Amenorrhea Flashcards

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
Q

What is this? primary amenorrhea, absent uterus, normal breast development, scant or absent pubic or axillary hair

A

androgen insensitivity syndrome

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26
Q

What is MC with primary amenorrhea

A

alteration of the genital outflow tract

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27
Q

What are the MC anomalies seen in the alteration of the genital outflow tract

A

imperforate hymen or absent of uterus or vagina

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28
Q

What is asherman syndrome

A

scarring inside the uterus

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29
Q

vaginal atresia

A

closed or absent

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30
Q

what is another name for Mullerian agenesis

A

Mayer Rokitansky-Kuster Hauser syndrome or vaginal agenesis

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31
Q

Clinical presentation of Mullerian agenesis

A

missing uterus, fallopian tubes and variable malformations of upper vagina

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32
Q

does ovulation occur with Mullerian Agenesis

A

yes, the ovaries are intact

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33
Q

when to suspect Mullerian Agenesis

A

primary amenorrhea, absent uterus, normal breast development and normal pubic and axillary hair

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34
Q

What diagnostic test can be ordered for pt with Mullerian agenesis

A

US to confirm complete or partial absent of cervix, uterus and vagina

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35
Q

Which amenorrhea is asherman syndrome

A

secondary

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36
Q

What causes Asherman syndrome

A

injury to pregnant or recently pregnant uterus

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37
Q

what diagnostic test is ordered to confirm Asherman syndrome

A

hysterosalpingogram

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38
Q

treatment for asherman syndrome

A

surgery, estrogen therapy, catheter

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39
Q

What kind of amenorrhea is cervical stenosis

A

secondary

40
Q

test to order for amenorrhea

A

pregnancy test, TSH, prolactin, FSH, LH, DHEA-S (testosterone)

41
Q

what test is used to determine competent endometrium

A

progesterone

42
Q

How is a progesterone challenge test done

A

10mg oral medroxyprogesterone 7-10 days course or 100mg injections of progesterone and then stop it to mimic progesterone withdrawal (bleeding)

43
Q

Bleeding seen in progesterone challenge test

A

indicates anovulatory or oligo-ovulatory

44
Q

if NO bleeding in the progesterone test

A

hypoestrogenic or have anatomic condition such as Asherman or outflow obstruction

45
Q

Treatment for amenorrhea is desires pregnancy

A
  • treat the underlying cause
    *Clomid to induce ovulation
  • surgery to correct genital tract obstructions
46
Q

Treatment if the patient does not desire for pregnancy

A

OCP, treat the underlying cause

47
Q

PALM

A

polyp, adenomyosis, leiomyoma, malignancy or hyperplasia

48
Q

COEIN

A

coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

49
Q

Luteal phase defect

A

not enough progesterone = bleeding earlier

50
Q

Mid-cycle spotting

A

caused by sudden drop in estrogen level that occurs at mid cycle which destabilizes endometrium causing bleeding

51
Q

Menorrhagia

A

excessive heavy bleeding

52
Q

hypomenorrhea

A

abnormal short menses
- obstructive
-Asherman’s syndrome
-hormonal imbalance from OCP
-low body fat
-pregnancy
-stress

53
Q

Hypermenorrhea

A

abnormally long
- fibroids
-endometrial polyps
-cancer uterus or cervix
-contraception related
-bleeding disorders

54
Q

metrorrhagia

A

intermenstrual bleeding
- endometrial polyps
-endometrial and cervical carcinoma
-exogenous estrogen administration

55
Q

Polymenorrhagia

A

21 days or less between cycles

56
Q

Menometrorrhagia

A

bleeding that occurs at irregular and/or frequent intervals

57
Q

oligomenorrhea

A

> 35 days apart, scant or light

58
Q

ovulatory bleeding

A

type of metrorrhagia

59
Q

Oligo-ovulation and anovulation with AUB

A

endometrium outgrows blood and sloughs off at irregular intervals

60
Q

contact bleeding can be considered_____

A

cervical cancer

61
Q

What needs to be performed with contact bleeding

A

pap test, colpo any visible cervical lesions

62
Q

common cause of contact bleeding

A

cervical ectropion, cervical polyps, cervical or vaginal infection, atrophic vagnitis

