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OB/GYN > Ch 6 Reproductive System Concerns > Flashcards

Ch 6 Reproductive System Concerns Flashcards

1
Q

What is the first step in the menstrual cycle?

A

The hypothalamus release GnRH (gonadotropin releasing hormone)

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2
Q

Gonadotropin releasing hormone (GnRH) is going to stimulate the…

A

Pituitary gland to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH)

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3
Q

What does FSH and LH being secreted do?

A

They stimulate the ovaries to produce estrogen first and then later progesterone

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4
Q

In response to estrogen and progesterone being secreted by the ovaries, what will happen?

A

The endometrial lining will proliferate and then shed

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5
Q

When does the menstrual cycle regulate?

A

About 1-2 years after puberty

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6
Q

What is the most common age for menarche?

A

Ages 9-12

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7
Q

What is the most common age for perimenopause?

A

Ages 40s and 50s

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8
Q

What is the normal interval for a menstrual cycle?

A

21-35 days

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9
Q

What is the normal range for length of flow?

A

2-8 days, average is 4-7 days

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10
Q

What is a normal amount of flow?

A

Less than 1 pad or tampon every 3 hours

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11
Q

What is considered severe acute bleeding or HMB, heavy menstrual bleeding?

A

More than a tampon or a pad an hour

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12
Q

What is considered abnormal uterine bleeding?

A

Irregular bleeding that many be light, heavy, or spotting only

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13
Q

Amenorrhea generally =

A

Anovulation

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14
Q

Absence of both menarche AND sexual secondary characteristics by…

A

13

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15
Q

Absence of absence of menses by age…

A

15, regardless of normal growth and development

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16
Q

If someone has normal growth and development but no period by age 15 that would be considered…

A

primary amenorrhea

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17
Q

Absence of menstruation within__ years of breast development is primary amenorrhea

A

5

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18
Q

6 months of more of absence of period after menses is considered…

A

secondary amenorrhea

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19
Q

Primary versus secondary amenorrhea

A

Primary - never had a period

Secondary - they used to but now it’s gone

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20
Q

Inner layer of the uterus

A

endometrium

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21
Q

Muscular layer of the uterus, middle layer

A

myometrium

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22
Q

Outside layer of the uterus

A

perimetrium

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23
Q

What structure of the fallopian tubes takes up products of the ovaries?

A

fimbriae

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24
Q

Where do sperm and egg usually meet?

A

ampulla in the fallopian tube

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25
Q

50% of abnormal uterine bleeding occurs in women over the age of..

A

45

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26
Q

Only 20% of abnormal uterine bleeding occurs in

A

adolescents

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27
Q

What is an anovulatory cycle?

A

a menstrual cycle in which ovulation, or the release of an egg from the ovaries, does not occur.

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28
Q

What is the cause of ovulatory problems?

A

Problems affecting the release of hormones from the hypothalamus or anterior pituitary

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29
Q

What are three primary causes of abnormal uterine bleeding?

A

Ovulatory problems
Uterine cancer
Endometrial problems

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30
Q

What are two potential causes of endometrial problems?

A

Ectopic pregnancy

Infection

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31
Q

Ovulatory dysfunction makes up only 10% of what?

A

abnormal uterine bleeding

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32
Q

Hormonal causes of ovulatory dysfunction are most commonly due to…

A

Obesity
PCOS
Perimenopause
Menarche

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33
Q

What is the most common cause of ovulatory dysfunction?

A

PCOS

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34
Q

What does iatrogenic mean?

A

relating to illness caused by medical examination or treatment

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35
Q

What are iatrogenic causes of ovulatory dysfunction?

A

Contraception
Anticoagulant drugs
Some seizure medications
Antipsychotic meds

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36
Q

How can antipsychotics cause anovulation?

A

Blockade of dopamine D2 receptors cause an increase in the levels of prolactin. Elevated prolactin levels can lead to irregular menstrual cycles and anovulation by altering levels of estrogen and FSH

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37
Q

How do antipsychosis and some seizure medications cause anovulation?

