Dysmenorrhea or Amenorrhea Flashcards
Why should copper IUD not be used for dysmenorrhea?
Can lead to even heavier bleeding; is only used for contraception
How do OCPs relieve dysmenorrhea?
Progestin –> endometrial atrophy –> decreased prostaglandin production –> improved dysmenorrhea
Risks of depo medroxyprogesterone acetate
Gaining weight
Depression
What are causes of secondary dymenorrhea?
Endometriosis
Adenomyosis
Fibroids
Pelvic inflammatory disease from STIs (e.g. Chlamydia) or adhesions
Ovarian cysts
in whom are oral contraceptive pills contraindicated?
Smokers
>age 35
What demographic more likely has adenomyosis?
Older multiparous women
Women >45 yo (late reproductive years and older) with abnormal uterine bleeding should receive what?
Endometrial biopsy - to rule out endometrial hyperplasia or cancer
How would pathology show endometriosis?
Endometrial glands/stroma and hemosiderin-laden macrophages outside the uterine cavity
What is indicated by well-circumscribed, non-encapsulated myometrium?
Fibroids
What fibroid location is less likely to cause pain with menstruation?
Subserosal
Endometrial polyps are most common in which women, and how do they present?
Age 40-50; increased menstrual flow with increased cramping, as well as intermenstrual spotting
What is red/carneous degeneration?
Fibroid growth in pregnancy that may become symptomatic due to hemorrhagic changes associated with rapid growth
In whom might myotectomy be preferred over hysterectomy?
Younger patients with fibroids who want to preserve fertility
How long after GnRH agonist cessation do things return?
Hot flashes end by 1-2 months after
Myoma and uterine size return to pretreatment levels in 3-4 months
When does fibroid degeneration happen?
When it outgrows its blood supply and is independent of the use of GnRH agonist
What hormone labs in workup for hyperandrogenism?
DHEAS (for adrenal tumor)
17-OH progesterone (for late-onset 21-hydroxylase deficiency)
Testosterone (androgen secreting tumor)
What are symptoms of premature ovarian failure?
Hot flashes
Insertional dyspareunia
Hypergonadotropic amenorrhea could be due to ovarian failure or follicular resistance to gonadotropins
What types of patients typically have hypothalamic amenorrhea?
Female athlete triad
Nutritional deficiency
What is the definition of oligomenorrhea?
Periods occur >35 days apart
Periods <9 per year
What test if suspect Cushing’s syndrome?
Overnight dexamethasone suppression test for measuring cortisol
What tests if suspect PCOS?
Pelvic ultrasound
Insulin
Testosterone (to rule out androgen secreting tumor)
Rotterdam criteria for PCOS
2 of 3:
1. Chronic anovulation
2. Hyperandrogenism (clinical/biologic)
3. Polycystic ovaries on US
Need testosterone to rule out androgen secreting tumor if diagnosing without US
Why can patients have hair loss postpartum?
High estrogen during pregnancy increases synchrony of hair growth; postpartum telogen effluvium may occur
What drug can be added to OCPs to help with hirsutism?
Spironolactone
