GYN MTB Flashcards
DSM-V for PMDD (premenstrual dysphoric disorder)
-symptoms present for 2 consecutive cycles
-symptom-free period of 1 week in the 1st part of the cycle (follicular phase)
-symptoms present in second half of cycle (luteal phase)
-dysfunction in life
tx: reduce caffeine, etOH, smoking, chocolate
DO exercise, if refractory: SSRI
menopause hormone levels
oocytes produce less estrogen and progesterone
both LH, FSH start to rise (^FSH is diagnostic)
begins with irregular menstrual bleeding
contraindications of hormone replacement therapy (HRT)
estrogen-dependent carcinomas (breast or endometrial)
hx of DVT/PE
etiology of menorrhagia
(heavy, prolonged bleeding)
endometrial hyperplasia, fibroids, DUB, IUD
metrorrhagia etiologies
(intermenstrual bleeding)
endometrial polyps, endometrial/cervical cancer, exogenous estrogen admin
menometrorrhagia etiologies
endometrial polyps, endometrial/cervical cancer, exogenous estrogen admin, malignant tumors
oligomenorrhea
(cycles longer than 35 days, so less periods)
pregnancy, menopause, anorexia/weight loss, estrogen-secreting tumor
causes of post-coital bleeding
cervical cancer (until proven otherwise), cervical polyps, atrophic vaginitis
how anovulatory cycles occur
ovary produces estrogen, but no corpus luteum is formed so no progesterone produced and no “withdrawal bleeding” (withdrawal from progesterone causes bleeding)
continuously high estrogen causes endometrium to keep growing and bleeding only occurs when endometrium outgrows blood supply
rule out systemic causes of anovulation
hypothyroidism, hyperprolactinimia
carcinoma: EMB if over 35 yo
DUB is severe if ?
how to treat?
pt is anemic, not controlled on OCPs, or lifestyle is compromised
tx: endometrial ablation or hysterectomy
OCPs reduce the risk of ?
ovarian and endometrial carcinoma, ectopic pregnancy
slight increase in thromboembolism risk
most common cause of labial fusion
21-B hydroxylase deficiency (excess androgens)
tx: reconstructive sx
pts with chronic irritation develop raised white lesion (hyperkeratosis) think ?
how to treat?
squamous cell hyperplasia
tx: sitz baths or lubricants (relieve itching)
if flat, violet papules, 30-60 yo, think?
lichen planus
tx: topical steroids
bartholin gland cyst treatment
I/D, if recur may need marsupialization: open space kept open with sutures
dx/tx for candidiasis
pseudohyphae on KOH
miconazole, clotrimazole, econazole, nystatin
red vulvar lesion with superficial white coating +vulvar soreness and pruritis think?
Paget disease: intraepithelial neoplasm
tx: radical vulvectomy if bilateral (modified if u/l)
pruritis, bloody vaginal discharge, postmenopausal bleeding think ?
squamous cell carcinoma
may be small ulcerated lesion to large cauliflower like lesion
dx: biopsy
SqCC staging
0: carcinoma in situ
I: limited to vaginal wall less than 2cm
II: limited to vulva or perineum more than 2cm
III. tumor spreading to lower urethra or anus, u/l LN present
IV. tumor invasion into bladder, rectum, or b/l LNs
IVa. distant metastasis
dysmenorrhea and menorrhagia + large, globular, boggy uterus, think?
how to dx/tx?
adenomyosis (invasion of endometrial glands into myometrium)
dx: MRI??
tx: hysterectomy (also definitive dx)
cyclic pelvic pain 1-2 wks before menstruation and pks 1-2 days before menstruation (+ ends with menstruation) + nodular uterus and adnexal mass +/- abnormal bleeding
endometriosis (implantation of endometrial tissue outside endometrial cavity, most commonly ovary and pelvic peritoneum)
dx: direct visualization via laparoscopy (“chocolate cysts”
endometriosis treatment
tx: NSAIDs, OCPs
danazole (androgen derivative), Lupron (GnRH agonist)(both decrease LH, FSH, Lupron suppresses estrogen if given continuously)
surgery possibly TAH BSO if refractory
hormone derangements in PCOS
^testosterone leads to ^estrogen formation outside ovary, which stimulates LH secretion while inhibiting FSH secretion leading to LH:FSH ration more than 3:1
what treatments will do what for PCOS
weight loss: decrease insulin resistance
OCPs: control amount estrogen/progestin, therefore controls androgens and prevents endometrial hyperplasia
clomiphene, metformin: if wish to conceive
