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EOR GYN > Amenorrhea > Flashcards

Amenorrhea Flashcards

Menstruation

1
Q

amenorrhea

A

absence of menstruation

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2
Q

primary amenorrhea

A

NO period by 16 w/normal secondary sex characteristics OR by 14 w/no secondary sex characteristics

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3
Q

secondary amenorrhea

A

the absence of menstruation after a period of normal menses (>3 mo if regular or >6 mo if not)

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4
Q

etiologies of primary amenorrhea (+ dx and tx)

+ breast/+uterus

A

outflow obstruction (transverse vaginal septum, imperforate hymen)

dx: PE tx: surgery

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5
Q

Turner’s Syndrome

A

45XO

primary amenorrhea

PE: short webbed neck and NO breasts

tx: OCs

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6
Q

etiologies of primary amenorrhea

- breast/+ uterus –> FSH/LH elevated

A

indicates ovarian cause

premature ovarian failure or gonadal dysgenesis

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7
Q

etiologies of primary amenorrhea

- breast/ + uterus –> FSH/LH normal or decreased

A

hypothalamus - pituitary failure (tx with OCP) or puberty delay

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8
Q

etiologies of primary amenorrhea

Mullerian Agenesis (46XX) or Androgen Insensitivity (46XY)

A

Mullerian Agenesis (46XX) or Androgen Insensitivity (46XY)

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9
Q

Androgen Insensitivity Syndrome (AIS)

definition and labs

A

no response to androgens = genetic male, phenotypically female

elevated testosterone levels

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10
Q

tx of AIS

A

start estrogen and remove testes

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11
Q

etiologies of primary amenorrhea

- breast/-uterus

A

rare

defect in testosterone synthesis causes.an immature girl with testes

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12
Q

MC cause of secondary amenorrhea

A

pregnancy!

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13
Q

Causes of secondary amenorrhea (5)

A
  1. Pregnancy
  2. hypothalamus dysfunction
  3. pituitary dysfunction
  4. ovarian d/o
  5. uterine d/o
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14
Q

hypothalamus dysfunction and secondary amenorrhea

A

abnormal GnRH secretion causes decreased LH/FSH

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15
Q

hypothalamus dysfunction etiologies

A

hypothalamic d/o
anorexia
exervise
stress nutritional deficiency

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16
Q

how is hypothalamus dysfunction diagnosed ?

A

normal to decreased FSH/LH with low estradiol and low/normal prolactin

17
Q

hypothalamus dysfunction treatment

A

stimulate GnRH secretion

clomiphene OR menotropin

18
Q

pituitary dysfunction and secondary amenorrhea

labs +tx

A

low FSH/LH with increased prolactin

must get MRI of pituitary sella (prolactin = decreased GnRH)

tx= transphenoidal removal of tumor

19
Q

ovarian d/o and secondary amenorrhea etiologies

A

PCOS
premature ovarian failure

20
Q

premature ovarian failure

A

onset of spontaneous menopause before the age of 40

no response to FSH/LH

21
Q

dx of ovarian disorder in secondary amenorrhea

A

ncreased FSH/LH with decreased estradiol or progesterone challenge test with withdrawal bleeding

22
Q

Asherman syndrome

A

scarring of the uterine cavity due to pp hemorrhage, D&C or endometrial infection

23
Q

Dx Asherman’s syndrome

A

u/s with no uterine stripe or hysteroscopy

24
Q

what is diagnostic and therapeutic for asherman’s syndrome?

A

hysteroscopy

25
Q

progesterone challenge test

what do you take to start it?

A

10 mg medroxyprogesterone x 10 days

26
Q

progesterone challenge test

+ withdrawal bleeding

A

OVARIAN cause

enough estrogen present to stimulate release of lining

27
Q

progesterone challenge test

  • w/d bleeding means?
A

hypoesterogenic or uterine abnormalitiy is cause of amenorrhea

28
Q

why do we care if you have a period?

A

women who don’t menstruate but have estrogen stimulation are at increased risk of endometrial cancer

29
Q

amenorrhea s/s might clue you in to the etiology

A
  1. drug use
  2. stress

3 significant weight change

  1. excessive exercise
30
Q

estrogen irregularity possible amenorrhea causes

A

PCOS

CNS tumor

hyperprolactinemia

Sheehan syndrome

31
Q

sheehan syndrome

A

pituitary failure from ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth

32
Q

galactorrhea is present, what cause of secondary amenorrhea?

A

prolactinemia MC

33
Q

first line testing amenorrhea

A

B-Hcg, TSH and prolactin

34
Q

second line lab work

A

FSH, estrogen, LH and testosterone

may also need MRI or CT, or genetic testing

EOR GYN (3 decks)

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