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gu/repro > gynecologic disorders > Flashcards

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
Q

what are other pharm options for endometriosis

A

aromatase inhibitors (anastrozole, letrozole)

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26
Q

what are aromatase inhibitors approved for

A

breast cancer, not endometriosis

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27
Q

what is the primary tx for endometrosis if infertility

A

surgery

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28
Q

what is not a cure for endometriosis

A

hysterectomy

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29
Q

what is a potential cure for endometriosis

A

hysterectomy and oophorectomy (uterus and ovaries removed)

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30
Q

what is menorrhagia

A

abnormally heavy (>80 mL) or prolonged (>7 days) menses

31
Q

what occurs usually during menorrhagia

A

ovulation

32
Q

what are common causes of menorrhagia

A

hypothyroidism
uterine fibroids
uterine cancer
drugs (anticoags)

33
Q

what are signs/sx of menorrhagia

A

heacy flow
clots
faitgue
lightheaded
orthostasis
tachycardia
low hemoglobin/ferritin

34
Q

what are first line options for menorrhagia

A

NSAIDs (if contraception not desired)
levonrogestrel IUD
oral progesterone or IM medroxy q 4 mo

35
Q

what is second line for menorrhagia

A

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
Q

what is anovulatory bleeding

A

menstrual bleeding that occurs bc of disorganized menstrual system from absence of ovulation

37
Q

what does absence of ovulation do

A

progesterone not produced–> endometrium continues to thicken–> eventually sloughs off–> irregular or heavy bleeding

38
Q

how long is adolescent anovulatory bleeding normal for

A

5 yrs due to immature hypothalamic pituitary ovarian axis

39
Q

what is the tx for anovulatory bleeding

A

CHC
progestin only contraceptive
treat underlying causes
dilation and curettage

40
Q

what are reasons for no ovulation

A

ovarian failure
pituitary disease
eating disorder
thyroid dysfunction
hyperprolactinemia
adrenal disease
PCOS

41
Q

what is primary amenorrhea

A

absence of menarche by 16 WITH secondary development OR absence of menarche by 14 W/O secondary development

42
Q

what is secondary amenorrhea

A

absence of menses for 6 mo or 3 cycles

43
Q

how to diagnose amenorrhea

A

rule out preg
obtain hx (stress, change in diet, drugs–androgenic meds, new acne, etc)
rule out estrogen def, galactorrhea, hypothalamus/pituitary disease

44
Q

how to treat amenorrhea

A

correct underlying etiology
-primary: CHC
decrease exercise and weight gain
-hyperprolactinemia (Cabergoline–twice weekly, bromocriptine–2.5 mg 3x daily)

45
Q

what is PCOS

A

disorder that affects organ sys including cycle, fertility, hormones, heart/blood vessels

46
Q

T/F genetics do not play a role in PCOS

A

false

47
Q

what are some causes of PCOS

A

actual cause unknown but can be from hormonal imbalance and defect in insulin action

48
Q

what are signs and sx of PCOS

A

amenorrhea
anovulatory bleeding
excessive hair growth
alopecia
patches of dark skin on neck
acne
weight gain
hyperinsulinemia

49
Q

how to diagnose pcos

A

signs and sx of hyperandrogenism
polycystic ovaries on ultrasound (undeveloped follicles in grape like clumps)

50
Q

what are non pharm tx of pcos

A

exercise
diet changes
wt loss
dietary–low fat, high fiber

51
Q

what are pharm options for pcos

A

hormonal therapy
insulin synthesizers
misc agents to improve androgenic effects
fertility agents

52
Q

what are hormonal tx options for pcos

A

CHC
intermittent progestin (only if estrogen CI)

53
Q

what tx for insulin agents for pcos

A

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
Q

what antiandrogen can be used for pcos

A

spironolactone
-continue contraception
-usually need progestin

55
Q

what are somatic sx for premenstrual sx

A

physical
-bloating, body aches, breast tender, cramps, headaches

56
Q

what are affective sx for premenstrual

A

mood/behavioral
-anger, anxiety, changes in appetite, depressed, mood swings

57
Q

what is premenstrual dysphoric disorder

A

a more severe variant of PMS

58
Q

what is the diagnostic criteria for PMS

A

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
Q

how long should non pharm be inititaed for pms and pmdd

A

2 months

60
Q

what is non pharm for pms and pmdd

A

-decrease caffeine
-aerobic
-yoga
-adequate sleep

61
Q

what is pharm tx for pms

A

-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
Q

what is first line for PMDD

A

SSRI (all are efficacious)–sertraline, fluoxetine
avoid paroxetine

63
Q

what is second line for pmdd

A

venlafaxine
clomipramine
buspirone

64
Q

what is vulvodynia

A

vulvar pain–burning, stinging, irritating last for > 3 mo w/o obvious etiology

65
Q

what is vulvodynia often misdiagonsed as

A

constant yeast infection

66
Q

what can trigger pain for vulvodynia

A

intercourse

67
Q

what to rule out for vulvodynia

A

infection
derm causes
cancer

68
Q

what should be avoided for vulvodynia

A

scented products
dyes
chemicals
-also tight clothing, daily pad use

69
Q

what non pharm helps with vulvodynia

A

hydration
cold packs
lubricant w intercourse
pelvic floor

70
Q

what is pharm for vulvodynia

A

-hormonal (dc chc, topical estradiol w T for 12 wks–good for local vulvodynia)
-topical lidocaine 6x/day
-TCAs
-gabapentin/pregab
-snri
-capsaicin

71
Q

what is female sexual dysfunction

A

decreased sexual desire, impaired arousal, inability to achieve orgasms

72
Q

what are risk factors for female sexual dysfunction

A

depression, anxiety
fatigue, stress
increased age
childbirth
diabetes
HTN
obesity
meds (ssris, hormonal, nictoine)

73
Q

what is non pharm for sexual dysfunction

A

sex therapy
treat incontinence
psychotherapy
lifestyle changes (reduce stress, yoga, wt loss)
lubricants

74
Q

what is pharm for female sexual dysfunction

A

androgens (T)
estrogen
bupropion
buspirone

gu/repro (5 decks)

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