Amenorrhea/Bleeding Flashcards
46XX w/primary amenorrhea
Mullerian agenesis
= no Müllerian ducts = no uterus or upper vag
+ boobs, pubes, ovaries but -uterus = primary amenorrhea
46XY w/primary amenorrhea
Androgen insensitivity
=no androgen receptor! Balls present and making testosterone but due to lack of receptor wolf degrades, MIF degrades mullerian.
+testes +breast -pubes -uterus =primary amenorrhea
45X w/primary amenorrhea
Turners!
No ovaries and no estrogen!
Streak ovaries, short stature, webbed neck, infertility, amenorrhea, broad chest, urinary track abnormalities, bicuspid aortic, aortic core Tatian, dysgerminomas risk, normal intelligence
- ovaries,breast,pubes but + uterus = primary amenorrhea
Amenorrhea and can’t smell
Kallman syndrome = no GnRH = no LH & FSH = no E&P
-boobs +uterus
+ boobs, pubes, ovaries but -uterus = primary amenorrhea
Mullerian agenesis 46XX
+testes +breast -pubes -uterus =primary amenorrhea
Androgen insensitivity 46XY
Causes of primary amenorrhea
Kallman syndrome Mullerian agen(46XX) Androgen insensitivity(46XY) Turners (45X) Swyer Syndrome(46XY)
What is important to do for ppl with androgen insensitivity that you don’t do for mullerian agenesis?
Remove testes once developed to prevent cancer and then start hormone therapy.
Kallmann syndrome tx
Replace hormones appropriate for sex
what might need to be done for women with mullerian agenesis & androgen insensitivity?
elevate the vagina to increase its length to increase satifaction with sex
all girls should develop menarche by —- and begin to develop secondary sex char by —-.
15, 13
testosterone in mullerian agen vs androgen insens?
normal in mullerian but elevated in androgen insen.
what does a negative progesterone challenge test tell you?
absence of withdrawal bleeding is caused by either inadequat estrogen priming of the endometrium or outflow tract obstruction(imperforate hymen).
what does a positive Progesterone challenge test tell you?
diagnostic of anovulation! = need to give cyclic progesterone to prevent endometrial hyperplasia. give Clomiphene if pregnancy is desired.
What does a negative estrogen-progest challenge test tell you?
diagnostic of outflow obstruction or endometrial scarring(Asherman Syndrome) = do hysterosalpingogram(HSG) to ID
What does a positive estrogen-progest challenge test tell you?
bleeding = there just wasnt enough estrogen in the first place. look at FSH to ID etiology.
- elevated FSH = ovarian failure
- low FSH = need to r/o brain tumor.
what is asherman syndrome?
scarring of the uterus due to extensive uterine curettage and infection-producting adhesions.
define primary amenorrhea
girl who has never had a period
define secondary amenorrhea
women of reproductive age who has stopped having periods for >6 months.
^nobody waits that long to investigate though lol
causes of secondary amenorrhea
- Pregnancy
- Hypothyroidism
- Prolactinoma
- Meds
- Menopause
- Savage Syndrome/Resistant ovarian Syndrome
- Asherman’s Syndrome
- Hypothalamus
- Primary Ovarian Insufficiency
how does hypothyroid cause secondary amenorrhea? how do you treat?
hypothyroid = increased TSH = increases prolactin production = inhibits GnRH causing amenorrhea.
*will also see dec FSH & LH(duh) just like wiht a prolactinoma.
tx: levothyroxine
work up and tx of prolacintoma
suspect if galactorrhea or amenorhea. get prolactin level then MRI.
tx: Pramixpaxole < cabergoline
what drugs will cause secondary amenorrhea?
DA antagoinist like atypical antipsychotics.
hormone levels in menopause…
elevated FSH and LH
28 yo women who has 2nd amenorrhea. FSH and LH are elevated. U/S shows many follicles. dx? tx?
Savage Syndrome/Resistant ovary Syndrome = basically early menopause =(
*no tx =(
How do you dx secondary amenorrhea due to hypothalamus?
dx of exclusion! look at FSH and LH levels along with E & P levels
causes of vaginal bleeding in premenstral girls. Whats the most common?
- Foreign Body (MC)
- sexual abuse
- precocious puberty
- Sarcoma Botyroides
dx: speculum Exam!
causes of vaginal bleeding in reproductive age women. Whats the most common?
- Pregnancy(MC)
- Anatomy(PALM COEIN)
- Dysfunctional/abnormal Uterine Bleeding
causes of vaginal bleeding in postmenopausal women. Whats the most common?
- Atrophy(MC)
- Endometrial Carcinoma
- Hormone Repacment Therapy(HRT)
What are the escalating steps for heavy, life threatening bleeding.
- always remember 2 large bore IVs + IVF
1. IV estrogen to stop
2. Balloon tamponade
3. D&C
4. Uterine A. Embolization
5. Hysterectomy
PALM COINE
Polyps, Adenomyosis, Leiomyomas, Malignancy, Coagulopathies, Ovarian Dysfunction, Endometrial probs, Iatrogenic = IUD, Not Yet Classified
^causes of anatomic causes of uterine bleeding
What are Fibroids?
Leiomyomas in the Uterus = benign. Asymmetric, hard nodules, painful, may have iron def due to bleeding, can cause problems wiht pregnancy or obstruction due to location(due to size). Will increase in size with estrogen. dx: U/S tx: w/OCP
Adenomyosis. tx?
endometrium grows into the myometrium. symmetrically enlarged, soft, tender uterus, menorrhagia and dysmenorrhea
when is abnormal uterine bleeding(AUB) normal?
near menarche or menopause
how do you dx AUB? Tx?
exclusion! tx: OCP & NSAIDs to reduce bleeding
What happens in Polycystic ovarian Syndrome?
ovary is replaced by thousands of follicles that produce large amounts of estrogen which then is converted to testosterone = fat, hairy, irregular menses, deep voice, trouble getting prego, DM, dyslipidemia
dx: LH/FSH >3 makes dx. elevated testosterone but normal DHEAS
tx: OCP + Metformin(reduces androgens), clomiphene to help with getting prego
IUP w/bleeding, closed OS, U/S shows live baby….
threatened abortion, get bed rest and see if its okay.
IUP w/bleeding, open OS & U/S shows dead baby..
inevitable abortion
IUP w/bleeding, + passage of clots, open OS, retained parts…
Incomplete abortion
IUP w/bleeding, + passage of contents, closed OS, U/S shows nothing…
complete abortion
1st trimester to induce abortion
misoprostol
Rh - mothers need to be given….
Rogam! = mom doesnt Rh factor and will have Ab to this factor – baby will have this factor = give rogam toprevent abortion
UPT +, vaginal bleeding…next step?
do U/S to diff = baby, abortion, molar prego or ectopic pregnancy
How do you use B-quant in ectopic prego?
B-quant = bhcg.
- If >/=1500 and in fallopian tube = ectopic.
- if <1500 and in fallopian tube = wait! may still be traveling to uterus = wait 48hrs and try again.
When can you use methotrexate + leukovorin for ectopic pregnancy?
if bhcg <5000 or 8000, <3cm, no heart tones, moms not on folate
tx for non-ruptured ectopic prego…
salpingostomy = reach in and remove
tx for ruptured ectopic prego…
salpingectomy = remove fallopian tube
Heavy menstrual bleeding is defined as…
> 85 mL
Oligomenorrhea
<9 periods a year
Amenorrhea
No peroids for 3+ consecutive months
Swyer Syndrome
46XY congenital lack of testes. Resulting in no MIS causing female appearance
