Amenorrhea Flashcards
Pregnancy account for how many percentages of amenorrhea
95%
Difference between primary and secondary amenorrhea
Primary, never had menstruation before
Definition of secondary amenorrhea
regular cycle (stopped for at least 3 months), irregular cycles (6 months)
MC of secondary amenorrhea
pregnancy
Definition of ectopic pregnancy
abnormal menses and positive hCG
Labs for hypothalamic-pituitary dysfunction
disruption in GnRH = no FSH and LH
cause of hypothalamic-pituitary amenorrhea
functional (weight loss/malnutrition, excessive exercise), drug-induced, neoplastic (prolactin-secreting pituitary adenoma), psychogenic, head injury, chronic illness, thyroid conditions
Female athlete triad
Low energy availability (with or without disorder eating), menstrual dysfunction (amenorrhea), low bone density
Sheehan syndrome is considered primary or secondary
secondary
postpartum hemorrhage is associated with which disease
sheehan syndrome
prolactin-secreting pituitary is considered primary or secondary?
secondary
5% with hyperprolactinemia and galactorrhea have underlying ________
hypothyroidism
primary ovarian insufficiency
ovarian follicles either exhausted or resistant to stimulation f FSH and LH
Lab results found in primary ovarian insufficiency
high FSH and LH levels
what syndrome is associate with primary ovarian insufficiency
tuner syndrome
what kind of amenorrhea is gonadal dysgenesis
primary
what should you consider in any female with delayed puberty
gonadal dysgenesis
what is the main cause of gonadal dysgenesis
tuner syndrome
what test confirms gonadal dysgenesis
elevated FSH
What kind of amenorrhea is Turner syndrome
MC of primary amenorrhea
What testing can confirm Turner syndrome
karyotyping
treatment for turner syndrome
growth hormone replacement, estrogen and progesterone
what kind of amenorrhea is androgen insensitivity syndrome
primary
complication with androgen insensitivity syndrome
undescended testicles
What is this? primary amenorrhea, absent uterus, normal breast development, scant or absent pubic or axillary hair
androgen insensitivity syndrome
What is MC with primary amenorrhea
alteration of the genital outflow tract
What are the MC anomalies seen in the alteration of the genital outflow tract
imperforate hymen or absent of uterus or vagina
What is asherman syndrome
scarring inside the uterus
vaginal atresia
closed or absent
what is another name for Mullerian agenesis
Mayer Rokitansky-Kuster Hauser syndrome or vaginal agenesis
Clinical presentation of Mullerian agenesis
missing uterus, fallopian tubes and variable malformations of upper vagina
does ovulation occur with Mullerian Agenesis
yes, the ovaries are intact
when to suspect Mullerian Agenesis
primary amenorrhea, absent uterus, normal breast development and normal pubic and axillary hair
What diagnostic test can be ordered for pt with Mullerian agenesis
US to confirm complete or partial absent of cervix, uterus and vagina
Which amenorrhea is asherman syndrome
secondary
What causes Asherman syndrome
injury to pregnant or recently pregnant uterus
what diagnostic test is ordered to confirm Asherman syndrome
hysterosalpingogram
treatment for asherman syndrome
surgery, estrogen therapy, catheter
What kind of amenorrhea is cervical stenosis
secondary
test to order for amenorrhea
pregnancy test, TSH, prolactin, FSH, LH, DHEA-S (testosterone)
what test is used to determine competent endometrium
progesterone
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)
Bleeding seen in progesterone challenge test
indicates anovulatory or oligo-ovulatory
if NO bleeding in the progesterone test
hypoestrogenic or have anatomic condition such as Asherman or outflow obstruction
Treatment for amenorrhea is desires pregnancy
- treat the underlying cause
*Clomid to induce ovulation - surgery to correct genital tract obstructions
Treatment if the patient does not desire for pregnancy
OCP, treat the underlying cause
PALM
polyp, adenomyosis, leiomyoma, malignancy or hyperplasia
COEIN
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified
Luteal phase defect
not enough progesterone = bleeding earlier
Mid-cycle spotting
