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General Gynecology > Amenorrhea > Flashcards

Amenorrhea Flashcards

1
Q

What is the definition of primary Amenorrhea?

A
  1. No menses by the age of 15 yrs in the presence of normal secondary sexual characteristics
  2. No menses within 5 years of breast development if occurs before age 10
  3. No menses or development of secondary sexual characteristics by age 13
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2
Q

What is the definition of secondary Amenorrhea?

A

No menses for a total of at least 3 previous cycles, 3 months

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3
Q

What are the 4 main causes of Amenorrhea

A

PCOS, Hypothalamic amenorrhea, Hyperprolactinoma, ovarian failure

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4
Q

Mullerian Agenesis is also known as ____.

A

Mayer-Rokitansky-Kuster-Hauser syndrome

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5
Q

On physical exam what finding will indicate mullerian agenesis rather than Androgen Insensitivity?

A

Presence of pubic hair

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6
Q

How do you prescribe a progesterone for a withdrawl bleed?

A

Medroxyprogesterone 10 mg PO for 5-10 days

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7
Q

What does a positive withdrawl bleed indicate?

A

Functional outflow tract and presence of responsive endometrium

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8
Q

Why might a progesterone whithdrawl bleed not occur in a patient with PCOS?

A

endometrium may be decidualized by high circulating androgen levels

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9
Q

What does obtaining an estradiol level help achieve?

A

Whether the patient is eugonadal or hypogonadal

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10
Q

What level of estrogen suggests ovarian follicular activity?

A

> 40 pg/mL

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11
Q

What level of FSH suggests ovarian failure?

A

> 20 IU/L

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12
Q

What level of FSH indicates hypogonadotropic hypogonadism?

A

< 5 IU/L

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13
Q

Low FSH in the setting of low estradiol suggests what type of dysfunction?

A

Hypothalamic

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14
Q

What labs should be obtained when evaluating a patient with amenorrhea?

A

HCG, TSH, Prolactin, FSH, Estradiol

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15
Q

Hypergonadotropic Hypogonadism refers to ____

A

premature ovarian failure

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16
Q

Hypogonadotropic Hypogonadism refers to_____

A

hypothalamic amenorrhea, pituitary or CNS tumor

17
Q

If both FSH and Estradiol are in the normal range are the two possible causes of amenorrhea?

A

Annovulation, Anatomic Defect

18
Q

What are the three main syndromes associated with Hypergonadotropic Hypogonadism?

A

Gonadal Dysgenesis, Primary ovarian insufficiency, Menopause

19
Q

What is the definition of primary ovarian insufficiency?

A

depletion of ovarian follicles and cessation of menses before the age of 40

20
Q

What percent of women does primary ovarian insufficiency affect?

A

1 %

21
Q

What genetic syndrome is associated with primary ovarian insufficiency?

A

Fragile X (FMR1 gene)

22
Q

What specific sex chromosomal abnormalities are associated with primary ovarian insufficiency?

A

X and Y chromosome mosaicism

23
Q

True or false: If Y chromosome present in a genetic analysis for a patient who has ammenorhea and POI, then gonads should be removed due to malignant potentia?

A

True

24
Q

In a patient with Primary ovarian Insufficiency, what Autoimmune diseases should you test for?

A

21 hydroxylase antibodies, Antithyroid antibodies

25
Q

primary ovarian insufficiency is strongly associated with what Autoimmune syndrome?

A

Adrenal Insufficiency

26
Q

Following radiation, how long does it take for menses to resume?

A

6 - 18 months

27
Q

True or false: prior radiation therapy can cause birth defects?

A

false

28
Q

Which chemotherapy agents result in highest rate of premature ovarian insufficiency?

A

Alkylating agents

29
Q

How does chemotherapy affect fertility?

A

causes depletion of primordial follicles

30
Q

What percentage of patients with premature ovarian insufficiency may conceive spontaneously?

A

5 - 10%

31
Q

What should be prescribed for patients with premature ovarian insufficiency?

A

HRT with low dose estrogen

32
Q

What must be added to HRT for those patients who still have a uterus?

A

Progesterone

33
Q

What is the most common disorder of the pituitary that causes amenorrhea?

A

Pituitary Adenoma

34
Q

What disorder of the hypothalamus is associated with Amenorrhea?

A

Kallman Syndrome

35
Q

What are common causes of hypothalamic amenorrhea?

A

Eating disorder, excessive exercise, excessive weight loss

36
Q

In a patient with hypothalamic amenorrhea, what agents must be used to achieve pregnancy?

A

Gonadotropin ovulation induction agents

37
Q

What is Kallman syndrome?

A

Congenital GnRH deficiency associated with anosmia

38
Q

What causes Kallman Syndrome?

A

failure of GnRH neurons to migrate to the hypothalamus during embryogenesis

39
Q

True or false: adrenarche is not compromised in a patient with Kallman syndrome, therefore patients will still have pubic hair

A

True

General Gynecology (11 decks)

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