63
Q

what must you ensure when doing a physical examination fo AUB

A

ensure the bleeding is coming from the uterus

64
Q

AUB treatment

A

OCP, NSAIDs, IUD, discussion of stressful situations/lifestyle

65
Q

treatment for unresponsive AUB

A

D&C, ablation, uterine artery embolization or hysterectomy

66
Q

when is ablation reserved for in the treatment of AUB

A

when childbearing is over and endometrial cancer has been ruled out

67
Q

cause of primary dysmenorrhea

A

excess prostagladins

68
Q

treatment for primary dysmenorrhea

A

NSAIDs, OCP to suppress ovulation

69
Q

Cause of secondary dysmenorrhea

A

structural abnormality or disease process

70
Q

clinical presentation of secondary dysmenorrhea

A

pain often lasts longer than menstrual period

71
Q

diagnosis of secondary dysmenorrhea

A

culture for GC if infection is suspected, UA, TVUS preferred initial imaging study, laparoscopy, MRI

72
Q

Definition of Chronic Pelvic pain

A

pain lasting more than 6 months

73
Q

labs/diagnostics for chronic pelvic pain

A

UA, UC,CT/GC, US, CBC, Laparoscopy, CT abdomen if not pregnant

74
Q

perimenopause definition

A

period before menopause

75
Q

vasomotor symptoms

A

felt due to pulsatile release of GnRH from hypothalamus, affects temperature regulatory area in brain, more severe after surgical menoapuse

76
Q

Why is sleep disturbances present in a patient with perimenopause

A

sleep changes as a result of estradiol levels declining

77
Q

What is the FSH value in patient with perimenopause and menopause

A

perimenopause: 14-24
Menopause: >30

78
Q

Treatment for perimenopause

A

Hormone replacement therapy, estrogen replacement therapy, SSRI (night sweats), Clonidine

79
Q

When does perimenopause begin

A

4 years prior to final period

80
Q

What defines menopause

A

no cycle for a year

81
Q

what is the predominant endogenous estrogen in postmenopausal women

A

estrone

82
Q

lab results of patients with menopause

A

elevated FSH and LH, decreased estrogen, increase total cholesterol, decrease in HDL, increase in LDL

83
Q

what is Obese women at higher risk for

A

hyperplasia and carcinoma

84
Q

what is slender menopausal women at higher risk for

A

menopausal symptoms

85
Q

What kind of surgical procedure contributes to menopause

A

bilateral oophorectomy

86
Q

When do menopause symptoms resolve if not treated

A

2-3 years, some 10 years or longer

87
Q

CI for hormone therapy

A

undiagnosed abnormal genital bleeding, known or suspected estrogen-dependent neoplasia, active DVT, liver dysfunction, known or suspected pregnancy

88
Q

alternatives to hormone therapy

A

soy, black cohosh, st john’s wort, acupuncture, exercise

89
Q

At what thickness of the endometrial do you NOT suspect endometrial cancer

A

5mm or less suggest low possibility of hyperplasia or endometrial cnacer

90
Q

At what thickness of the endometrial do you NOT suspect endometrial cancer

A

5mm or less suggests a low possibility of hyperplasia or endometrial cancer

91
Q

What defines PMS

A

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
Q

What is DSM-V mental illness

A

PMDD

93
Q

Physical symptoms of PMS

A

Abdominal bloating and fatigue

94
Q

behavioral symptoms of PMS

A

emotional liability(MC), irritability, depressed mood

95
Q

pharmacological treatment for PMS

A

NSAIDs, OCPs, SSRI, danazol and GnRH agonist

96
Q

what is the gold standard treatment in patients with PMDD

A

SSRI