Abnormal Bleeding Flashcards
Normal Bleeding
* Cycle length: ___ days
* Menstruation lasting ___ days
* ___ mL of blood per day
* median age of menarche ___ years
- 22-35 days
- 3-7 days
- 35
- 12.4 years
Dysmenorrhea definition
painful menstruation
Patho of Dysmenorrhea
- build up of ___ acids in cell membranes, then released
- ___ and ___ released in the uterus
- ___ reponse causes symptoms
- fatty acids
- Prostaglandins and leukotrienes
- inflammatory
Risk Factors of Dysmenorrhea
- less than ___ years old
- weight loss ___
- depression/anxiety
- ___ menses
- menarche before ___ yo
- no previous ___ (nulliparity)
- smoking
- 20 yo
- attempts
- heavy
- 12 yo
- pregnancy
First Line treatments for Dysmenorrhea
- NSAIDS
- OC
- non-pharmacologic
Second Line treatments for Dysmenorrhea
- DMPA
- Levonorgestrel IUD
try IUD before shots
Primary Amenorrhea:
no menses by age ___
15
Secondary Amenorrhea: no menses for ___ months in someone who was previously menstruating
3 months
Patho of Amenorrhea
- Uterus and ovaries (___ abnormalities)
- Pituitary gland (disruption ___)
- hypothalamus (anorexia, exercise, stress)
- anatomical
- hormones (GnRH, LH, FSH, and prolactin)
Drug Induced Amenorrhea
- First-Gen antipsychotics (3)
- Second-Gen antipsychotics (1)
- Antihypertensives (1)
- GI promotility agents (1)
- prochlorperazine, chlorpromazine, haloperidol
- risperidone
- verapamil
- metoclopramide
Treatment for Amenorrhea
If low estrogen is the cause, add estrogen (must also have progestin)
* Conjugated equine estrogen (3)
* Estradiol (patch) (2)
- Premarin, Cenestin, Enjuvia
- Climara, Vivelle-Dot
Treatment for Amenorrhea
if caused by medications that increase ___ levels, provide dopamine agonist (2)
Contraindications: ___ feeding and uncontrolled ___
- prolactin
- Bromocriptine and Cabergoline
- breastfeeding, hypertension
Oligomenorrhea Definition:
Menstrual cycle interval > ___ days (but less than ___ days)
35 days, 90 days
T or F: Oligomenorrhea has simialr causes and treatment approaches as amenorrhea
True
Polymenorrhea Definition:
menstrual cycle greater than ___ days.
21 days
Causes of polymenorrhea (4)
- stress
- STDs
- Endometriosis
- menopause
HMB Definition:
bleeding over ___ mL OR lasting over ___ days
- 80 mL
- 7 days
Patho of HMB
Hematologic: bleeding/ ____ disolders
Hepatic: ___
Endocrne: ___ thyroidism
Uterine: ___ abnormalities and uterine ___
- clotting
- Cirrhosis
- hypothyroidsm
- structural, fibroids
Chronic HMB Treatment
Hormonal (5)
- CHC
- progestins
- Levonorgestrel IUD
- Danazol
- GnRH agonists
Chronic HMB Treatment
Non-hormonal (3)
- NSAIDs
- Tranexamic Acid
- Iron
Contraindiations to tranexamic acid:
* active or history of ___ or pulmonary ___
* history of ___
- DVT, embolism
- seizure
Acute HMB Treatment
- high dose ___
- ___ 20 mg PO TID x7 days
- ___ acid
- estrogen
- medroxyprogesterone
- tranexamic
Metrorrhagia Definition:
Irregular menstrual bleeding ___ cycles
between
Causes of Metrorrhagia
- hormone imbalance
- Fibroids, polyps,endometriosis
- Medications
- IUDs
- infections
Endometriosis Definition:
Pelvic inflammatory condition associated with growth of endometrial tissue found ___ the uterus
outside
T or F: Endometriosis had the same risk factors as dysmenorrhea
True
Most supported theory behind endometriosis: ___ menstrual flow
retrograde
First line endometriosis treatment (3)
- NSAIDs
- CHCs
- Progestins
Second line endometriosis treatment (2)
- GnRH agonsits/antagonists
- Danazol
Third line endometriosis treatment (1)
- aromatase inhibitors
Danazol is an ___ that supresses ___ and ___.
