complciations

88
Q

What are complications associated w/ amenorrhea?

A

Osteoporosis, chronic anovulation, hirsutism, insulin reisistance, dysplipidemia

89
Q

When is surgical referral necessary for amenorrhea sx?

A

For correction of outlet obstruction or for gonadectomy

90
Q

Breast development is a marker for what?

A

Ovarian function (except w/ AIS)

91
Q

Absense of the uterus should be further investigated w/ what tests?

A

Karyotype and total testosterone

92
Q

If pt w/ amenorrhea presents w/ breast development what is the most likely cause of their sx?

A

Uterus or vagina

93
Q

If pt w/ amenorrhea presents w/o breast development what is the most likely cause of their sx?

A

Hypothalamus or ovaries

6. Women's Health (13 decks)

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