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Women's Health Exam 3 > Amenorrhea > Flashcards

Amenorrhea Flashcards

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1
Q

Pregnancy account for how many percentages of amenorrhea

A

95%

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2
Q

Difference between primary and secondary amenorrhea

A

Primary, never had menstruation before

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3
Q

Definition of secondary amenorrhea

A

regular cycle (stopped for at least 3 months), irregular cycles (6 months)

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4
Q

MC of secondary amenorrhea

A

pregnancy

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5
Q

Definition of ectopic pregnancy

A

abnormal menses and positive hCG

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6
Q

Labs for hypothalamic-pituitary dysfunction

A

disruption in GnRH = no FSH and LH

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7
Q

cause of hypothalamic-pituitary amenorrhea

A

functional (weight loss/malnutrition, excessive exercise), drug-induced, neoplastic (prolactin-secreting pituitary adenoma), psychogenic, head injury, chronic illness, thyroid conditions

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8
Q

Female athlete triad

A

Low energy availability (with or without disorder eating), menstrual dysfunction (amenorrhea), low bone density

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9
Q

Sheehan syndrome is considered primary or secondary

A

secondary

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10
Q

postpartum hemorrhage is associated with which disease

A

sheehan syndrome

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11
Q

prolactin-secreting pituitary is considered primary or secondary?

