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gynecologic disorders Flashcards

1
Q

what is dysmenorrhea

A

painful cramps with or prior to mensess

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2
Q

what is primary dysmenorrhea

A

pain not due to an underlying disease (most cases)

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3
Q

what causes the pain in dysmenorrhea

A

increased release of uterine PG and leukotrienes

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4
Q

what are the risk factors for dysmenorrhea

A

young age
early age of period
heavy flow
long periods
cig smoking

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5
Q

how long does dysmenorrhea last

A

1-3 days

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6
Q

when is dysmenorrhea the most intense

A

24-36 hours (max PG release)

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7
Q

signs and sx of dysmenorrhea

A

labor like pain–can radiate to inner thighs
N/V
diarrhea

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8
Q

what is nonpharm for dysmenorrhea

A

heat
aerobic exercise
low fat veg diet

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9
Q

what is the first line for dysmenorrhea

A

NSAIDs
-use higher anti-inflammatory doses

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10
Q

what is another first line for dysmenorrhea

A

combined hormonal contraceptive (suppresses ovulation)
-periods more predictable

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11
Q

can you use CHC + NSAID in combo

A

yes

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12
Q

what is the 2nd line for dysmenorrhea

A

progestin only contraceptive

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13
Q

what is endometriosis

A

lining of uterus grows outside the uterus

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14
Q

what are risk factors to endometriosis

A

the longer the time exposed to menstruation, higher the risk
-early menarche
-late menopause
-shorter cycle or longer

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15
Q

what are signs/sx of endometriosis

A

pain w periods, intercourse, urination
chronic lower back pain
chronic fatigue
infertility

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16
Q

pharm agents treat what

A

pain NOT infertility

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17
Q

what are first line options for endometriosis

A

NSAIDs–doesnt work for severe pain
CHCs
progestin only contraceptive (oral norethindrone, medroxy)

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18
Q

how long should you trial first line options for endometrosis

A

3-4 months

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19
Q

what is the second line for endometriosis

A

GnRH agonist–expensive
danazol–testosterone derivative

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20
Q

how do GnRH help endometriosis

A

decrease pain
suppress mense

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21
Q

how long is second line therapy limited to for endometriosis

A

6 months bc of bone loss

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22
Q

what category is danazol

A

X

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23
Q

what should be monitored while taking danazol

A

hepatic function (can increase LFTs)

