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Endocrine > Endometriosis and Amenorrhea > Flashcards

Endometriosis and Amenorrhea Flashcards

1
Q

Define endometriosis

A

A disorder in which tissue that normally lines the uterus grows outside the uterus

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2
Q

a definitive diagnosis of endometriosis requires what?

A

surgical visualization (laparscopy)

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3
Q

a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs

A

laparascopy

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4
Q

what is the main complaint in the clinical presentation of endometriosis?

A

pelvic pain

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5
Q

dyspareunia

A

painful intercourse

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6
Q

dysmenorrhea

A

painful menstruation, typically involving abdominal cramps.

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7
Q

most common cause of secondary dysmenorrhea

A

endometriosis

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8
Q

endometriosis is accompanied by what percentage of infertility?

A

30-50%

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9
Q

the incidence of endometriosis occurs in what % of women of child bearing age?

A

6-10%

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10
Q

can endometriosis occur prior to menarche?

A

yes

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11
Q

how does genetic predisposition play a role in endometriosis?

A

6-fold greater if a mother or sister has disease

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12
Q

when the womb lining (endometrium) flows backwards through the fallopian tubes and into the abdomen (tummy) instead of leaving the body as a period. This tissue then embeds itself on the organs of the pelvis and grows.

A

retrograde menstration

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13
Q

what are the 3 ideas for the etiology of endometriosis?

A

retrograde menstruation, vasular/lymphatic spread, and immunological disorder

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14
Q

describe how endometriosis is thought to be an immunologic disorder

A

it is when there is a failure to clear retrograde menstral flow, because retrograde flow is thought to be fairly common but doesn’t elicit endometriosis in most women

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15
Q

lesions are usually restricted to what areas?

A

within the pelvic cavity such as ovaries, fallopian tubes, outside uterus, intestines, bladder, and ureters

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16
Q

lesions generate local inflammation and can be more painful during menstruation why?

A

because they respond to estrogen and progesterone

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17
Q

how do you eliminate the problem of endomteriosis entirely?

A

ovarectomy +/- hysterectomy

18
Q

what yields the best results in reduction of pain?

A

surgical excision

19
Q

what is the primary chose for restoring fertility when it’s loss is due to endometriosis?

A

surgical excision

20
Q

GOT for endometriosis?

A

pain reduction

21
Q

what are the 2 first choice drugs for endometriosis?

A

NSAIDs or CHC’s

22
Q

do NSAID’s of CHC’s help with lesion eradication or fertility?

A

no, just help pain

23
Q

how to Tx pain of endometriosis but maintain fertility (if it’s there)?

A

NSADs

24
Q

what do progestins do?

A

establish anovularoty state with amenorrhea

25
Q

do progestins affect fertility?

A

yes, may result in prolonged infertility

26
Q

how to GnRH agonists work?

A

they establish an anovulatory/menopausal state by inhibition of FSH and LH release from anterior pituitary

27
Q

how long are GnRH agonists usually used and why?

A

6 months, because past that point bone loss is more difficult to reverse

28
Q

what are the ADR’s of GnRH agonists?

A

similar to menopause Sx, bone loss, hot flashes, vaginal dryness, insomnia

29
Q

what is a method to decrease the ADR’s of GnRH agonists?

A

add back therapy - estrogens, progestins, and bisphosphonates

30
Q

what 2 kinds of supplements should be added to GnRH agaonists? why?

A

calcium (0.5-1g/day) and exercise, to counteract bone loss

31
Q

what are the 3 GnRH agaonists currently available?

A

leuprolide, goserelin, and nafarelin

32
Q

route of admin for leuprolide?

A

IM q3months

33
Q

route of admin for goserelin?

A

SQ Qmonth

34
Q

route of admin for nafarelin?

A

intranasal spray bid

35
Q

what is danazol?

A

a steroid with weak androgenic effects that suppresses FSH and LH release

36
Q

does danazol have immunosuppressive activity?

A

yes

37
Q

why is danazol no longer the “gold standard” in Tx of endometriosis?

A

it’s androgenic ADR’s - hirsutism, hot flashes, weight gain, etc…

38
Q

what other major ADR does danazol have besides androgenic effects? particulary for pregnant women

A

teratogenic

39
Q

should you use danazol it PT’s with hyperlipidemia or liver didease?

A

no

40
Q

amenorrhea

A

absence of menses

41
Q

primary amenorrhea

A

no previous menses

42
Q

secondary amenorrhea

A

absence of menses for 6 months or more

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