Dunn OB/GYN X Flashcards
amenorrhea
no menses for 3 cycles
17yo F no menses
- cramping monthly with breast tender
- fam hx late menarche
- suprapubic tenderness
- rectal mass
primary amenorrhea
pregnancy test, CBC, US, FSH/LH, E2, karyotype
exam under anesthesia - imperforate hymen**
hematocolpos
retained menstruation by imperforate hymen
female who just reached puberty
tx - cup open
thelarche
onset of female breast development
appearance of sex hair
pubarche
onset of axillary and pubic hair, body odor, acne
adrenarche
onset of menstruation
menarche
tanner stage
1 - prepubertal
to
5 - mature
breast and pubic hair analysis
failure to menstruate by age 16
primary amenorrhea
secondary amenorrhea
absence of menses 3 cycles or >6 months
more common
no secondary sex characteristics
FSH and LH
low -hypogonadotropic gypogonadism
high - karyotype
yes secondary sex characteristics
genetic male or female?
female - mullerian anomaly - no uterus - renal issues as well
male - androgen insensitivity - complete vs. partial
secondary amenorrhea work up
had menstruation, but then stopped
pituitary and thyroid - normal
-then do progestin challenge
causes of primary amenorrhea
constitutional delay
45XO - turner
46XY
pituitary tumor
congenital adrenal hyperplasia**most common cause
second most common cause - Mayer-Rokitansky-Küster-Hauser syndrome
webbed neck, amenorrhea
turner syndrome
45X
Mayer-Rokitansky-Küster-Hauser syndrome
absent uterus
clue to diagnosis of primary amenorrhea
karyotype patient
FSH, LH, PRL levels
headache and visual field defect
pituitary tumor
diagnosis of primary amenorrhea
height, weight, BP secondary sex characteristics look for androgen excess - virilization visual fields chromosomes FSH, LH, E2 hydroxyPROG, androgen, PRL, TSH
causes of secondary amenorrhea
stressed - hypothalamic weight loss/gain - anorexia post pill PCO syndrome premature menopause - idiopathic hyperPRL drug induced pregnancy** thyroid disease
sheehans
infarct pituitary
cause of secondary amenorrhea
asherman
adhesions/fibrosis of uterine cavity after D and C
cause of secondary amenorrhea
evaluation of secondary amenorrhea
life events weight/exercise pregnant drugs galactorrhea hot flashes
PE - height weight BP secondary sex characters
- virsutism/virilization
- cervical stenosis
tests for secondary amenorrhea
primary - FSH, LH, E2, TSH PRL, androgens, US, visual fields
secondary - CT pituitary, dexamethasone suppression test, hydroxyPROG
32yo LMP 1 month ago, irregular menses
- trying to get pregnant 1 year
- ruptured appendix, age 14
- smoker
primary infertility
endometriosis
- subfertility
- painful menses
peritonitis
tubal issues
work up for primary infertility
FSH, LH, progesterone, semen analysis, HSG
-diagnostic laparoscopy
FSH day 3
progesterone day 22
endometriosis
amount present does not predict amount of pain
powder burn appearance
hemosiderin laden macros
endometriosis
endometrium outside the uterus
have seen in lungs, bowel, vagina - how did it get there? metaplasia?
symptoms do not always correlate to grading**
diagnosis of endometriosis
laparoscopy and biopsy
-gold standard**
careful history
US - of little help
elevated CA125 - but lacks sensitivity
dysmenorrhea, dyspareunia, infertility
triad of endometriosis
also - abnormal bleeding
- pain with defecation during menses
- disordered cycles
etiology of endometriosis
retrograde menstruation
peritoneal metaplasia
predisposing fx endometriosis
family hx
disordered immunity
toxins
recurrent ovulation
management of endometriosis
based on patient
pain - medical management
infertility - surgical management
no problem - no tx
medical tx endometriosis
progestins
continuous oral contraceptives
provera
mirena
danazol - GnRH suppression
-like inducing menopause
cochrane conclusions
chinese rectal/herbl medicine - better than danazol - pain and shrinkage of masses
auricular acupuncture - pain relief
NSAIDs - better than placebo
COC as effective GnRH agonist
laparoscopy with diathermy
improves infertility and pain
surgical burn it off
menopause patient on HRT with E2
endometriosis can come back
chocolate cyst
ovaries with endometriosis
endometrioma
12 months sex without contraception
infertility
biggest influence on infertility
age of women
subfertility
failing to conceive when expect to
main causes infertility
ovulation issue sperm issue tubal problem cervical problem endometriosis
patient with regular cycle
ovulating normally
test for ovulation
basal body temperature char
progesterone - raises temp
LH surger in urine
endometrial biopsy
test for tubal patency
hysterosalpingogram
laparoscopy with dye
all of these tests potentially therapeutic
testing cervical factor
sample of mucous of cervix
-good backup for men who don’t want semen sample
semen analysis
examined 1-2 hours at room temp count >20 mil motility >50% morphology >15% normal repeat if abnormal
