Lec 10

Question 1

what is Primary amenorrhea

Answer 1

it Is the absence of menses by age 15 years in women who
have never menstruated.

Question 2

what is Secondary amenorrhea

Answer 2

it Is the absence of menses for three cycles or for 6 months
in a previously menstruating woman.

Question 3

General Approach to Treatment of Amenorrhea

Answer 3

proper identification of the disorder’s underlying cause(s).

Question 4

non pharm and pharm treatment of amenorrhea secondary to hypoestrogenic states

Answer 4

1-a diet rich in calcium and vitamin D is essential to minimize any negative impact on bone health.

2-as an oral contraceptive, conjugated equine estrogen, or estradiol patch,
in conjunction with progestin in an attempt to decrease osteoporosis risk

Question 5

• Non pharmacologic therapy for Amenorrhea secondary to anorexia

Answer 5

weight gain

Question 6

non pharm treatment of Amenorrhea secondary to excessive excersice

Answer 6

– reduction of exercise quantity and intensity

Question 7

women with Amenorrhea 2ndry to FHA (functional hypothalamic
amenorrhea) are treated with?

Answer 7

1-CBT Cognitive behavioral therapy.
2-short-term use of transdermal estradiol with cyclic oral progestins.

Question 8

treatment of Amenorrhea 2ndry hyperprolactinemia

Answer 8

Dopamine agonists (bromocriptine and cabergoline )

Question 9

…………., induce withdrawal bleeding in women with secondary amenorrhea?

Answer 9

Progestins

Question 10

effecasy of:
1- oil administered intramuscularly and
2-oral medroxyprogesterone acetate (MPA) progestins in Amenorhea

Answer 10

1- results in withdrawal bleeding in 70%
2-induces withdrawal bleeding in 95%

Question 11

is the recommended treatment for managing acute severe bleeding episodes in women without suspected or known bleeding disorders.

Answer 11

• Estrogen

estrogen-containing CHCs and progestin-only regimens can be used for maintenance therapy.

Question 12

the only agent that has been FDA approved to reduce menstrual blood loss is.

Answer 12

a combination of estradiol valerate and dienogest

Question 13

used as first line option in HMB women that dont wanna use contraceptives

HMB = heavy mentrual bleeding

Answer 13

NSAID

Question 14

used as first line option in HMB women that dont mind using contraceptives

HMB = heavy mentrual bleeding

Answer 14

CHC’s:The only agent approved by the FDA for the indication of HMB
is the four-phasic valerate and dienogest formulation containing estradiol

CHC = combined hormonal contraceptives

Question 15

HMB For women with contraindications to CHCs

HMB = heavy mentrual bleeding

Answer 15

progestin-only methods induce amenorrhea and reduce menstrual blood loss
Cyclic progesterone therapy for 14 oral norethindrone acetate or medroxyprogesterone acetate on the 5th day of menses.

Question 16

mention a progestin-only option in the treatment of HMB

Answer 16

the levonorgestrel-releasing intrauterine system (LNG-IUS)

Is considered the most effective treatment to reduce menstrual flow

Question 17

approved for HMB who dont wanna use contraceptives and cant use NSAID

Answer 17

• Tranexamic acid

Question 18

main pharm treatment of AUB-O

AUB-O = Abnormal utrine bleeding- ovulatory

Answer 18

• Hormonal contraceptives

Question 19

used in AUB-O to make menstrual cycles more predictable?

Answer 19

CHC’s (in women who cant take estrogen, progesting only is an option).

• They should be strongly considered for women experiencing HMB associated with anovulatory cycles

Question 20

treatment for For women with PCOS who have high androgen levels and its related signs

PCOS = polycystic ovulatory syndrome

Answer 20

CHC’s containing:
1- less than or equal to 35 mcg of ethinyl estradiol.
2- a progesterone that exhibits minimal androgenic side effects (eg, norgestimate ,desogestrel).
3- with antiandrogenic effects (eg, drospirenone) may be desirable

Question 21

used in in women and adolescents with PCOS for management of metabolic features when ifestyle changes do not achieve desired goals.

Answer 21

Metformin

Question 22

first line treatment for ovulation induction

Answer 22

letrozole

Question 23

first line treatment in women with AUB-O who do
not desire pregnancy.

Answer 23

• Hormonal contraceptives

Question 24

first line treatment of PCOS

PCOS = polycystic ovulatory syndrome

Answer 24

CHCs are first-line pharmacologic agents for cycle control and minimizing the androgenic signs and symptoms of PCOS.

Question 25

• Primary dysmenorrhea is?

Answer 25

– implies pain in the setting of normal pelvic anatomy and physiology

Question 26

secondary dysmenorrhea is?

Answer 26

pain that is associated with underlying pelvic pathology

Question 27

Non pharm treatment for Dysmenorrhea?

Answer 27

1-Topical heat.
2-excercise.
3-Diet.

Question 28

Pharm treatment of Dysmenorrhea

Answer 28

1-NSAID (naproxen and ibuprofen).

2-In women who have a history of NSAID-induced gastric effects (celecoxib) is an alternative.

3-* CHC containing a potent progestin (eg, levonorgestrel)

4- * Long-acting progesterones, such as depot MPA and the LNG-IUS, (makes you Amenorrheic within 6-12 months

NSAID is used 1-2 prior to menses

Question 29

Dysmenorrhea treatment that cause rapid pain reduction?

Answer 29

– continuous CHC regimens

Question 30

what is Premenstrual syndrome (PMS) ?

Answer 30

cyclic pattern of symptoms occurring in the last week of the menstrual cycle that resolve with menstrual flow.

diagnosis requires at least one moderate-to-severe somatic or psychiatric symptom in 3months

Question 31

diagnosis of premenstrual dysphoric disorder (PMDD).

related to Premenstrual syndrome (PMS)

Answer 31

at least five symptoms are present in the last week prior to
the onset of menses

Question 32

Nonpharm treatment of mild to modrate premenstrual symptoms is?

Answer 32

Life style modifications:
1-Diet / excercise
2-vitamine and supplement
3-CBT

Question 33

• The first-line pharmacologic treatment options for severe symptoms of PMS and PMDD is?

Answer 33

1- SSRI: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline.

2-SNRI: Venlafaxine (for PMDD).

3-The use of a monophasic oral CHC containing ethinyl estradiol and drospirenone (approved by FDA for PMDD symptoms).

4-* The continuous cycle CHC regimen deliveringlevonorgestrel and ethinyl estradiol daily .

5- LAST LINE (Leuprolide)