#3: Amennorhea Flashcards
PMDD 1st line TX: (4)
First-line: SSRI 1-Citalopram 20-30mg PO daily 2-Paroxetine 20-30mg PO daily 3-Fluoxetine 20mg PO daily**MC 4-Sertraline 50 to 150mg PO daily QD throughout month or QD during luteal phase (starting day 14)
PMDD 2nd line TX: (3)
1- another SSRI
2- OCP
3- alpralozam (limited quantity to luteal phase i.e. 3 or 4 days)
PMDD 3rd line TX:
GnRH agonist, but rq consult
PMDD Behavioral SXS: MATS
1-Mood swings, sudden sadness, increased sensitivity to rejection
2-Anger, irritability
3-Sense of hopelessness, depressed mood, self-critical thoughts
4-Tension, anxiety, feeling on edge
PMDD Physical SXS: BCDDEFS
1-Difficulty concentrating
2-Change in appetite: cravings, overeating
3-Diminished interest in usual activities
4-Easy fatigability/decreased energy
5-Feeling overwhelmed/out of control
6-Breast tenderness, bloating, weight gain, or joint/muscles aches
7-Sleeping too much/not sleeping enough
PCOS SXS: (7)
HI MOM HI
1- hyperandrogenism
2- infertility: higher rates due to anovulation and higher rates of miscarriage
3- metabolic syndrome and hyperinsulinemia: almost half with CAD, lipid abnormalities, and metabolic syndrome
4- menstrual disorders: often since menarche
5- obesity: 1/2 of women with DX
6- hirsutism
7- insulin resistance/DM: *pre-DM MC, but 10% frank DM by 40yo
Result of chronic anovulation on U/S:
Thickened cortex with “pearl necklace” appearance
DX study of choice for ovarian torsion:
U/S to ID adnexal mass and evaluate blood flow
MC cause of primary amenorrhea
Chromosomal abnormalities – gonadal dysgenesis
—Ovarian insufficiency due to premature depletion of all oocytes and follicles
a reliable indicator of estrogen production or exposure to exogenous estrogens
breast development
a reliable indicator of androgen production or exposure
presence of pubic hair growth
assess the level of endogenous estrogen and the competence of the outflow tract
Progestin challenge test
If prolactin is elevated: imaging to evaluate for prolactinoma
MRI
Progestin Challenge Test: 3 choices include
1-Parenteral progesterone oil (200mg)
2-Oral micronized progesterone (300mg)
3-Oral medroxyprogesterone acetate (10mg) daily for 5 days
Turner Syndrome Manifestations: 9
- Short stature
- webbed neck
- shield chest
- increased carrying angle at the elbow
- hypergonadotropic hypoestrogenic amenorrhea
- Lack of ovarian follicles
- no gonadal sex hormone production
- primary amenorrhea
- Perform a karyotype
Mosaicism Manifestations: 4
- multiple cell lines of varying sex chromosome composition
- Presence of a Y chromosome: rq excision of gonadal areas
- Short stature (<63 inches)
- early menopause
XY gonadal dysgenesis Manifestations: 3
- Female pt with XY karyotype
- palpable mullerian system
- normal female testosterone levels and lack of sexual development: Swyer’s Syndrome
Gonadal atresia manifestations: 3
- May be due to viral and metabolic influences in early gestation or undiscovered genetic mutations
- Female development
- Remove gonadal streaks
The resistant ovary syndrome manifestations: 4
- Rare
- amenorrhea and normal growth and development
- elevated gonadotropins with unstimulated ovarian follicles
- no evidence of autoimmune disease
Premature ovarian failure manifestations: 3
- Early depletion of ovarian follicles
- 1% of women will experience this before 40yo
- Age of presentation depends on how fast the follicles are lost
Premature ovarian failure etiology: 5
Genetic disorders Chromosome anomalies Autoimmune disease Infection: mumps Physical assault: chemo or XT
In premature ovarian failure due to chemo, these agents pose the greatest risk:
alkylating agents
In hypergonadotrophic chromosome evaluation, these pts DO rq a karyotype: 3
ovarian failure, elevated gonadotropins and age under 30yo
In hypergonadotrophic chromosome evaluation, these pts DO NOT rq a karyotype: 1
over 30 yo
—premature ovarian failure aka premature menopause
(recommend empiric TX)
What is Swyer’s Syndrome?
-normal female testosterone levels and lack of sexual development
(XY gonadal dysgenesis)
Weight percentile and % body fat minimum for maintaining menstruation:
10th %ile at 16yo ~ 22% body fat
Weight percentile and % body fat minimum for menarche to start:
10th %ile at 13yo ~ 17% body fat
Post-contraceptive amenorrhea investigation should be pursued if patient is amenorrheic: 2
- 6 mos after discontinuing OCPs
- 12 mos after last injection of Depo-Provera
Macroadenoma TX and F/U:
- If SXS – surgical resection
- High recurrence rate so radiation therapy is needed
- F/U imaging q6 mos for 1 year, then yearly for 3-5 years
Microadenoma TX and F/U:
No treatment needed
F/U imaging every 1-2 years
PRL >1000 in a prolacrtin secreting adenoma associations: 3
- invasive tumor
- treat with dopamine agonists
- amenorrhea due to prolactin inhibition of the pulsatile secretion of GnRH
Transephenoidal surgery is indicated inPituitary Prolactin-Secreting Adenomas if: (2)
- visual changes persist
- pt unresponsive to dopamine agonists