A

They interfere with the release of GnRH

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38
Q

Endometrial cancer the the __ leading cause of cancer deaths among women

A

4th

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39
Q

Endometrial cancer most often occurs in women who are…

A

Peri or postmenopausal

Overweight

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40
Q

What race is most likely to get endometrial cancer?

A

Black women, and they are also less likely to survive

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41
Q

What is the FIRST symptom of uterine cancer?

A

Abnormal bleeding

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42
Q

Is pain common with early uterine cancer?

A

No

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43
Q

Pain is a __ sign of uterine cancer

A

late

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44
Q

Abnormal bleeding is a __ sign of uterine cancer

A

early

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45
Q

When are endometrial disorders likely to occur?

A

In the presence of normal ovulatory function when other abnormalities have been ruled out

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46
Q

Endometrial disorders may include…

A

ectopic pregnancy and infection, endometritis, or UTI

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47
Q

What should you ask a patient about if they have heavy menstrual bleeding?

A

Coagulopathy, family history of bleeding disorders

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48
Q

About 13% of women with heavy menstrual bleeding have…

A

Coagulopathy

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49
Q

An adolescent presents with extremely heavy menstrual bleeding but her cycles are regular

A

Suspicious of undiagnosed bleeding disorder

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50
Q

Menopause, menarche, uterine cancer, and uterine infection are all potential causes of what disorder?

A

abnormal uterine bleeding

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51
Q

When a patient presents with amenorrhea, what are the four things you need to assess?

A

Absence of menarche and secondary sex characteristics by age 13
Absence of menses by 15 regardless of normal growth and development
Absence of menstruation within 5 years of breast development
6 month or more absence of periods after a period of menstruation

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52
Q

What are potential causes of primary amenorrhea? List 7

A 
Stress
Pregnancy
Premature menopause
Eating disorders
Strenuous exercise
Thyroid disease
Medications that elevate prolactin levels (esp seizure medications)
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53
Q

Things to test for when a patient has primary amenorrhea

A

Pregnancy test
UA
CBC
Endocrine test such as FSH, TSH, Estradiol

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54
Q

OVULATORY cycles are characterized by… List 6

A 
Regularity
Mid-cycle discomfort (Mittelschmerz pain)
Spinbarkeit mucus
Mid-cycle thermal shift
Cramping with menses
Cycle of generally 4-7 days
55
Q

What is Spinnbarkeit mucus?

A

the elastic quality that is characteristic of mucus of the uterine cervix especially shortly before ovulation

56
Q

What is Mittelschmerz pain?

A

mid-cycle pain

57
Q

How is Spinnbarkeit pronounced?

A

Spin-bar-keet

58
Q

How is Mittelschmerz pronounced?

A

Mittel-schmerz

59
Q

When does abnormal uterine bleeding (AUB) most often occur?

A

A times of anovulation. So, at the beginning of menstrual cycles, and at the beginning of menopause

60
Q

What are the secondary sex characteristics?

A

Breast and pubic hair developement

61
Q

How can we classify the secondary sex characteristics?

A

Tanner stages, 1-5

62
Q

What is the definition of secondary amenorrhea:

A

Absence of menses for 6 months in a women whom normal menstruation has been established (for at least 3 previous cycles)

63
Q

What is thelarche?

A

Onset of breast development

64
Q

When does thelarche usually begin?

A

2 years before first menstrual period

65
Q

What is menarche?

A

First menstrual period

66
Q

When does menarche occur?

A

Ages 10-16 years in most developed countries

67
Q

The first initial menstrual cycles are…

A

anovulatory

68
Q

How do we know when a girl’s cycles become ovulatory?