* Blackbox warning for ___
* containdicated in ___ and ___feeding
androgen, LH, FSH
* thromboembolism
* pregnancy and breastfeeding
T or F: the patho of fibroids is not well understood
True
Risk factors for fibroids:
* ___ race
* time since last ___
* premenopausal
* hyperstension
* menarche less than ___ yo
- black
- birth
- 10
protective factors against fibroids
* smoking
* more than ___ pregnancies
* hormonal ___ use
- 3
- contraception
Treatment of fibroids
- NSAIDs
- hormonal contraception
- ___ acid
- ___ agonists
- selective ___ receptor modulators (SPRM)
- tranexamic
- GnRH
- progesterone
GnRH Agonists for Uterine Fibroids
- ___ term preoperative
- ___ size
- __ blood loss
- Decrease ___ and ___ time
- long term treatment associated with ___ symptoms and ___ loss
- Increased recurrence risk with ___
- short
- decrease
- decrease
- operative and recovery
- menopausal, bone
- myomectomy
SPRM for Uterine Fibroids
- ___ term preoperative
- ___ size
- decrease blood ___
- Decrease ___ and ___ time
- not associated with ___ estrogenic effect
- increased recurrence risk with ___
- HA and ___ tenderness
not FDA-approved
* mifepristone ___ mg daily
* ulipristal ___ mg daily
- short
- decrease
- loss
- operative and recovery
- hypo-estrogenic
- myomectomy
- breast
- 10-50 mg
- 5-10 mg
T or F: Fibroids can increase the risk of complications during pregnancy
True; can rseult in miscarriage, premature, abnormal fetal position, and placental abruption
PMS
Must have at least 1 symptom (affective or somatic) for at least ___ menstrual cycles
3
PMDD
included in the DSM-5
* must have at least ___ symptoms with at least 1 in 2 different criteria for ___ consecutive months
- 5 symptoms
- 2 months
PMS and PMDD similarities
- Onset: 5-7 days prior to menses (during the ___ phase)
- Symptoms ending at the start of the ___ phase (onset of menses)
- Requires ___ free period for diagnosis
- luteal
- follicular
- symptom
Patho of PMS/PMDD
Largely unknown, many theories:
* reduced levels of ___, ___, and ___
* fluctuations in ___ and ___
- serotonin
- GABA
- allopregnanolone
- estrogen
- progesterone
PMS/PMDD First Line Treatment
- SSRIs
- NSAIDs
- Spironolactone
PMS/PMDD Second Line Treatment
- Venlafaxine
- Duloxetine
- Clomipramine
- Alprazolam
- COCs
PMS/PMDD Last Line Treatment
- GnRH agonists
- Surgery
Patients on SSRIs typically see improvement in symptoms within ___ menstrual cycles
2-3
FDA approved SSRIs for PMS/PMDD
* Fluoxetine ___ mg daily
* Sertraline ___ mg daily
* Paroxetine CR ___ mg daily
- 20 mg
- 50-150 mg
- 12.5-25 mg
Spironolactone for PMS/PMDD
- Non-FDA approved indication
- antimineralcorticoid and antiandrogenic effects interfere with ___ synthesis
- Dose: ___ mg daily on days ___
- decreases fluid ___, somatic symptoms, ___ tenderness, and low mood
- SE: ___kalemia and irregualr menses
- testosterone synthesis
*100 mg, 15-28 - retention, breast
- hyperkalemia
Second Line options for PMS/PMDD in order
- SNRIs
- COCs
- Clomipramine
- Alprazolam
T or F: for second line treatment of PMS/PMDD you should consider Alprazolam beforeClomipramine
False; Xanax is last option
How SSRIs Help PMS/PMDD
- emotional and physical symptoms
- ___ funtioning
- work performancy
- quality of life
psychosocial
How Spironolactone Helps PMS/PMDD
- ___ tenderness
- bloating
- ___ mood
- breast
- low
How COCs Help PMS/PMDD
- physcial symptoms: bloating, HA, abdominal pain, breast tenderness
- ___ functioning and productivity
***COC can also cause physical symptoms
social
How Alprazolam helps PMS/PMDD
- depression
- tension
- anxiety
- irritability
- hostility
- and ___ withdrawal
social