A

secondary

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12
Q

5% with hyperprolactinemia and galactorrhea have underlying ________

A

hypothyroidism

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13
Q

primary ovarian insufficiency

A

ovarian follicles either exhausted or resistant to stimulation f FSH and LH

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14
Q

Lab results found in primary ovarian insufficiency

A

high FSH and LH levels

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15
Q

what syndrome is associate with primary ovarian insufficiency

A

tuner syndrome

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16
Q

what kind of amenorrhea is gonadal dysgenesis

A

primary

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17
Q

what should you consider in any female with delayed puberty

A

gonadal dysgenesis

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18
Q

what is the main cause of gonadal dysgenesis

A

tuner syndrome

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19
Q

what test confirms gonadal dysgenesis

A

elevated FSH

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20
Q

What kind of amenorrhea is Turner syndrome

A

MC of primary amenorrhea

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21
Q

What testing can confirm Turner syndrome

A

karyotyping

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22
Q

treatment for turner syndrome

A

growth hormone replacement, estrogen and progesterone

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23
Q

what kind of amenorrhea is androgen insensitivity syndrome

A

primary

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24
Q

complication with androgen insensitivity syndrome

A

undescended testicles

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25
What is this? primary amenorrhea, absent uterus, normal breast development, scant or absent pubic or axillary hair
androgen insensitivity syndrome
26
What is MC with primary amenorrhea
alteration of the genital outflow tract
27
What are the MC anomalies seen in the alteration of the genital outflow tract
imperforate hymen or absent of uterus or vagina
28
What is asherman syndrome
scarring inside the uterus
29
vaginal atresia
closed or absent
30
what is another name for Mullerian agenesis
Mayer Rokitansky-Kuster Hauser syndrome or vaginal agenesis
31
Clinical presentation of Mullerian agenesis
missing uterus, fallopian tubes and variable malformations of upper vagina
32
does ovulation occur with Mullerian Agenesis
yes, the ovaries are intact
33
when to suspect Mullerian Agenesis
primary amenorrhea, absent uterus, normal breast development and *normal pubic and axillary hair*
34
What diagnostic test can be ordered for pt with Mullerian agenesis
US to confirm complete or partial absent of cervix, uterus and vagina
35
Which amenorrhea is asherman syndrome
secondary
36
What causes Asherman syndrome
injury to pregnant or recently pregnant uterus
37
what diagnostic test is ordered to confirm Asherman syndrome
hysterosalpingogram
38
treatment for asherman syndrome
surgery, estrogen therapy, catheter
39
What kind of amenorrhea is cervical stenosis
secondary
40
test to order for amenorrhea
pregnancy test, TSH, prolactin, FSH, LH, DHEA-S (testosterone)
41
what test is used to determine competent endometrium
progesterone
42
How is a progesterone challenge test done
10mg oral medroxyprogesterone 7-10 days course or 100mg injections of progesterone and then stop it to mimic progesterone withdrawal (bleeding)
43
Bleeding seen in progesterone challenge test
indicates anovulatory or oligo-ovulatory
44
if NO bleeding in the progesterone test
hypoestrogenic or have anatomic condition such as Asherman or outflow obstruction
45
Treatment for amenorrhea is desires pregnancy
* treat the underlying cause *Clomid to induce ovulation * surgery to correct genital tract obstructions
46
Treatment if the patient does not desire for pregnancy
OCP, treat the underlying cause
47
PALM
polyp, adenomyosis, leiomyoma, malignancy or hyperplasia
48
COEIN
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified
49
Luteal phase defect
not enough progesterone = bleeding earlier
50
Mid-cycle spotting
caused by sudden drop in estrogen level that occurs at mid cycle which destabilizes endometrium causing bleeding
51
Menorrhagia
excessive heavy bleeding
52
hypomenorrhea
abnormal short menses - obstructive -Asherman's syndrome -hormonal imbalance from OCP -low body fat -pregnancy -stress
53
Hypermenorrhea
abnormally long - fibroids -endometrial polyps -cancer uterus or cervix -contraception related -bleeding disorders
54
metrorrhagia
intermenstrual bleeding - endometrial polyps -endometrial and cervical carcinoma -exogenous estrogen administration
55
Polymenorrhagia
21 days or less between cycles
56
Menometrorrhagia
bleeding that occurs at irregular and/or frequent intervals
57
oligomenorrhea
>35 days apart, scant or light
58
ovulatory bleeding
type of metrorrhagia
59
Oligo-ovulation and anovulation with AUB
endometrium outgrows blood and sloughs off at irregular intervals
60
contact bleeding can be considered_____
cervical cancer
61
What needs to be performed with contact bleeding
pap test, colpo any visible cervical lesions
62
common cause of contact bleeding
cervical ectropion, cervical polyps, cervical or vaginal infection, atrophic vagnitis
63
what must you ensure when doing a physical examination fo AUB
ensure the bleeding is coming from the uterus
64
AUB treatment
OCP, NSAIDs, IUD, discussion of stressful situations/lifestyle
65
treatment for unresponsive AUB
D&C, ablation, uterine artery embolization or hysterectomy
66
when is ablation reserved for in the treatment of AUB
when childbearing is over and endometrial cancer has been ruled out
67
cause of primary dysmenorrhea
excess prostagladins
68
treatment for primary dysmenorrhea
NSAIDs, OCP to suppress ovulation
69
Cause of secondary dysmenorrhea
structural abnormality or disease process
70
clinical presentation of secondary dysmenorrhea
pain often lasts longer than menstrual period
71
diagnosis of secondary dysmenorrhea
culture for GC if infection is suspected, UA, TVUS *preferred initial imaging study*, laparoscopy, MRI
72
Definition of Chronic Pelvic pain
pain lasting more than 6 months
73
labs/diagnostics for chronic pelvic pain
UA, UC,CT/GC, US, CBC, Laparoscopy, CT abdomen if not pregnant
74
perimenopause definition
period before menopause
75
vasomotor symptoms
felt due to pulsatile release of GnRH from hypothalamus, affects temperature regulatory area in brain, more severe after surgical menoapuse
76
Why is sleep disturbances present in a patient with perimenopause
sleep changes as a result of estradiol levels declining
77
What is the FSH value in patient with perimenopause and menopause
perimenopause: 14-24 Menopause: >30
78
Treatment for perimenopause
Hormone replacement therapy, estrogen replacement therapy, SSRI (night sweats), Clonidine
79
When does perimenopause begin
4 years prior to final period
80
What defines menopause
no cycle for a year
81
what is the predominant endogenous estrogen in postmenopausal women
estrone
82
lab results of patients with menopause
elevated FSH and LH, decreased estrogen, increase total cholesterol, decrease in HDL, increase in LDL
83
what is Obese women at higher risk for
hyperplasia and carcinoma
84
what is slender menopausal women at higher risk for
menopausal symptoms
85
What kind of surgical procedure contributes to menopause
bilateral oophorectomy
86
When do menopause symptoms resolve if not treated
2-3 years, some 10 years or longer
87
CI for hormone therapy
undiagnosed abnormal genital bleeding, known or suspected estrogen-dependent neoplasia, active DVT, liver dysfunction, known or suspected pregnancy
88
alternatives to hormone therapy
soy, black cohosh, st john's wort, acupuncture, exercise
89
At what thickness of the endometrial do you NOT suspect endometrial cancer
5mm or less suggest low possibility of hyperplasia or endometrial cnacer
90
At what thickness of the endometrial do you NOT suspect endometrial cancer
5mm or less suggests a low possibility of hyperplasia or endometrial cancer
91
What defines PMS
at least one symptoms that occurs during the five days before the menses and is present at least 3 consecutive menstrual cycle using ACOG
92
What is DSM-V mental illness
PMDD
93
Physical symptoms of PMS
Abdominal bloating and fatigue
94
behavioral symptoms of PMS
emotional liability(MC), irritability, depressed mood
95
pharmacological treatment for PMS
NSAIDs, OCPs, SSRI, danazol and GnRH agonist
96
what is the gold standard treatment in patients with PMDD
SSRI

Women's Health Exam 3 (4 decks)

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