A

Cycles become regular and she starts having cramps

69
Q

Major causes of PRIMARY amenorrhea

A

Genetic causes such as Turner’s syndrome

Hormonal imbalances such as PCOS

70
Q

What are symptoms of PCOS? 12 listed

A

Excessive body hair, weight gain, ovarian cysts, irregular or missed periods, low sex drive, alopecia, high testosterone levels, insulin resistance, fatigue, acne, mood changes, trouble conceiving or infertility

71
Q

PCOS is a __ disorder

A

endocrine

72
Q

In PCOS, there are very high levels or what 3 hormones?

A

Estrogen, testosterone, and luteinizing hormone (LH)

73
Q

What hormone is decreased in PCOS?

A

FSH (follicle stimulating hormone)

74
Q

What is Turner’s syndrome?

A

a condition affecting women having only one X chromosome, characterized by distinctive physical characteristics including short stature and webbed neck, and by failure of normal development of the ovaries, uterus, and breasts.

75
Q

What are the major causes of secondary amenorrhea? List 6

A 
Pregnancy
Contraception
Asherman's syndrome
Hormonal imbalances
Pituitary tumor
Menopause
76
Q

What is Asherman’s syndrome?

A

A rare condition where scar tissue, also called adhesions or intrauterine adhesions, builds up inside your uterus. This extra tissue creates less space inside your uterus.

77
Q

What can cause Asherman’s syndrome? 4 listed

A

Too vigorous myomectomy
Complicated D&C
Abortion
C section

78
Q

What is characteristic of Asherman’s syndrome?

A

Intrauterine band like adhesions that cause pain and interfere with the menstrual cycle

79
Q

An increase in the hormone __ can cause amenorrhea

A

prolactin

80
Q

What can cause hyperprolactinemia? List 7

A 
Hyperthyroidism
Stress
Some medications
Excessive exercise
Excessive sleep
Pituitary adenoma
Weight loss: Anorexia or bulimia
81
Q

How does hyperthyroidism cause an increase in prolactin levels?

A

Thyroid relising hormone (TRH) stimulates prolactin synthesis through the activation of ERK

82
Q

What medications can increase prolactin levels?

A

OCPs
Phenothiazines
Anti-HTN
Narcotics

83
Q

Most causes of secondary amenorrhea are caused by…

A

The hypothalamus not the pituitary gland

84
Q

What is a rare syndrome of the pituitary gland that can cause secondary amenorrhea?

A

Sheehan Syndrome

85
Q

What is Sheehan syndrome?

A

Postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery.

86
Q

How does postpartum hemorrhage lead to Sheehan syndrome?

A

Hypovolemia and vasospasm causes cellular swelling. The pituitary gland is surrounded by a bony prominence that inhibits blood flow, which causes the necrosis

87
Q

What is the treatment for amenorrhea when the cause is hypothalamic failure?

A

GnRH replacement

88
Q

What is the treatment for amenorrhea when the cause is hypothyroidism?

A

TSH replacement

89
Q

What is the treatment for hyperprolactinemia?

A

Bromocriptine

90
Q

What is the treatment for amenorrhea when anovulation is the cause?

A

Cyclic progesterone

91
Q

How is Sheehan syndrome ruled out?

A

By way of hysteroscopy and hysterosalpingogram

92
Q

What is primary dysmenorrhea?

A

Prostaglandin released from uterine lining ONLY in ovulatory cycles

93
Q

What is prostaglandin responsible for?

A

Cramps, N/V, HA and other associated symptoms

94
Q

How can you suppress prostaglandin release?

A

Use NSAIDS 24-48 hours BEFORE the onset of menses

95
Q

Primary dysmenorrhea is associated with an…

A

ovulatory cycle

96
Q

Primary dysmenorrhea is most common for women in what age group?

A

Early teens - early 20s

97
Q

Secondary dysmenorrhea most common causes

A

Endometriosis
Fibroids
Adenomyosis

98
Q

What is endometriosis?

A

Presence and growth of endometrial tissue outside of the uterus

99
Q

Endometrial tissue can be as far away from the uterus as the…

A

Thoracic cavity, heart

100
Q

Endometrial tissues contains…

A

uterine glands and stroma

101
Q

Uterine glands and stroma that is outside of the uterus will..