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24
Q

who is danazol not recommended for

A

adolescents

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25
what are other pharm options for endometriosis
aromatase inhibitors (anastrozole, letrozole)
26
what are aromatase inhibitors approved for
breast cancer, not endometriosis
27
what is the primary tx for endometrosis if infertility
surgery
28
what is not a cure for endometriosis
hysterectomy
29
what is a potential cure for endometriosis
hysterectomy and oophorectomy (uterus and ovaries removed)
30
what is menorrhagia
abnormally heavy (>80 mL) or prolonged (>7 days) menses
31
what occurs usually during menorrhagia
ovulation
32
what are common causes of menorrhagia
hypothyroidism uterine fibroids uterine cancer drugs (anticoags)
33
what are signs/sx of menorrhagia
heacy flow clots faitgue lightheaded orthostasis tachycardia low hemoglobin/ferritin
34
what are first line options for menorrhagia
NSAIDs (if contraception not desired) levonrogestrel IUD oral progesterone or IM medroxy q 4 mo
35
what is second line for menorrhagia
oral contraceptives (less efficacy) oral tranexamic acid (start 1st day of bleeding for a max of 5 days) surgery (hysterectomy or endometrial ablation--only cure)
36
what is anovulatory bleeding
menstrual bleeding that occurs bc of disorganized menstrual system from absence of ovulation
37
what does absence of ovulation do
progesterone not produced--> endometrium continues to thicken--> eventually sloughs off--> irregular or heavy bleeding
38
how long is adolescent anovulatory bleeding normal for
5 yrs due to immature hypothalamic pituitary ovarian axis
39
what is the tx for anovulatory bleeding
CHC progestin only contraceptive treat underlying causes dilation and curettage
40
what are reasons for no ovulation
ovarian failure pituitary disease eating disorder thyroid dysfunction hyperprolactinemia adrenal disease PCOS
41
what is primary amenorrhea
absence of menarche by 16 WITH secondary development OR absence of menarche by 14 W/O secondary development
42
what is secondary amenorrhea
absence of menses for 6 mo or 3 cycles
43
how to diagnose amenorrhea
rule out preg obtain hx (stress, change in diet, drugs--androgenic meds, new acne, etc) rule out estrogen def, galactorrhea, hypothalamus/pituitary disease
44
how to treat amenorrhea
correct underlying etiology -primary: CHC decrease exercise and weight gain -hyperprolactinemia (Cabergoline--twice weekly, bromocriptine--2.5 mg 3x daily)
45
what is PCOS
disorder that affects organ sys including cycle, fertility, hormones, heart/blood vessels
46
T/F genetics do not play a role in PCOS
false
47
what are some causes of PCOS
actual cause unknown but can be from hormonal imbalance and defect in insulin action
48
what are signs and sx of PCOS
amenorrhea anovulatory bleeding excessive hair growth alopecia patches of dark skin on neck acne weight gain hyperinsulinemia
49
how to diagnose pcos
signs and sx of hyperandrogenism polycystic ovaries on ultrasound (undeveloped follicles in grape like clumps)
50
what are non pharm tx of pcos
exercise diet changes wt loss dietary--low fat, high fiber
51
what are pharm options for pcos
hormonal therapy insulin synthesizers misc agents to improve androgenic effects fertility agents
52
what are hormonal tx options for pcos
CHC intermittent progestin (only if estrogen CI)
53
what tx for insulin agents for pcos
metformin (2nd line due to endometrial protection) -improves glucose tolerance -helps regulate cycle, wt loss pioglitazone (investigational for pcos) -reduces insulin levels -helps regulate cycle
54
what antiandrogen can be used for pcos
spironolactone -continue contraception -usually need progestin
55
what are somatic sx for premenstrual sx
physical -bloating, body aches, breast tender, cramps, headaches
56
what are affective sx for premenstrual
mood/behavioral -anger, anxiety, changes in appetite, depressed, mood swings
57
what is premenstrual dysphoric disorder
a more severe variant of PMS
58
what is the diagnostic criteria for PMS
1-4 sx that are phys, behav, or affective OR has > 5 sx that are phys or behav -sx must impair functioning -sx must remit at menses or shortly after
59
how long should non pharm be inititaed for pms and pmdd
2 months
60
what is non pharm for pms and pmdd
-decrease caffeine -aerobic -yoga -adequate sleep
61
what is pharm tx for pms
-nsaids/apap -spironolactone (100 mg dail--phys/mood sx) -calcium carb (phys +mood sx) -vitamin B6 (phys/mood sx) -mag (can cause diarrhea--phys/mood sx)
62
what is first line for PMDD
SSRI (all are efficacious)--sertraline, fluoxetine avoid paroxetine
63
what is second line for pmdd
venlafaxine clomipramine buspirone
64
what is vulvodynia
vulvar pain--burning, stinging, irritating last for > 3 mo w/o obvious etiology
65
what is vulvodynia often misdiagonsed as
constant yeast infection
66
what can trigger pain for vulvodynia
intercourse
67
what to rule out for vulvodynia
infection derm causes cancer
68
what should be avoided for vulvodynia
scented products dyes chemicals -also tight clothing, daily pad use
69
what non pharm helps with vulvodynia
hydration cold packs lubricant w intercourse pelvic floor
70
what is pharm for vulvodynia
-hormonal (dc chc, topical estradiol w T for 12 wks--good for local vulvodynia) -topical lidocaine 6x/day -TCAs -gabapentin/pregab -snri -capsaicin
71
what is female sexual dysfunction
decreased sexual desire, impaired arousal, inability to achieve orgasms
72
what are risk factors for female sexual dysfunction
depression, anxiety fatigue, stress increased age childbirth diabetes HTN obesity meds (ssris, hormonal, nictoine)
73
what is non pharm for sexual dysfunction
sex therapy treat incontinence psychotherapy lifestyle changes (reduce stress, yoga, wt loss) lubricants
74
what is pharm for female sexual dysfunction
androgens (T) estrogen bupropion buspirone

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