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Women's Health > Disorders of Menstruation and the Uterus > Flashcards

Disorders of Menstruation and the Uterus Flashcards

1
Q

Menstrual Cycle

A

See Study Guide!

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2
Q

Symptoms of PMS initiate during the ____ phase.

A

Luteal

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3
Q

What type of contraception is best for a woman with PMDD (severe PMS w/ functional impairment)?

A

Drospirenone (progestin)-containing OCP

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4
Q

Secondary dysmenorrhea is due to a pelvic pathology. What are some examples?

A
  • Endometriosis
  • Adenomyosis
  • Leiomyomas
  • Adhesions
  • PID
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5
Q

Treatment options for dysmenorrhea include:

A
  • NSAIDs!
  • Ovulation suppression: OCPs, Depo, Vaginal ring
  • Laparoscopy: to r/o secondary causes such as endometriosis or PID
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6
Q

The MC secondary cause of dysmenorrhea in younger patients is _____. A common cause of dysmenorrhea with increasing age is ______.

A
  1. Endometriosis

2. Adenomyosis

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7
Q

DUB is either due to:

  1. Chronic Anovulation (90%) OR
  2. Ovulatory
A
  1. Chronic Anovulation: Seen at EXTREMES OF AGE (teenagers after menarche and perimenopausal). Related to UNOPPOSED ESTROGEN. Without ovulation there is no progesterone. Leads to increased endometrial growth w/ irregular, unpredictable shedding/bleeding.
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8
Q

What tests and labs do you order for a DUB workup?

A
  • hormone levels
  • TVUS
  • endometrial bx if endometrial stripe is > 4mm on TVUS or in woman > 35y/o to r/o endometrial hyperplasia or carcinoma

*If workup shows no evidence of organic cause and you have a negative pelvic exam then DUB is the dx

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9
Q

Acute severe bleeding in DUB is controlled how?

A

High dose IV estrogens or high dose OCPs

-D&C may be used if IV estrogen fails

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10
Q

1st line treatment for anovulatory DUB is _____.

A

OCPs

-Progesterone and GnRH agonists (Lupron) can be considered

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11
Q

Treatment for ovulatory DUB includes:

A
  • OCPs
  • Progesterone: orally or IUD
  • Lupron
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12
Q

If not responsive to medical treatment for DUB then what surgical options are considered?

A
  1. Hysterectomy= definitive management

2. Endometrial ablation

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13
Q

What labs should be ordered in a patient with amenorrhea?

A
  • Pregnancy!
  • Serum prolactin
  • FSH & LH
  • TSH
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14
Q

Primary amenorrhea is defined as the failure of menarche onset by the age of ___ in the presence of secondary sex characteristics or ___ in the absence of secondary sex characteristics.

A

15- presence of secondary sex characteristics

13- absence of secondary sex characteristics

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15
Q

Amenorrhea in a patient with a uterus and breasts is most likely caused by what?

A

Outflow obstruction–> Transverse vaginal septum, imperforate hymen

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16
Q

Amenorrhea in a patient with a uterus but NO breasts is likely due to what?

A

IF…

  1. Elevated FSH and LH= Ovarian Cause
    - Premature ovarian failure (46XX)
    - Gonadal dysgenesis (Turner’s XO)
  2. Normal/Low FSH and LH= Hypothalamus-Pituitary Failure
    - Puberty delay (athletes, illness, anorexia)
17
Q

Secondary amenorrhea is defined as absence of menses for > ___ (length of time) in a patient with previously normal menstruation, or > ___ in a patient who was previously oligomenorrheic.

A
  • > 3 months

- > 6 months

18
Q

______ is the MC cause of secondary amenorrhea.

A

Pregnancy

19
Q

A 17 year old patient comes to the office stating she hasn’t had her period in 4 months (was previously regular). Her pregnancy test is negative. Lab work reveals:

  • FSH and LH= LOW
  • Estradiol= LOW
  • Prolactin= Normal

What are some possible causes of her amenorrhea?

How should she be treated?

A
  • Anorexia or weight loss
  • Exercise
  • Stress
  • Nutritional deficiencies
  • Systemic disease (celiac)

Treatment: Stimulate GnRH secretion. Clomiphene!

20
Q

A 17 year old patient comes to the office stating she hasn’t had her period in 4 months (was previously regular). Her pregnancy test is negative. Lab work reveals:

  • FSH and LH= LOW
  • Prolactin= HIGH

What is the likely cause of her amenorrhea?

How should she be treated?

A

Prolactin-secreting pituitary adenoma
-prolactin inhibits GnRH

Treatment= Transsphenoidal surgery (removal of tumor)

21
Q

A 17 year old patient comes to the office stating she hasn’t had her period in 4 months (was previously regular). Her pregnancy test is negative. Lab work reveals:

  • FSH and LH= HIGH
  • Estradiol= LOW

What is the likely cause of her amenorrhea?

How should she be treated?

A

Ovarian disorder= PCOS, Premature Ovarian Failure- follicular failure or resistance to FSH or LH or Turner’s (see symptoms of estrogen deficiency- similar to menopause)

22
Q

If a patient completes the progesterone challenge test and has withdrawal bleeding this suggests that the cause of the amenorrhea is likely what?

A

Ovarian: patient is anovulatory or oligoovulatory (there is enough estrogen present that has built up the endometrial lining)

23
Q

If a patient completes the progesterone challenge test and does NOT HAVE withdrawal bleeding this suggests that the cause of the amenorrhea is likely what?

A

Hypoestrogenic
1. Hypothalamus-Pituitary Failure OR

  1. Uterine!= Asherman’s or Uterine Outflow Tract Obstruction (Imperforate Hymen)
24
Q

How is Asherman’s Syndrome (acquired endometrial scarring) diagnosed?

A
  • Pelvic US (absence of normal uterine stripe)
  • Hysteroscopy

*Treatment= estrogen to stimulate endometrial regeneration

25
Q

Cessation of menses for > 1 year due to loss of ovarian function is known as ____.

A

Menopause

26
Q

What are some estrogen deficiency changes associated with menopause?

A
  • hot flashes
  • mood changes
  • skin/nail/hair changes
  • increased risk of cardiovascular events
  • HLD
  • osteoporosis
  • dyspareunia due to vaginal atrophy
  • urinary incontinence
27
Q

How is menopause diagnosed?

A

FSH ASSAY: MOST SENSITIVE INITIAL TEST

  • increased serum FSH > 30 IU/mL
  • decreased estrogen (due to depletion of ovarian follicles)
28
Q

Name 5 medications that can be prescribed to treat vasomotor insufficiency.

A
  • Estrogen
  • Progesterone
  • Clonidine
  • SSRIs
  • Gabapentin
29
Q

Biphosphonates and SERM (Raloxifene and Tamoxifene) can be used to treat/prevent _____ in menopausal women.

A

Osteoporosis

30
Q

What are the risks and benefits of estrogen only therapy?

A
  1. Risks:
    - Increased risk of endometrial cancer (often used in hysterectomy patients)
    - Thromboembolism (CVA, DVT, PE)
    - Liver Disease
  2. Benefits:
    - Most effective symptomatic treatment
    - No increased risk for breast cancer
31
Q

What are the risks and benefits of Estrogen + Progesterone therapy?

A
  1. Risks:
    - VTE
    - Slightly increased risk for breast ca?
  2. Benefits:
    - Symptomatic relief, decreased heart and stroke risk, decreased risk of osteoporosis and dementia
    - Protective against endometrial cancer!

Women's Health (8 decks)

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