caused by sudden drop in estrogen level that occurs at mid cycle which destabilizes endometrium causing bleeding
Menorrhagia
excessive heavy bleeding
hypomenorrhea
abnormal short menses
- obstructive
-Asherman’s syndrome
-hormonal imbalance from OCP
-low body fat
-pregnancy
-stress
Hypermenorrhea
abnormally long
- fibroids
-endometrial polyps
-cancer uterus or cervix
-contraception related
-bleeding disorders
metrorrhagia
intermenstrual bleeding
- endometrial polyps
-endometrial and cervical carcinoma
-exogenous estrogen administration
Polymenorrhagia
21 days or less between cycles
Menometrorrhagia
bleeding that occurs at irregular and/or frequent intervals
oligomenorrhea
> 35 days apart, scant or light
ovulatory bleeding
type of metrorrhagia
Oligo-ovulation and anovulation with AUB
endometrium outgrows blood and sloughs off at irregular intervals
contact bleeding can be considered_____
cervical cancer
What needs to be performed with contact bleeding
pap test, colpo any visible cervical lesions
common cause of contact bleeding
cervical ectropion, cervical polyps, cervical or vaginal infection, atrophic vagnitis
what must you ensure when doing a physical examination fo AUB
ensure the bleeding is coming from the uterus
AUB treatment
OCP, NSAIDs, IUD, discussion of stressful situations/lifestyle
treatment for unresponsive AUB
D&C, ablation, uterine artery embolization or hysterectomy
when is ablation reserved for in the treatment of AUB
when childbearing is over and endometrial cancer has been ruled out
cause of primary dysmenorrhea
excess prostagladins
treatment for primary dysmenorrhea
NSAIDs, OCP to suppress ovulation
Cause of secondary dysmenorrhea
structural abnormality or disease process
clinical presentation of secondary dysmenorrhea
pain often lasts longer than menstrual period
diagnosis of secondary dysmenorrhea
culture for GC if infection is suspected, UA, TVUS preferred initial imaging study, laparoscopy, MRI
Definition of Chronic Pelvic pain
pain lasting more than 6 months
labs/diagnostics for chronic pelvic pain
UA, UC,CT/GC, US, CBC, Laparoscopy, CT abdomen if not pregnant
perimenopause definition
period before menopause
vasomotor symptoms
felt due to pulsatile release of GnRH from hypothalamus, affects temperature regulatory area in brain, more severe after surgical menoapuse
Why is sleep disturbances present in a patient with perimenopause
sleep changes as a result of estradiol levels declining
What is the FSH value in patient with perimenopause and menopause
perimenopause: 14-24
Menopause: >30
Treatment for perimenopause
Hormone replacement therapy, estrogen replacement therapy, SSRI (night sweats), Clonidine
When does perimenopause begin
4 years prior to final period
What defines menopause
no cycle for a year
what is the predominant endogenous estrogen in postmenopausal women
estrone
lab results of patients with menopause
elevated FSH and LH, decreased estrogen, increase total cholesterol, decrease in HDL, increase in LDL
what is Obese women at higher risk for
hyperplasia and carcinoma
what is slender menopausal women at higher risk for
menopausal symptoms
What kind of surgical procedure contributes to menopause
bilateral oophorectomy
When do menopause symptoms resolve if not treated
2-3 years, some 10 years or longer
CI for hormone therapy
undiagnosed abnormal genital bleeding, known or suspected estrogen-dependent neoplasia, active DVT, liver dysfunction, known or suspected pregnancy
alternatives to hormone therapy
soy, black cohosh, st john’s wort, acupuncture, exercise
At what thickness of the endometrial do you NOT suspect endometrial cancer
5mm or less suggest low possibility of hyperplasia or endometrial cnacer
At what thickness of the endometrial do you NOT suspect endometrial cancer
5mm or less suggests a low possibility of hyperplasia or endometrial cancer
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
What is DSM-V mental illness
PMDD
Physical symptoms of PMS
Abdominal bloating and fatigue
behavioral symptoms of PMS
emotional liability(MC), irritability, depressed mood
pharmacological treatment for PMS
NSAIDs, OCPs, SSRI, danazol and GnRH agonist
what is the gold standard treatment in patients with PMDD
SSRI
