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CD3409 > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

what are the disorders of the menstrual system (4)

A

Primary + Secondary amenorrhea
Dysfunctional uterine bleeding
Dusmenorrhea
Premestrual disorders

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2
Q

how does the hypothalamus influence the menstrual cycle

A

responsible fro producing GnRH

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3
Q

What role does the pituitary gland have in the menstrual cycle

A

GnRH acts on ant pituitary which releases FSH and LH

FSH and LH help release follicle from ovaries

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4
Q

what hormones does the ovaries influence

A

Influences estrogen and progesterone

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5
Q

what happens to estrogen/progesterone if the follicle is fertilized or not

A

fertilized- increase in estrogen and progesterone that will allow uterine lining to thicken and prepare for implantation

Non fertilized- Decrease in estrogen and progesterone to restart mentrual

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6
Q

what is primary amenorrhea

A

Absence of menarche in females of reproductive age

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7
Q

Evaluation for delayed puberty should be suggested if…

A
  • no menarche by 15
  • no menarche 3-5y post thelarche
  • lack of pubertal development/secondary sex characteristics by 13
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8
Q

what genetic probs can primary amenorrhea be cause by

A
  1. Gonadal dysgenesis
  2. Androgen insensitivity syndrome
  3. Turners syndrom
  4. Mosaicism (mitosis doesnt work right)
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9
Q

What else can cause primary amenorrhea

A

hormone imbalances (elevated FSH, hyperprolactimia)

constitutional delay (late bloomer)

Inf

autoimmune disorder

Hypothalamic amenorrhea

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10
Q

What is secondary Amenorrhea

A

occurs when a women who has been having normal cycles stops getting her periods for greater than 3-6 months

-period of 6m w/o is concerning

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11
Q

What could secondary amenorrhea be caused by

A
  • Physical damage to endometrium
  • obstruction of mentrual flow
  • Preg and lactation
  • Menopause
  • Birth control or Depoprovera
  • exogenous androgens
  • pituiatry conditions
  • chemo
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12
Q

What is functional hypothalamic amenorrhea + what does it cause

A

-causes secondary amenorrhea

  • obesity
  • very low body fat
  • stressors such as excessive ex/anxitey
  • 35% of secondary amenorhhea
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13
Q

What is polycystic ovarian syndrome (PCOS) + what does it cause

A
  • mc endocrine disorder (7-10% of W)
  • characterized by ovulatory dysfunction w mentrual cycle being irregular + frequent
  • presence of hyperandrogegism, often overweight w insulin resistance
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14
Q

how much more likely are girls in sports gunna develop amenorrhea

A

3x more likely

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15
Q

if weight is >15% below ideal weight or if BMI is >17.5kg/m what should be considered

A

eating disorder or malnutrition

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16
Q

what initially was needed to be dx with female athlete triad and now

A

Use to need: disordered eating/low energy, mentrual disturbance, bone loss

now don’t need pathology in all 3

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17
Q

What is energy availability and what does it cause when low

A

intake of cals- energy expenditure
-when body falls into negative balance the body reacts by reducing amount of energy needed for bodily functions

-many negatives such as low self esteem, depression, CV probs, GI probs

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18
Q

long term consequences for red s syndrome

A
  • increased rate of MSK injuries
  • Stress fx
  • Abnormal lipid profiles
  • endothelial dysfunction/ CVD probs
  • irreversible boen loss
  • Depression
  • Anxiety
  • Low self esteem
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19
Q

physical exam of somebody w red s

A

poor detention

  • fine hair on body
  • swollen parotid glands
  • russel sign (callus on the knuckles)
  • hoarsness
20
Q

what is abnormal uterine bleeding and when is it mc

A

bleeding that diffes in quantity or timing from a women usual mentrual flow

-mc seen in women who are experiencing menarche for the first time

21
Q

What is dysfunctional uterine bleeding and when does it mc happen

A
  • in absence of any organic disease
  • mc during reproductive years
  • characterized by irregular and prolonged menstrual bleeding
  • mc in <20 + >40
22
Q

what is oligomenorrhea, po,ymenorrhea and menorrhagia

A

oligomenorrhea- bleeding that occurs in intervals of greater than 35 days

polymenorrhea- bleeding that occurs in intervals <21 days

Menorrhagia- Prolonged or excessive bleeding at reg intervals

23
Q

what is mid cycle spotting + what is it due to

A

spotting that occurs before ovulation (day 13-14)

due to decreased estrogen lvls

24
Q

What is menometrorrhagia

A

combo of menorrhagia and metrorrhagia

-Prolonged or excessive bleeding occurring irregular and more frequently than normal intervals

