Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gynaecology > Dysmenorrhea > Flashcards

Dysmenorrhea Flashcards

1
Q

DDX of secondary amenorrhea

A

With hyperandrogegism
- PCOS
- antonomus hyperandrogegism (androgen secretion independent of HPO axis) can be ovarian tour, hyperthecosis, adrenal androgen-secreting tumour.
- late onset or mild cognital adrenal hyperplasia
Without hyperandrogegism
- increase gonadotrophin(↑ FSH) and decrease gonodism (↓E). 3 types Idiopathic, autoimmune (T1DM, Addison’s or thyroid), Iatrogenic (radiation or cyclophosphamide)
- Hyperprolactinemia
- Endocrinopathies - most common ↑or↓ thyroid
- Hypogonadotrophic hypogonadism
- Functional hypothalamic - most common - amenorrhea often related to stress, excessive exercise +/or anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of hypogonadotrophic hypogonadism

A 
Pituitary compression or destruction
Pituitary adenoma, craniopharoma?
Lymphocytic hypophysitis, infiltration
Head injury
Sheehan's syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of amenorrhea

A

Primary amenorrhea
Secondary amenorrhoea
Oligomenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define primary amenorrhea

A

No menses by age 13 in the absence of 2° sexual characteristics or no menses by age 15 with 2° sexual characteristics or no menses 2 yrs after thelarche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define secondary amenorrhea

A

No menses for >6 m or 3 cycle after documented menarche.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define oligomenorrhea

A

episodic vaginal bleeding occurring at internals >35 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DDX of primary amenorrhea and 2° sexual development

A 
Normal breast and pelvic development
- Hypothyroidism
- hyperprolactinemia
- PCOS
- Hypothalamic dysfunction 
Normal breast and abnormal uterine development
- Androgen insensitivity
- Anatomic abnormality eg mullerian genesis, uterovaginal septum, Imperforate hymen.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DDX of primary amenorrhea and without 2° sexual development

A

↑FSH (hypergonadotrophic/ ↓gonadism
- Gonada dysgenesis - abnormal sex chromosome eg Turner’s, Noral sex chromosome
↓FSH (↓gonadtrophic, ↓gonadis)
- constitutional delay - most common. Can be due to Congenital abnormality such as isolated GnRH deficiency, pituitary failure e.g. Kallman syndrome, Head injury, pituitary adenoma. Can also be acquired such as endocrine disorders e.g. T1DM, Pituitary tumour, systemic disorder e.g. IBD, JRA, Chronic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What work up for a patient with amenorrhoea

A

BhcG
Hormonal work up - TSH, Prolactin, FSH, LH, Androgens, Estradiol
Progesterone challenge to assess E status
if withdrawal bleed = adequate E. If no withdrawal bleed = inadequate E or excessive androgens or progesterone
Karyotype if premature ovarian failure or absent puberty
USS to confirm normal anatomy and ID PCOS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mx of primary amenorrhea caused by androgen insensitivity syndrome

A

Gonadal resection after puberty,
Psychological counselling
creation of neo vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx of primary amenorrhea caused by Anatomical abnormalities e.g. imperforate yen, cervical agenesis, transverse vaginal septum

A

Surgical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mx of primary amenorrhea caused by mullein dysgenesis

A

Psychological counselling
creation of neovagina with dilation
diagnosis study to confirm normal urinary system and spine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mx of secondary amenorrhea caused by uterine defect e.g. Asherman’s syndrome

A

Evolution with hypersalpingography or sonohysterography.

Hysteroscopy excision of synechiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mx of secondary amenorrhea caused by HP acts dysfunction

A

ID modifiable underlying cause

COCP to ↓ risk osteoporosis, maintain normal vaginal and breast development (not proven)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mx of secondary amenorrhea caused by premature ovarian failure

A

Screen for DM, ↓thyroid, ↓PTH, ↓corticolism.

Hormonal therapy with E and P to reduce risk of osteoporosis - OCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mx of secondary amenorrhea caused by hyperprolactinemia

A

MRI/CT if neg Bromocriptine, cabergolin if fertility wanted += surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mx of secondary amenorrhea caused by PCOS

A

Cycle control
Infertility
Hirsutism.

18
Q

Prolactinoma Symptoms

A

Galactorrhea
visual changes
headache

19
Q

Ix for 1° amenorrhea with secondary sex characteristics

A

Karyotypes
XX = imperforate hymen, transverse vagina spectrum, cervical agenesis, mullein ageneses
XY = androgen insensitivity syndrome

20
Q

Ix for 1° amenorrhea without secondary sex characteristics

A

FSH/LH
If high = hypergonadotrophic gondola agenesie/dysgenesis
If low = hypogonadotrophic with constitutional delay or HP axis abnormalities.

21
Q

Ix for 2° amenorrhoea

A

Start with B-hcG

22
Q

Ix for 2° amenorrhoea with -ve B-hcG

A

Prolactin first

  • Normal = Progestin challenge.
  • Abnormal >100 then CT head. test TSH for hypothyroidism
23
Q

What to do after progestin challenge

A

Withdrawal bleed - test FSH/LH
if high = premature ovarian failure or PCOS due to increase androgen
If normal or low = HPA axis dysfunction need MRI. Measure progesterone. may be caused by wt los, increase exercise and systemic disease.
No withdrawal bleeding = uterine defect, washerman’s syndrome or HPA axis dysfunction.

