IC17eL & IC17

Question 1

Definition of Amenorrhea

Answer 1

No menstrual bleeding for 90 days

Question 2

Definition: Primary/ functional Amenorrhea

Answer 2

Absence of menses by age 15
in females who never menstruated

Question 3

Secondary amenorrhea

Answer 3

Absence for 3 cycles in a previously menstruating female

Question 4

Risk factors for Secondary amenorrhea

Answer 4

• < 25 yo with hx of menstrual irregularities
• Competitive athletics
• Massive weight loss

Question 5

S/sx for dysmenorrhea

Answer 5

Crampy pelvic pain with or just before menses

Question 6

Pathophysiology for primary dysmenorrhea

Answer 6

Release of prostaglandins & leukotrienes -> vasoconstriction -> cramp

Question 7

Likely Pathophysiology for secondary dysmenorrhea

Answer 7

endometriosis

Question 8

Pathophysiology for PCOS

Answer 8

Ovaries produce an abnormal amount of androgens -> Small cysts (fluid-filled sacs) form in the ovaries

Question 9

Definition of Menopause

Answer 9

Permanent cessation of menses for at least 12 months following the loss of ovarian follicular activity

Question 10

Continuous-cyclic: Is bleeding with progestin normal?

Answer 10

No, it is abnormal

Question 10

Continuous-cyclic: Is bleeding with progestin normal?

Answer 10

No, it is abnormal

Question 11

Dietary supplements recommended for non-pharm in menopausal women

Answer 11

Isoflavones & black cohosh

Question 12

How long should HRT be used before seeing a vast improvement of menopausal symptoms?

Answer 12

2-3 months of use

Question 13

Pharmacological, non-contraceptive options for heavy menses

Answer 13

• NSAIDs during menses
• Tranexamic acid during menses
• Cyclic progesterone

Question 14

Non-pharm option for heavy menses

Answer 14

endometrial ablation / hysterectomy

Question 15

Clinical presentation of menopause (big 4)

Answer 15

1. Vasomotor symptoms (hot flushes & night sweat)
2. Genitourinary symptoms/ atrophy
3. Psychological/ cognitive
4. Bone fragility

Question 16

Estrogen dosage forms

Answer 16

1. Oral tablets
2. Topical (gel/ patch)
3. Local vaginal (pessary/ cream)

Question 17

Counselling for estrogen patch

Answer 17

Replaced twice a week -> lower back, abdomen, thigh or buttocks -> rotate sites

Question 18

Counselling for estrogen gel

Answer 18

Ruler provided to measure dose of gel -> apply over arms or thigh daily -> let gel dry -> rotate sites

Question 19

Counselling for estrogen tablet

Answer 19

Take same time everyday -> once finished with a pack, start a new one right away

Question 20

Counselling for estrogen pessary

Answer 20

Inserted twice a week -> insert tablet just before bedtime to minimize movement

Question 21

HRT: Which to give if u want/ dw period?

Answer 21

Want period: Continuous-cyclic
Dw period: Continuous-combined

Question 22

HRT: How long does it take to show vast improvement in s/sx?

Answer 22

2-3 months

Question 23

Monitoring after initiating HRT

Answer 23

1. Annual mammography
2. Endometrial surveillance for any abnormal symptoms

Question 24

Why is progestin added to estrogen for HRT?

Answer 24

protect the endometrium from overgrowth (& risk of endometrium cancer)

Question 25

Pharmacological option for vasomotor symptoms apart from HRT

Answer 25

1. SNRI & SSRI
2. Gabapentin
3. Tibolone

Question 25

Pharmacological option for vasomotor symptoms apart from HRT

Answer 25

1. SNRI & SSRI
2. Gabapentin
3. Tibolone (improves mood & GMS symptoms also)

NOTE: Tibolone can only be used for post-menopausal women

Question 26

Concern for tibolone use

Answer 26

1. Breast CA recurrence
2. Endometrial cancer
3. Risk of stroke