Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Endocrine > Endometriosis and Amenorrhea > Flashcards

Endometriosis and Amenorrhea Flashcards

1
Q

What is the clinical presentation of Endometriosis?

A
  1. Chronic Pelvic Pain
  2. Accompanied by infertility 30-50% patients
  3. Definitive diagnosis requires surgical visualization (laparoscopy).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does laparoscopy confirm in terms of Endometriosis?

A

Presence of endometrial tissue outside uterus.

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

What are the characteristics of chronic pelvic pain?

A
  1. May be cyclic or acyclic
  2. May include painful intercourse
  3. May include dysmenorrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the incidence of Endometriosis in reproductive age women?

A

6-10%

  • 35-50% of women w/ chronic pelvic pain
  • 38% of women w/ infertility.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is there a genetic component to Endometriosis?

A

6 fold greater incidence in women w/ mother or sister w/ disease.

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

What is the Etiology of Endometriosis?

A
  1. Retrograde menstrual flow (most pop.)
  2. Vascular/Lymphatic spread
  3. Immunologic disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pathophysiology of Endometriosis?

A
  1. Lesions usually restricted to pelvic cavity.
  2. Lesions generate local inflammation
  3. Adhesions form between organs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

During endometriosis when there is generation of local inflammation, what is that a response to?

A
  1. Estrogen and Progesterone.

2. Pain can be greatest during menstruation.

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

During endometriosis when there is adhesions between organs, what does that do?

A

Restricts movement of uterus, intestines causes pain w/ intercourse and bowel movements.

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

How is the severity of endometriosis classified?

A

Stages I-IV. BUT does not relate to pain, infertility, or therapeutic outcomes.

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

What are the 3 surgical laparoscopy methods?

A
  1. Implants excised
  2. Implants burned away
  3. Implants removed w/ laser.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which surgical laparoscopy method yields the best results?

A

Excision of lesions –> reduction in pain.

Recurrence rate 20% at 2 yrs, 40-50% 5yrs

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

Which surgical laparoscopy method is preferred in restoring fertility?

A

Excision of lesions.

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

Which is the only method that eliminates the problem of endometriosis?

A

Ovarectomy +/- hysterectomy.

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

What are the 5 pharmacological treatments of endometriosis?

A
  1. NSAIDs
  2. CHCs
  3. Progestins
  4. GnRH agonists
  5. Danazol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the primary goal of pharmacological therapy in endometriosis?

A
  1. Reduce Pelvic Pain.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the first choice in pharmacological treatments of Endometriosis and what are the limitations?

A
  1. NSAIDs and CHCs

2. Do no eradicate lesions or improve fertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why are CHCs a treatment for Endometriosis?

A
  1. Establishing hypoestrogenic (cyclic CHCs) or Anovulatory (continuous CHCs) state.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why are Progestins a treatment for Endometriosis?

A
  1. Establish anovulatory state w/ amenorrhea, but may result in prolonged infertility.
  2. Well tolerated, but can cause breakthrough bleeding, weight gain, fluid retention, mood changes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which progestins are effective for endometriosis?

A
  1. Oral and Depot medroxyprogesterone
  2. Norethindrone
  3. Levonorgestrel IUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why are GnRH agonists a treatment for endometriosis?

A
  1. Establish an anovulatory/menopausal state by inhibition of FSH and LH release from anterior pituitary.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the normal administration of GnRH agonists?

A

Normally administered for 6 months.
85-100% effective but recurrence >50% 5yrs.
Bone loss is reversible up to 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the adverse effects of GnRH agonists?

A

Bone loss, vasomotor symptoms, vaginal dryness, insomnia.

Addback therapy decreases AE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What should patients supplement with while taking GnRH agonists?