25
Q

What are the main 2 causes of AUB/DUB

A

Anovulatory (90%)

Ovulatory (10%)

26
Q

What is anovulatory AUB (AUB-o) and what is it caused by

A

menstrual cycle with ovulation or AUB with ovulatory dysfunction

systemic disorders which occur secondary to endocrine, neurochemical or pharm mechanisms
-dx of exclusion

27
Q

What is the effect of no ovulation

A

no progesterone which leads to proliferative endometrium and non uniform bleeding

28
Q

What is the ovulatory cause of AUB/DUB

A

occurs secondary to defects in the control mechanisms of menstruation

  • -chromosomal abnormalities
  • -congenital anatomic genital abnormalities that obstruct mentrual flow

tends to be more excessive bleeding during regular menstrual cycles compared to normal

29
Q

What is dysmenorrhea (primary vs secondary)

A

Pain during menstraution that restricts daily activities
primary- lower abdominal pain during mentrual cycle
secondary - usually associated with other pathologies in or outside uterus

30
Q

age for dysmenorrhea

A

usually effects nulliparous women between 16-25

often decreases after 25

31
Q

risk factors of dysmenorrhea

A
  • age younger than 30
  • nulliparous
  • BMI less than 20 and obesity
  • Smoking and alcohol consumption
  • high lvls of stress
  • menarche younger than 12
  • irregular flow etc
32
Q

when does primary dysmenorrhea usually start

A

6 m to 2 y after menarche

33
Q

classic symptoms of primary dysmenorrhea

A
  • cramp like pain in lower abdomen and can radiate to back/inner thighs or both
  • fluctuating intensity
  • onset of pain shortly before or at the onset of bleeding and lasting up to 72hrs
  • peak intensity 24-36hrs from onset
34
Q

Causes of primary dysmenorhea

A
  • usually have high lvls of prostaglandins, leukotriene, vasopressin, platelet activating factor
  • cytooxygenase path increases prostanoids and prostaglandins result in uterine ishemia which leads to an increase in metabolites that stim pain
35
Q

hormonal tx for dysmenorrhea

A
  • combined hormonal contraceptoves (70-80% effective)
  • combined oral contraceptive pill
  • progestrone only method contraception
36
Q

Known risk factors of hormonal tx for dysmenorrhea

A

Deep vein thrombosis

37
Q

non hormonal tx for dsymenorrhea

A
  • Acetaminophin
  • NSAIDs (first line, 1-2days before menaces)
  • Low fat veg diet
  • essential fatty acids
  • calc and magnesium (stabilize contractions)
  • B1 (reduces pan)
38
Q

Herbs used for dysmenorrhea

A
  • black cohosh and cramp bark
  • ginger root
  • dong quai
39
Q

other non pharm tx for dysmenorrhea

A
  • TENS
  • Heat
  • Exercise and yoga
  • Accupunctioure
  • behabioural interventions
40
Q

What is secondary dysmenorrhea

A
  • caused by a disorder in the reproductive organs

- tends to get worse over tie and often lasts longer than normal mentrual cramps

41
Q

causes for secondary dysmenorrhea

A
  • Endometriosis (endometrium grows outside uterus, younger)
  • Adenomyosis (Endrometrial tissue that grows into mm layer of uterus, 40-50y)
  • pelvic inflammatory disease
  • Cerve stenosis
  • IUD
  • Leomyomas/fibroids
  • polyps
42
Q

How many women does PMS occur in and what part of menstrual cycle does it happen

A

75-80% of women

  • hormone disorder that occurs in luteal phase
  • mc in 20-30s
43
Q

what do u need to dx PMS

A
  • at least one affective symptom and one somatic that causes dysfunction in social, academic, work performance
  • cyclical
  • begin after olulativ and resolving shortly after onset of menes
44
Q

What is premenstrual dysphoric disorder and how many women does it occur in

A

occurs in 5-8%

-experienc symptoms a few days to two weeks (intensify 6 days before and most severe 2 days before0

45
Q

How to dx premenstrual dysphoric disorder

A

five symptoms in the week before menses and these symptoms must improve within a few days after the onset of menaces

46
Q

Pot causes of premenstrual dysphoric disorder

A
  • not really known
  • Increased estrogen (had an effect on prolactin, suppress dopamine action, suppress serotonin)
  • B6 def

CD3409 (10 decks)

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