Gyn 2

Question 0

Secondary amenorrhea

Answer 0

Much more common. Menses cease >3-6 mos

1) pregnancy 2) hypothalamic dysfunction 3) PCOS

• not pregnant, lactating, menopausal
• • hypothalamic disregulation most common cause

Question 1

Primary amenorrhea

Answer 1

Lack of menarche at age 16, >2yrs after onset of puberty, or no signs of puberty by 14

Question 2

Anovulatory amenorrhea

Answer 2

Both ovulation and menses absent

HPO axis intact, gonadotropin secretion decreased–> mild estrogen deficiency
*check thyroid!

Question 3

Causes of hypothalamic dysfunction

Answer 3

Anorexia nervosa, excessive exercise/low body fat, hypothalamic chronic Anovulation, Kallman’s syndrome, severe stress, tumors, acute weight loss, chronic undernutrition

Question 4

Most common endocrinopathy

Answer 4

PCOS

Question 5

Amenorrhea red flags

Answer 5

Delayed puberty– rule out genetic disorder
Virilization–PCOS, Cushing’s, androgen secreting tumor
Visual field defects–prolactinoma

Question 6

Tests for amenorrhea

Answer 6

Pregnancy, thyroid, prolactin

FSH/estradiol, free testosterone, metabolic

Question 7

DUB

Answer 7

Diagnosis of exclusion: if all clinically indicated tests are negative, then diagnosis is made

Question 8

Primary dysmenorrhea

Answer 8

More common.

Decrease in progesterone–> increase in prostaglandins –> increase in uterine contractions

Question 9

Secondary dysmenorrhea

Answer 9

endometriosis (most common), adenomyosis, fibroids

Less commonly: congenital malformation, ovarian cyst, PID, copper IUD, pelvic congestion

Question 10

Dysmenorrhea red flags

Answer 10

New or sudden onset pain
Unremitting pain
Fever
Vaginal discharge

Question 11

PMS and PMDD etiology

Answer 11

Abnormal responses to fluctuations of estrogen and progesterone.
Fluid retaining effects of E, P, and ADH
Changes in carb metabolism in luteal phase
Serotonin connection: much more emotional response to hormones

Question 12

PMDD definition

Answer 12

Must affect relationships. 5 of following:
Severe PMS during second half of cycle
Depressed/anxious mood
Suicidal thoughts
Decrease in activities of daily life
Sxs severe enough to interfere with routine/function
Changes in eating habits (inc binging)

**dx is clinical

Question 13

PCOS mechanism

Answer 13

Insulin resistance! Inability to process insulin in the liver and muscles dt genetic susceptibility that causes hyper insulinemia

Question 14

PCOS Sxs

Answer 14

Start with menarche and worsen with time
Irregular menses, hirsutism (acne, male pattern baldness), acanthosis nigricans
Mild to severe obesity

*seq if untreated: CVD, DMII, metabolic syndrome, endometrial carcinoma, breast cancer

Question 15

PCOS diagnosis

Answer 15

2 of the following:
Ovulatory dysfunction –> menstrual irregularity
Clinical or biochemical evidence of hyperandrogenism
>10 follicles per ovary on TVUS “string of pearls”

Question 16

Primary ovarian insufficiency

Answer 16

Ovaries do not produce enough Estrogen (despite high levels of FSH)

Question 17

POI etiology

Answer 17

Autoimmune, galactosemia, gonadal dysgenesis, chemo/irradiation, smoking, viral infxn

Question 18

Premature menopause

Answer 18

Cessation of menses dt noniatrogenic ovarian failure before 40yrs.

Risk factors: smoking, high alt, undernutrition.

(Iatrogenic= oophorectomy, chemo, pelvic irradiation)

Question 19

Hot flash triggers

Answer 19

Low estrogen and high gonadotropins
Smoking, hot bevvies, nitrites/sulfites, spicy food, alcohol, caffeine

*may mask hypo/hyperthyroidism

Question 20

Sxs of menopause

Answer 20

Changes in bleeding, hot falshes, vaginal atrophy, night sweats, lack of libido, musculoskeletal changes