A

Calcium
0.5-1 g/d
AND exercise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When is GnRH agonists contraindicated?
For Adolescents due to propensity to cause bone loss.
26
What are the 3 GnRH agonists and their formulations?
1. Leuprolide - IM q3months 2. Goserelin - SQ monthly 3. Nafarelin - Intranasal BID
27
Why is Danazol a treatment for endometriosis?
It is a steroid w/ weak androgenic effects that suppress FSH and LH release.
28
What other effect does Danazol have that may not be good?
Immunosuppresive activity.
29
What is the efficacy of Danazol?
treatment of 6 mo, 80-90% symptom relief.
30
What are the limitations of Danazol?
Androgenic effects cause: 1. weight gain, acne, hot flashes, hirsutism. 2. Increased LDL 3. Teratogenic
31
When is Danazol contraindicated?
In women with hyperlipidemia or liver disease.
32
What is Amenorrhea?
Absence of menses.
33
How is primary amenorrhea characterized?
NO Previous menses (
34
How is secondary amenorrhea characterized?
Absence of menses for 6 mo (up to 4% of women)
35
When is secondary amenorrhea most common?
1. Women
36
What are the main etiologies of Amenorrhea?
1. Unrecognized pregnacy. 2. Hypothalamic/pituitary suppression. 3. Anovulatory amenorrhea. 4. Premature ovarian insufficiency.
37
What is the most common cause of amenorrhea?
1. Unrecognized pregnancy.
38
How is hypothalamic/pituitary suppression involved in Amenorrhea?
1. tumor 2. anorexia, excessive exercise, obesity 3. Thyroid disease 4. Hyperprolactinemia.
39
What is hyperprolactinemia?
When excess prolactin suppresses GnRH release which decreases FSH/LH.
40
What are causes of Anovulatory amenorrhea?
1. PolyCystic Ovarian Syndrome (PCOS) 2. Ovarian tumors 3. Congenital Adrenal Hyperplasia
41
What is Polycystic Ovarian Syndrome (PCOS)?
Most common endocrine disorder in reproductive age women 5-10%. Androgen Excess.
42
What is congenital adrenal hyperplasia?
Excessive androgen production.
43
What are characteristics of premature ovarian insufficiency?
1. Genetic, Idiopathic, autoimmune 2. LOW estrogen, HIGH FSH Affects 1% of women before 40.
44
What Progestins can be used to identify cause of amenorrhea?
Oral (preferred) or IM MPA for 10-14 days.
45
When progestins are given to identify cause of amenorrhea what happens when estradiol levels >50pg/ml?
Withdrawal bleeding will occur upon cessation. | 1. Ammenorrhea is "anovulatory" - PCOS
46
When using progestins to identify cause of amenorrhea: what is indicated when there is a failure to induce menses?
Low Estrogen Levels. 1. Ovarian dysfunction/Premature menopause (low estrogen) 2. Hypothalamic/Pituitary dysfunction, hyperprolactemia (Low FSH/LH)
47
When using progestins to identify cause of amenorrhea: what do uterine problems indicate?
Asherman's syndrome - uterine adhesions, outflow problems. *NORMAL estrogen levels*
48
How do you treat Hypothalamic amenorrhea?
aka hypoestrogenic 1. Estrogen +/- Progestins - OCs, Conjugated equine estrogen, Estradiol patch. - Reduces risk of osteoporosis and other signs of insufficient estrogen.
49
What level of blood prolactin indicates hyperprolactinemia?
>100 ng/ml indicates pituitary adenoma (prolactinoma)
50
What are other causes of Hyperprolactinemia?
OCs, Antipsychotics, antidepressants. -Antagonize dopamine release/effect - disinhibiting prolactin release.
51
Examples of dopamine receptor blockers that can cause hyperprolactinemia are?
1. Risperidone 2. Chlorpromazine 3. Haloperidol
52
Examples of Imipramines & SSRIs that cause hyperprolactinemia are?
1. Amitriptyline | 2. Fluoxetine
53
Other drugs that can cause hyperprolactinemia?
alpha-methyldopa opiates H2 antagonists.
54
What do you treat hyperprolactinemia with?
Dopamine agonists | 1. Cabergoline preferred twice wk.
55
What is the mechanism of Cabergoline?
Prolactin increases DA secretion in hypothalamus, which suppresses Prl secretion from anterior pituitary. (Feedback inhibition)
56
What is PolyCystic Ovarian Syndrome (PCOS) also known as?
1. Stein-Levanthal Syndrome
57
What can PCOS present as?
Amenorrhea Menorrhagia Anovulatory Bleeding
58
What is Menorrhagia?
Excessive bleeding >80ml or >7days
59
What is Anovulatory bleeding (non-cyclical)?
Corpus luteum does not form Progesterone not secreted. Unopposed production of estradiol Overgrowth of endometrium
60
What is PCOS considered to be a disorder of?
Androgen Excess
61
What is PCOS a risk factor for?
