gynecologic disorders Flashcards
what is dysmenorrhea
painful cramps with or prior to mensess
what is primary dysmenorrhea
pain not due to an underlying disease (most cases)
what causes the pain in dysmenorrhea
increased release of uterine PG and leukotrienes
what are the risk factors for dysmenorrhea
young age
early age of period
heavy flow
long periods
cig smoking
how long does dysmenorrhea last
1-3 days
when is dysmenorrhea the most intense
24-36 hours (max PG release)
signs and sx of dysmenorrhea
labor like pain–can radiate to inner thighs
N/V
diarrhea
what is nonpharm for dysmenorrhea
heat
aerobic exercise
low fat veg diet
what is the first line for dysmenorrhea
NSAIDs
-use higher anti-inflammatory doses
what is another first line for dysmenorrhea
combined hormonal contraceptive (suppresses ovulation)
-periods more predictable
can you use CHC + NSAID in combo
yes
what is the 2nd line for dysmenorrhea
progestin only contraceptive
what is endometriosis
lining of uterus grows outside the uterus
what are risk factors to endometriosis
the longer the time exposed to menstruation, higher the risk
-early menarche
-late menopause
-shorter cycle or longer
what are signs/sx of endometriosis
pain w periods, intercourse, urination
chronic lower back pain
chronic fatigue
infertility
pharm agents treat what
pain NOT infertility
what are first line options for endometriosis
NSAIDs–doesnt work for severe pain
CHCs
progestin only contraceptive (oral norethindrone, medroxy)
how long should you trial first line options for endometrosis
3-4 months
what is the second line for endometriosis
GnRH agonist–expensive
danazol–testosterone derivative
how do GnRH help endometriosis
decrease pain
suppress mense
how long is second line therapy limited to for endometriosis
6 months bc of bone loss
what category is danazol
X
what should be monitored while taking danazol
hepatic function (can increase LFTs)
who is danazol not recommended for
adolescents
what are other pharm options for endometriosis
aromatase inhibitors (anastrozole, letrozole)
what are aromatase inhibitors approved for
breast cancer, not endometriosis
what is the primary tx for endometrosis if infertility
surgery
what is not a cure for endometriosis
hysterectomy
what is a potential cure for endometriosis
hysterectomy and oophorectomy (uterus and ovaries removed)
what is menorrhagia
abnormally heavy (>80 mL) or prolonged (>7 days) menses
what occurs usually during menorrhagia
ovulation
what are common causes of menorrhagia
hypothyroidism
uterine fibroids
uterine cancer
drugs (anticoags)
what are signs/sx of menorrhagia
heacy flow
clots
faitgue
lightheaded
orthostasis
tachycardia
low hemoglobin/ferritin
what are first line options for menorrhagia
NSAIDs (if contraception not desired)
levonrogestrel IUD
oral progesterone or IM medroxy q 4 mo
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)
what is anovulatory bleeding
menstrual bleeding that occurs bc of disorganized menstrual system from absence of ovulation
what does absence of ovulation do
progesterone not produced–> endometrium continues to thicken–> eventually sloughs off–> irregular or heavy bleeding
how long is adolescent anovulatory bleeding normal for
5 yrs due to immature hypothalamic pituitary ovarian axis
what is the tx for anovulatory bleeding
CHC
progestin only contraceptive
treat underlying causes
dilation and curettage
what are reasons for no ovulation
ovarian failure
pituitary disease
eating disorder
thyroid dysfunction
hyperprolactinemia
adrenal disease
PCOS
what is primary amenorrhea
absence of menarche by 16 WITH secondary development OR absence of menarche by 14 W/O secondary development
what is secondary amenorrhea
absence of menses for 6 mo or 3 cycles
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
how to treat amenorrhea
correct underlying etiology
-primary: CHC
decrease exercise and weight gain
-hyperprolactinemia (Cabergoline–twice weekly, bromocriptine–2.5 mg 3x daily)
what is PCOS
disorder that affects organ sys including cycle, fertility, hormones, heart/blood vessels
T/F genetics do not play a role in PCOS
false
what are some causes of PCOS
actual cause unknown but can be from hormonal imbalance and defect in insulin action
what are signs and sx of PCOS
amenorrhea
anovulatory bleeding
excessive hair growth
alopecia
patches of dark skin on neck
acne
weight gain
hyperinsulinemia
how to diagnose pcos
signs and sx of hyperandrogenism
polycystic ovaries on ultrasound (undeveloped follicles in grape like clumps)
what are non pharm tx of pcos
exercise
diet changes
wt loss
dietary–low fat, high fiber
what are pharm options for pcos
hormonal therapy
insulin synthesizers
misc agents to improve androgenic effects
fertility agents
what are hormonal tx options for pcos
CHC
intermittent progestin (only if estrogen CI)
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
what antiandrogen can be used for pcos
spironolactone
-continue contraception
-usually need progestin
what are somatic sx for premenstrual sx
physical
-bloating, body aches, breast tender, cramps, headaches
what are affective sx for premenstrual
mood/behavioral
-anger, anxiety, changes in appetite, depressed, mood swings
what is premenstrual dysphoric disorder
a more severe variant of PMS
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
how long should non pharm be inititaed for pms and pmdd
2 months
what is non pharm for pms and pmdd
-decrease caffeine
-aerobic
-yoga
-adequate sleep
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)
what is first line for PMDD
SSRI (all are efficacious)–sertraline, fluoxetine
avoid paroxetine
what is second line for pmdd
venlafaxine
clomipramine
buspirone
what is vulvodynia
vulvar pain–burning, stinging, irritating last for > 3 mo w/o obvious etiology
what is vulvodynia often misdiagonsed as
constant yeast infection
what can trigger pain for vulvodynia
intercourse
what to rule out for vulvodynia
infection
derm causes
cancer
what should be avoided for vulvodynia
scented products
dyes
chemicals
-also tight clothing, daily pad use
what non pharm helps with vulvodynia
hydration
cold packs
lubricant w intercourse
pelvic floor
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
what is female sexual dysfunction
decreased sexual desire, impaired arousal, inability to achieve orgasms
what are risk factors for female sexual dysfunction
depression, anxiety
fatigue, stress
increased age
childbirth
diabetes
HTN
obesity
meds (ssris, hormonal, nictoine)
what is non pharm for sexual dysfunction
sex therapy
treat incontinence
psychotherapy
lifestyle changes (reduce stress, yoga, wt loss)
lubricants
what is pharm for female sexual dysfunction
androgens (T)
estrogen
bupropion
buspirone
