Exam 2- lecture 4 Flashcards
DA agonist treatment for amenorrhea
bromocriptine BID-TID cabergoline 2x/wk - suppress prolactin release from pituitary-> >FSH/LH - take 3-6 months - take with food - CYP3A4
treatment for PCOS
- insulin resistance: metformin or TDZ +/- OC
metformin MOA
inhibits glucose production & increases insulin sensitivity; redcues insulin resistance
thiazolidinediones MOA
increase insulin sensitivity; reduce resistance
menorrhagia treatment options
NSAIDS, OCs, mirena, progesterone,, tranexamic acid, surgery- endometiral ablation->hysterectomy
menorrhagia first line treatment
mirena & NSAIDs
progesterone for menorrhagia treatment
- during luteal phase or for 21 days starting on day 5 after onset of mendes
tranexamic acid for menorrhadga treatment
tid
- antifibrinolytic
- blocks lysine binding sites on plasminogen & prevents fibrin degradation
OC for menorrhagia treatment
> 35mcg estradiol
follow up with menorrhagia
after 1 cycle
- measure hemoglobin/hematocrit- dont want anemia
most common cause of anovulatory bleeding
PCOS
perimenopausal symptoms
hot flashes, night sweats, vaginal dryness
- anovulatory bleeding
PCOS symptoms
acne, hirsutism, obesity
- anovulatory bleeding
if acute, severe bleeding episodes
estrogen is beneficial
anovulatory OC treatment
estradiol dose <35mcg
what increases sex hormone- binding globulin (SHBG)
OCs, metformine & TZDs
- binds & reduces androgens
clomiphene citrate (Clomid)
50mg/day for 5 days between menstrual cycle days 3 & 5
- increase if no ovulation
anovulatory bleeding
anovulatory follow up
with in 1 week
- bleeding should decline within 10 days
- ovulation should return w/in 3-6 months (metformin)
dysmenorrhea nonpharmacologic treatment
topical heat therapy, exercise, low-fat vegetarian diet
dysmenorrhea first line treatment
NSAIDs- improve w/in 1 hour
dysmenorrhea follow-up
1-2 cycles
improved QOL within 1-3 cycles
therapeutic lifestyle changes for PMS.PMDD
reduce caffeine, sugar, & Na, increase exercise, Vitamin B6(50-100mg/day), calcium carbonate (1200mg/day)
first line PMS/PMDD treatment
SSRIs (fluoxetine, citalopram, paroxetine) & SSNRI(venlafaxine)
- other options- monophasic OCs 20mcg EE & 3 mg drospirenone, TCAs, GnRH agonists
endometriosis treatment options
combined OCs, GnRH agonists, andogen analogs, surgery
