Lec 10 Flashcards
what is Primary amenorrhea
it Is the absence of menses by age 15 years in women who
have never menstruated.
what is Secondary amenorrhea
it Is the absence of menses for three cycles or for 6 months
in a previously menstruating woman.
General Approach to Treatment of Amenorrhea
proper identification of the disorder’s underlying cause(s).
non pharm and pharm treatment of amenorrhea secondary to hypoestrogenic states
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
- Non pharmacologic therapy for Amenorrhea secondary to anorexia
weight gain
non pharm treatment of Amenorrhea secondary to excessive excersice
– reduction of exercise quantity and intensity
women with Amenorrhea 2ndry to FHA (functional hypothalamic
amenorrhea) are treated with?
1-CBT Cognitive behavioral therapy.
2-short-term use of transdermal estradiol with cyclic oral progestins.
treatment of Amenorrhea 2ndry hyperprolactinemia
Dopamine agonists (bromocriptine and cabergoline )
…………., induce withdrawal bleeding in women with secondary amenorrhea?
Progestins
effecasy of:
1- oil administered intramuscularly and
2-oral medroxyprogesterone acetate (MPA) progestins in Amenorhea
1- results in withdrawal bleeding in 70%
2-induces withdrawal bleeding in 95%
is the recommended treatment for managing acute severe bleeding episodes in women without suspected or known bleeding disorders.
- Estrogen
estrogen-containing CHCs and progestin-only regimens can be used for maintenance therapy.
the only agent that has been FDA approved to reduce menstrual blood loss is.
a combination of estradiol valerate and dienogest
used as first line option in HMB women that dont wanna use contraceptives
HMB = heavy mentrual bleeding
NSAID
used as first line option in HMB women that dont mind using contraceptives
HMB = heavy mentrual bleeding
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
HMB For women with contraindications to CHCs
HMB = heavy mentrual bleeding
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.
mention a progestin-only option in the treatment of HMB
the levonorgestrel-releasing intrauterine system (LNG-IUS)
Is considered the most effective treatment to reduce menstrual flow
approved for HMB who dont wanna use contraceptives and cant use NSAID
- Tranexamic acid
main pharm treatment of AUB-O
AUB-O = Abnormal utrine bleeding- ovulatory
- Hormonal contraceptives
used in AUB-O to make menstrual cycles more predictable?
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
treatment for For women with PCOS who have high androgen levels and its related signs
PCOS = polycystic ovulatory syndrome
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
used in in women and adolescents with PCOS for management of metabolic features when ifestyle changes do not achieve desired goals.
Metformin
first line treatment for ovulation induction
letrozole
first line treatment in women with AUB-O who do
not desire pregnancy.
- Hormonal contraceptives
first line treatment of PCOS
PCOS = polycystic ovulatory syndrome
CHCs are first-line pharmacologic agents for cycle control and minimizing the androgenic signs and symptoms of PCOS.