1. Metabolic syndrome 2. Type 2 diabetes 3. Dyslipidemia 4. CVD
62
What are characteristics of PCOS?
1. Menstrual abnormalities. 2. Infertility 3. Hyperandrogenism/virilization 4. Obesity (40-50%) 5. Symptoms of diabetes/IR 6. Acanthosis nigricans 7. Polycystic ovaries.
63
What is the most frequent cause of anovulatory infertility?
PCOS
64
What are risk factors for PCOS?
Family history of PCOS | Central Obesity
65
How is PCOS diagnosed?
1. Elevated LH/FSH ratio >2:1 is often present. | 2. Elevated Plasma testosterone
66
What does elevated LH/FSH do?
1. Increased ovarian androgen production. 2. arrest follicular development - cysts 3. Adipose cells contribute to androgen aromatization to estrogen. - elevated estrogen - suppresses FSH.
67
What does elevated plasma testosterone do?
1. Total T may be normal but FREE T is 2X in PCOS. 2. Lowered sex hormone binding globulin (SHBG) 3. Must exclude androgen-secreting tumors.
68
What are the goals of treatment for PCOS?
1. Reduce ovarian androgen secretion and restore normal hormonal cycle. - normalize endometrium - Restore fertility 2. Reduce Insulin Resistance - weight loss - Metformin
69
What is the first choice treatment for PCOS?
COCs.
70
What do COCs do for PCOS?
1. restore normal hormonal cycle 2. Increase SHBG to decrease free T. 3. Reduce ovarian hormone production 4. Decrease hyperandrogenima, hirsutism, and T by 50%
71
What are contraindications for using COCs for PCOS?
Not appropriate if prego is goal. Not appropriate if estrogens containdicated. Androgenic Progestogens should be avoided (desogestrel preferred)
72
When is estrogens contraindicated?
Breast/Uterine/endometrial/ovarian cancer, CV disease.
73
How can Progesterone only treatment help PCOS?
1. Suppresses ovulation and prevents endometrial hyperplasia. 2. Fewer adverse effects than COCs
74
When is progesterone only treatment for PCOS especially appropriate?
Menorrhagia b/c can cause amenorrhea
75
What progesterone only treatments are used for PCOS?
1. Oral MPA (NOT FDA Approved) | 2. Levonorgestrel IUD
76
What is to be noted when Oral MPA is used for PCOS?
1. taken 12-14 days to induce withdrawal bleeding 2. Prevents endometrial hyperplasia and reduces risk of endometrial cancer. 3. Does NOT provide contraception 4. Has some androgenic activity (hirsutism)
77
What can Metformin/TZDs do for PCOS?
1. Improve insulin sensitivity 2. Increase SHBG levels 3. Increase ovulatory rates 4. Pioglitazone and rosiglitazone are prego C
78
What Anti-androgens are used in PCOS?
Glucocorticoids, Sprionolactone, flutamide NOT FDA APPROVED
79
How can Glucocorticoids help PCOS?
1. Suppress adrenal androgen production | 2. Does NOT restore fertility.
80
How can Spironolactone and Flutamide help PCOS?
1. Androgen receptor antagonists 2. Used in conjunction with COCs 3. Flutamide more effective (but hepatic tox)
81
What are the treatments for Infertility due to PCOS?
1. Clomiphene | 2. Metformin
82
How can Clomiphene help infertility in PCOS?
1. Estrogen receptor antagonist (SERM) increases FSH and LH induce ovulation. 2. 50mg/d for 5 days, on day 3-5 3. Typically after MPA treatment to induce WB 4. Dose can be 250 mg/d 5. **Increases chance of twins 1-10%
83
How can metformin help infertility in PCOS?
1. Increases ovulatory rates but is less effective than clomiphene. 2. effective in clomiphene resistant patients 3. Use during prego decreases miscarriage rates.
84
What is Premature Ovarian Insufficiency (POI)?
1. Sex steroid deficiency, amenorrhea, and infertility in women under 40.
85
What are characteristics of POI?
1. Affects 1% of women under 40 | 2. >4 mo amenorrhea, FSH >40 IU/L (Normal
86
What does POI increase risk for?
Osteoporosis and CVD
87
Is POI early Menopause? and WHY?
NO Menopause - follicle depletion POI - follicles often present sex steroids low
88
What are causes of POI?
Autoimmune disease, genetic (Turner syndrome, Fragile X)
89
What are clinical indications of POI?
1. Hx of Oligomenorrhea (light) or Anovulatory bleeding (Prodromal POI) 2. Hot flashes, night sweats, mood change
90
What is the treatment for POI?
1. Begin w/ low dose estrogen ramping up to1.25 mg/d CEE. (Transdermal ok) 2. Progestogens added fro 12-14 d/mo 3. T replacement may also be appropriate.
91
Does replacement of estrogen or OCs prevent ovulation in women with elevated gonadotropins? (FSH+LH)
NO

Endocrine (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions