6 - Menstrual Disorders Flashcards
What 2 general abnormalities are the primary causes of amenorrhea?
1) Genetic abnormality (turners, androgen insensitivity)
2) Anatomic abnormalities (agenesis, vaginal septum)
What is the most common cause of secondary amenorrhea? and some other causes as well?
1 = pregnancy.
Also hypothyroid, hypothal-pituitary dysfunction, hyperprolactinemia, premature ovarian failure
What lab would you order to identify a genetic abnormality?
Karyotype
What lab would you order to assess for hypoestrogen state?
progesterone w/d
What is a progesterone withdrawal test?
Administer progesterone for 5 days and then stop. This should trigger menstruation within 7 to 14 days.
The major players in menstruation are 1) Estradiol 2) LH 3) Progesterone. What are they doing throughout the menstrual cycle? (assuming a 28 day cycle)
1) Estradiol is low and slowly rises for 14 days until it reaches a high enough level to trigger
2) the LH spike around day 14 which in turn triggers ovulation. Ovulation triggers a rise in
3) Progesterone which rises in hopes of a fertilized egg. If no egg is fertilized by the 28th day, the progesterone drops and woman begins her menses.
Your patient has painful periods due to excessive release of prostaglandin from a secretory endometrium. She has no anatomic defect. What do you call this?
PRIMARY dysmenorrhea
SECONDARY dysmenorrhea is due to _______________
an anatomic abnormality (fibroid, polyp, IUD, endometriosis, etc)
If a patient bleeds, or has a positive withdrawal from the progesterone w/d test, what is your dx?
a hypothalamic-pituitary dysfunction. Give oral BC or Clomid,
No bleeding with low FSH means hypothalamic-pituitary FAILURE. Give HRT or GnRH agonist.
No bleeding with high FSH means ovarian failure. Give HRT or egg donor
What diagnostic imaging would you do to eval dysmenorrhea?
US or laparoscopy
What are the 2 least invasive and most common treatments for dysmenorrhea?
NSAIDS and OC’s
Excessive blood loss during and between menses
menometrorrhagia
excessive menstrual blood loss
menorrhagia
What are common causes for AUB (abnormal uterine bleeding)?
1) anovulation
2) endometrial hyperplasia/cancer/polyp
3) myoma
4) endometritis
5) bleeding disorder (von willy, etc)
6) thyroid dz
What tests would you order to evaluate AUB?
1) PLT
2) TSH
3) CBC (Hb, Hct)
4) US
5) endometrial bx
