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CLINDX Unit 2 UFCOM > D. Amenorhea > Flashcards

D. Amenorhea Flashcards

1
Q

What does nulligravid mean?

A

No pregnancies

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2
Q

What is hirsutism?

A

Female with increased hair on upper lip, chin, inner mammary area, inter scapular, back of hands & forearms

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3
Q

What are the 3 stages of pubertal development & the related ages?

A

Thelarche - 8/9
Adrenarche/pubarche - 9/10
Growth spurt
Menarche - 12/13

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4
Q

What is Thelarche?

A

Breast development

1st stage

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5
Q

What is Adrenarche/Pubarche?

A

Hair development

2nd stage

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6
Q

What is Menarche?

A

Begin menses, 12/13

Could start later in malnourished (need certain body weight)

Last stage

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7
Q

Hormone pathway?

A

Hypothalamus –> GnRH (low level prepuberty & pulsatile after) –> Ant pit –> LH & FSH

LH –> theca –> estrogens
FSH –> granulosa –> estradiol

Rising estradiol –> triggers mid cycle LH surge –> ovulation –> Corpus luteum makes progesterone

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8
Q

What are the 2 cell types of the ovary? What do they make?

A

Theca Cells = cells that surround granulosa that make estrogen

Granuosa Cells = right around the egg that makes estradiol

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9
Q

What are the 2 endometrial stages & what hormone causes them?

A

Estradiol –> proliferative endometrium (1st half cycle)

Progesterone –> secretory endometrium

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10
Q

Cycle length?

A

Normally 21-35 (28 day avg)

Duration = 3-5 days (first day or two is heavy)

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11
Q

Definition of Primary Amenorrhea?

A

No menses, growth or secondary sexual characteristics by age 14

No menses by 16, but everything else seems normal

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12
Q

Definition of Secondary Amenorrhea?

A

Miss 3 periods after starting menses

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13
Q

Causes of Primary Amenorrhea & treatment?

A

Vaginal Agensis

Vaginal Septum (Corrective surgery)

Turner Syndrome/45x (IVF & egg donation)

Androgen insensitivity/46XY (stay female)

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14
Q

Most common cause of secondary Amenorrhea?

A

Pregnancy

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15
Q

What is the first test done for secondary amenorrhea?

A

Urine hcg

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16
Q

What tests are performed for primary amenorrhea?

A

anatomical assessment & karyotype

17
Q

What test is performed for secondary amenorrhea if the urine hcg is negative?

A

TSH (hypothyroidism can cause it)

18
Q

What test(s) is(are) performed for secondary amenorrhea if the patient is not pregnant or hypothyroid?

A

FSH & Progesterone challenge test

19
Q

What is the progesterone challenge test?

A

Give progesterone (medroxyprogesterone acetate oral) for 5 days then stop –> should bleed 2-7 days later

Any bleeding = + (dont need regular amount of flow

20
Q

What does withdrawal bleeding from a Progesterone Challenge Test mean generally?

A

Estradiol levels are ok (the endometrium was primed)

Outflow tract is ok

21
Q

What is the cause of secondary amenorrhea with withdrawal bleeding? What causes this disorder?

A

Hypo-pit dysfunction due to stress, weight change or polycystic ovarian disease

22
Q

What is the treatment for Hypo-Pit Dysfunction?

A

If having sex but dont want to get pregnant –> give oral contraceptive (induces cycle)

If not sexually active & dont want to get pregnant –> induce cycle every couple months with Progestin

If want to get pregnant –> make ovulate with Clomiphene Citrate

Weight loss if obese

Treat DM with metformin

Cosmetic meaasures to remove hair

23
Q

Causes of Hypo-pit failure?

A

Extreme stress & low body fat –> atheletes (ballet, marathon runner & gymnastics), anorexia or pit tumors

24
Q

Cause of secondary amenorrhea if no withdrawal bleeding from progesterone test, low FSH & elevated prolactin? Confirmatory test?

A

Pit tumor

MRI for pit adenoma
Visual field exam (upper outer fields gone)

25
Q

Cause of secondary amenorrhea if no withdrawal bleeding from progesterone test & low FSH?

A

Hypo-pit failure

26
Q

How to treat hypo-pit failure?

A

Dont want to get preg –> hormone replacement to prevent bone loss

Want to get preg –> induce with gonadotropins

Pit adenoma –> dopamine agonist

27
Q

Cause of secondary amenorrhea if no withdrawal bleeding from progesterone test & high FSH?

A

Ovarian Failure

28
Q

Causes of ovarian failure?

A

Menopause if over 40

X mosaicism (less eggs) if under 40

29
Q

Treatment for Ovarian Failure?

A

Premature menopause if don’t want to get preg –> hormone replacement

Premature menopause if want to be preg –> egg donation IVF

Normal menopause –> hormone replacement

30
Q

Cause of secondary amenorrhea if no withdrawal bleeding & normal FSH?

A

IUD or prior curettage –> Asherman Syndrome

Confirmatory test with HSG, hysteroscopy or saline infusion sonogram

31
Q

What are FSH levels for Hypo-pit dysfunction?

A

Normal

32
Q

Which type of secondary amenorrhea is linked to high hirsuitism?

A

Hypo-pit dysfunction

Testasterone will be elevated. DHEA can be elevated if due to an adrenal tumor

33
Q

What is hypo-pit dysfunction?

A

Mild decrease or imbalance in hormones from pit

Think about it as an LH deficiency (or estrogen excess) = Endometrial hyperplasia –> no ovulation

Linked to obesity & DM (fat can make androgen/estrogen)

34
Q

What is hypo-pit failure?

A

Neither of the pit hormones (LH or FSH) –> no ovulation (LH) or proliferative phase (estrogen)

35
Q

What is ovarian failure?

A

Hypo-pit axis is working fine, but the ovary doesnt work so the hormones being released can’t work

36
Q

HSG (Hysterosalpingography) is used for the diagnosis of what disorder?

A

Asherman

37
Q

What is HSG (Hysterosalpingography)?

A

radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical canal and usually fluoroscopy with image intensification.

38
Q

What is Asherman’s Syndrome?

A

Buildup of scar tissue that prevents ovulation –> even though hormones are normal egg gets stuck

CLINDX Unit 2 UFCOM (8 decks)

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