A

respond to the menstrual cycle

102
Q

What happens when the endometrial tissue responds to the menstrual cycle?

A

Those tissues bleed and cause the inflammatory process. This can cause adhesions and fibrosis to the adjacent tissues and organs

103
Q

What is a well known theory of endometriosis etiology?

A

Transplantation or retrograde menstruation

104
Q

What is transplantation or retrograde menstruation?

A

Endometrial tissue that’s reflux through the uterine tubes into the uterine cavity where it can implant into the ovaries and other organs

105
Q

Risk factors for endometriosis

A 
Increasing age
Family history
Short menstrual cycles (less than 28 days)
Long menstrual flow (over a week)
Age at menarche <12 years
Few or no pregnancies
106
Q

What does the provider look for on the exam when assessing for endometriosis?

A

Nodularity
Retroverted uterus
Pain with exam

107
Q

How is endometriosis diagnosed?

A

Laparoscopy

108
Q

What is a retroverted uterus?

A

A uterus that is tilted backwards

109
Q

What are the most common s/s of endometriosis?

A

Pain and infertility

110
Q

What is dyspareunia?

A

Pain with intercourse

111
Q

What are other s/s of endometriosis?

A

dysuria, depression, fatigue, chronic pelvic pain, premenstural vaginal spotting, dyspareunia, pain with bowl movement

112
Q

What are endometriomas?

A

“Chocolate cysts” that are found on the uterus due to endometriosis

113
Q

Endometriosis lesions can cause distortions of the…

A

pelvic anatomy that can lead to infertility

114
Q

Endometriosis can NOT be identified through…

A

ultrasound

115
Q

Pelvic endometriosis can only be identified through…

A

laparoscopy

116
Q

How else is endometriosis diagnosed besides laparoscopy?

A

CT scan may localize an incisional lesion and biopsy confirms the diagnosis

117
Q

How is endometriosis treated?

A

OCP, NSAIDs, GnRH agonist

Surgery to remove lesions

118
Q

What is the only cure for endometriosis?

A

Hysterectomy with bilateral oophrectomy

119
Q

What is an oophrectomy?

A

A surgical procedure to remove one or both of your ovaries

120
Q

What are the two main classes of medications used to treat endometriosis?

A

GnRH agonist and androgen derivatives

121
Q

How would a GnRH agonist help endometriosis?

A

It will help to stop the releasing of FSH and LH

122
Q

What is a total hysterectomy?

A

The uterus and cervix

123
Q

What is a radical hysterectomy?

A

Uterus with the surrounding lymph nodes/tissue

124
Q

What is a hysterectomy with a bilateral oophorectomy?

A

Uterus and both ovaries

125
Q

What is a supracervical hysterectomy?

A

Just the uterus, no cervix or anything else

126
Q

What is PMS?

A

Physical or mood changes day before menstruation

127
Q

When are mood swings or physical symptoms considered PMS?

A

Symptoms happen month after month and affect a women’s normal life

128
Q

What are 3 potential causes of PMS?

A

Cyclic changes in hormones
Chemical changes in the brain
Undiagnosed depression

129
Q

Undiagnosed depression is related to PMS…

A

NOT the cause

130
Q

What is the diagnostic criteria for PMS?

A

Symptoms must be present within the 5 days leading to her period and for at least 3 cycles in a row
Symptoms must end within 4 days after her period starts
Interfere with some of her normal activities

131
Q

What are dietary considerations for preventing PMS?

A

Diet rich in complex carbs to reduce cravings
Calcium rich foods instead of salt, sugar, fat
Avoid caffeine to reduce irritability
Eat small meals (6 instead of 3) or add snack in between meals

132
Q

What health considerations for preventing PMS?

A

Reduce stress with yoga, mindfulness, massage
Aerobic exercise
Get enough sleep

133
Q

What pharmacological considerations for preventing PMS?

A

OCPs

Low dose SSRIs (once a month before period)

OB/GYN (11 decks)

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