24
Q

Define abnormal uterine bleeding

A

Change in frequency, duration or amount of menstrual flow

25
Q

What are the different types of abnormal uterine bleeding

A

amenorrhea - absence of periods
Hypomenorrhea - decrease amount of blood
Oligomenorrhea - cycle intervals >35 days
polymenorrhea - cycle intervals 7 days or excessive amount >80cc/cycle
Metrorrhagia - irregular intervals particularly between period
Menometrorrhagia - excessive blood at period and in-between
Post menopausal - any bleeding after >1yr after menopause. Must rule out endometrial cancer.

26
Q

Compare anovulatory and ovulatory forms of abnormal uterine bleeding

A

Anovulatory is more common, unpredictable endometrial bleeding of various flow and duration where ovulatory is of typical cyclic but heavy or prolonged.

27
Q

Causes of anovulatory causes of abnormal uterine bleeding

A 
PCOS
thread dysfunction
elevated prolactin
E producing tumors
Stress
Wt loss
exercise
liver and kidney function
structural disease
Drug AE
28
Q

Causes of ovulatory abnormal uterine bleeding

A

anatomic eg polyps, fibroid, adenomyosis, neoplasm, Foreign body
Homeostatic defect
infection
trauma
local disturbances in prostaglandin eg ↑endomyometrial vasodilatory prostaglandin, ↓vasoconstrictive PG.

29
Q

Pathogenesis of anovulatory abnormal uterine bleeding

A

oestrogen dependent breakthrough bleeding. Increase E chronically with not enough P -> ↑ proliferation -> ↑ ET that out grows blood supply = focal necrosis = partial shedding = irregular prolonged/heavy bleeding.

30
Q

DDX of abnormal uterine bleeding by age

A

Pre menarchal - trauma, sexual abuse
Pre menopausal - ovulary, anovulatory, pregnancy related
Post - menopausal - genital tract disease - atrophy, neoplasms, or systemic disease or Drugs e.g. HRT, anticoagulants

31
Q

work up for abnormal uterine bleeding

A

Vital +/- orthostatic vitals
FBC, serum ferritin
BhcG
TSH, free T4
Coagulation profile esp in adolescent to rule out vWD
Prolactin if amenorrheic
RSH, LH
Serum androgens esp testeren
Day 21 progesterone to confirm ovulation
pap smear
Pelvis USS - polyps, fibroids, easier ET (Post menopause)
TVUSS - polyps and fibroids
Endometrial biopsy if >40 yr to exclude endometrial Ca
D+ C to diagnosis not to tx

32
Q

Tx of abnormal uterine bleeding

A

resus if needed
Tx underlying disorders- if all causes are ruled out = DUB
Medical DUB
Stop constant bleeding = continuous progestogen: medroxy-P4 acetate 30mg daily
Non-hormonal = NSAIDs or tranexamic acid
Hormonal = COCP, Mirena, or cyclical progestogens day 5 - 25
If abnormal endometrium - pipette, repeat USS in early follicular stage or Hysteroscopy
Clomiphene - if fertility is desired
Fibroids - refer
Surgical - Endometrial ablation, hysterectomy or myomectomy.

33
Q

Define Dysmenorrhea

A

Painful menstruation

34
Q

Types of Dysmenorrhoea

A 
Primary - Idiopathic - begin 6m-2yr after menarche
Secondary
- Endometriosis
- Adenomyosis
-Uterine polyps
- Uterine anomalies eg non-communicaating uterine hormones
- Leiomyoma
- Intrauterine synechiae
- Ovarian cysts
- Cervical stenosis
- Imperforate Hymene, Transverse vaginal septum
- PID
- IUD - Copper
- Foreign body.
35
Q

Symptoms of Primary Dysmenorrhea

A

Low midline abdo pain radiates to back or thighs
Varies from dull dragging to a severe cramping pain
Maximun pain at beginning of period
May commence up to 12hrs before menses
Usually last 24hr-2-3days.
+/- Nausea and vomiting
Headache, syncope or flushing

36
Q

Signs of Primary dysmenorrhea

A

No abnormal findings

37
Q

Tx of Primary dysmenorrhea

A

Rule out underlying pathology and dyspareunia, abnormal bleeding or infertility.
Full explain and reassurence
Promote healthy lifestyle eg reg exercise and stop smoking and reduce alcohol

38
Q

Define premenstrual syndrome

A

Physiological and emotional distrubances 1-2 wk prior to mensus

39
Q

Cause of premenstrual syndrome

A

Multifactoral, Genetic, Hormone effect and NT = Serotonin dysfunction

40
Q

Symptoms and diagnostic criteria

A

1 - At least 1 affective+1somatic symptom in 5 d before menses for 3 cycles.
- Affective = depression, angry, outbursts, irritability, anxiety, confusion, social withdrawal
- Somatic = Breast tenderness, abdo bloating, headache, swelling or peripheral
2 - Symptoms relieved 4d post onset of menses,
3 - symptoms present in absence of drugs or alcohol
4 - reproducible in 2 cycle
5 - ID dysfunction in social or economic performance

41
Q

Tx of premenstrual syndrome

A

Goal is symptom relief
Psycholical support
Diet/supplements - avoid Sodium, caffeine + alcohol, Ca, Mg, VE, VBG
Med - NSAIDs if pain/discomfort
- SSRI - either for the 14 days of luteal phase or continuous
- Spironolactone - in luteal phase to reduce fluid retention
- COCP
- Danazol - androgen -ve to block the POAxis.
Mind/body approach - exercise, CBT, Relaxation, if therapy
Herbal remedies - evening primrose oil, black cohosh, St John Wart
Surgery - BSO if severe.

Gynaecology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions