lecture 5 exam 5 Flashcards by Matti Daniel

What is dysmenorrhea

pain associated with menstruation

How well did you know this?

Not at all

Perfectly

primary vs secondary dysmenorrhea

primary- normal ovulatory cycles and pelvic anatomy
secondary- underlying or anatomic cause

How well did you know this?

Not at all

Perfectly

pathophysiology of dysmenorrhea

Buildup of fatty acid in cell membrane, released during menses
Prostaglandins and leukotrienes are released
causes inflammatory symptoms

How well did you know this?

Not at all

Perfectly

risk factors for dysmenorrhea

less than 20 yo (primary)
menarche before 12 yo

How well did you know this?

Not at all

Perfectly

Dysmenorrhea first line of treatment

NSAIDS
OC

How well did you know this?

Not at all

Perfectly

dysmenorrhea second line of treatment

Depo shot
levonorgestrel IUD

How well did you know this?

Not at all

Perfectly

non pharmacologic treatment of dysmenorrhea

Heating pad
exercise
O-3 fatty acid
smoking cessation

How well did you know this?

Not at all

Perfectly

NSAID counseling point, side effects and rug names

take with food, not for long term
GI bleeding
Naproxen, Ibuprofen,

How well did you know this?

Not at all

Perfectly

mechanism of action of NSAIDs

inhibits COX 1 and COX 2 leading to decrease in prostaglandin production

How well did you know this?

Not at all

Perfectly

when to take NSAIDs for dysmenorrhea

2 days before
short term

How well did you know this?

Not at all

Perfectly

pros and cons of NSAIDs

pros- good option for those wanting to conceive, short term

cons- side effects can be intolerable, not a great option for those with CV

How well did you know this?

Not at all

Perfectly

Side effect of NSAIDs

GI bleeding, ulcers
onset of CV events
exacerbate HTN

How well did you know this?

Not at all

Perfectly

Pros and cons of hormone therapy for dysmenorrhea

pros- appropriate for those seeking contraception
can be used with NSAIDs
cons- Not appropriate for patients desirimg pregnancy
Rx needed
delayed relief

How well did you know this?

Not at all

Perfectly

Side effects of hormone therapy for dysmenorrhea

increased BP
weight gain
fluid retention
risk of blood clots/ stroke

How well did you know this?

Not at all

Perfectly

Name the two hormone therapies in order of choice for dysmenorrhea

1st- levonogestrel IUD
2nd- depot

How well did you know this?

Not at all

Perfectly

What is amenorrhea

absence of blood flow

How well did you know this?

Not at all

Perfectly

Primary vs secondary amenorrhea

primary- no menses by 15
secondary- no menses X 3 months in previously menstruating women

How well did you know this?

Not at all

Perfectly

What lab tests can be seen for amenorrhea

pregnancy test, FSH/LH, TSH, prolactin, estrogen

How well did you know this?

Not at all

Perfectly

pathophysiology of amenorrhea

uterus and ovary anatomic abnormality
pituitary gland (GNRH, LH, FSH)
hypothalamus- stress bulimia

How well did you know this?

Not at all

Perfectly

What are the drugs that cause drug induced amenorrhea

First gen psychotics- prochlorperazine
chlorpromazine
haloperido

2nd gen anti psychotics- risperidine

antihypertensives- verapamil

How well did you know this?

Not at all

Perfectly

if cause of amenorrhea is medication, what can we do?

consider alternative agent that does not inhibit dopamine receptor or increase prolactin levels
or initiate dopamine agonist

How well did you know this?

Not at all

Perfectly

what kind of drugs should be considered during drug induced amenorrhea

drug that does not inhibit dopamine receptor or increase prolactin levels

or get drug that initiates dopamine agonist

How well did you know this?

Not at all

Perfectly

If cause of amenorrhea is hypoestrogenic, provide

supplemental estrogen
must include progestin component

How well did you know this?

Not at all

Perfectly

What are some conjugated equine estrogens that can be provided for hypoestrogenic amenorrhea

premarin
enjuvia
cenestin

How well did you know this?

Not at all

Perfectly

If amenorrhea is caused by medications that increase prolactin levels, what should we provide

Dopamine agonists (bromocriptine, cabergoline)

What is the difference between bromocriptine and cabergoline

bromocriptine is multiple daily dosing cabergoline is weekly or twice weekly

contraindications to bromocriptine and cabergoline

breast feeding and uncontrolled HTN

define oligomenorrhhea

menstrual cycle interval> 35 days but less than 90 days

define polymenorrhea

Menstrual cycle intervals less than 21 days

common causes of polymenorrhea

stress std endometriosis menopause

why does polymenorrhea cause challenges conceiving

does not allow for time for ovulation

What is HMB (heavy menstrual bleeding)

Bleeding >80 ml or lasting 7 days or excessive blood loss that interferes with a womans physical social emotional QOL

prevalence of HMB

18-30%

pathophysiology of HMB

Must rule out pregnancy, ectopic pregnancy, miscarriage 1. hematologic- bleeding, clotting disorders 2. hepatic- cirrhosis 3. endocrine- hypothyroidism 4. uterine- structure abnormality or uterine fibroids

Two types of HMB

acute and chronic

two treatments for chronic HMB

hormonal therapies non hormonal

What are some hormonal therapies for HMB

CHC progestins levonorgestrel danazol GnRH

what are some non-hormonal therapies for HMB

NSAIDs tranexamic acid Iron

How is tranexamic acid a treatment for HMB

prevents degradation of blood clots (lessens bleeding) Intended for short term use

contraindications of Tranexamic acid

Active or history of deep vein thrombosis and pulmonary embolism history of seizure

What is metrorrhagia

bleeding in between cycles

Causes of metrorrhagia

hormone imbalance IUD medication infection fibroids endimetrosis

Treatment for metrorrhagia

hormonal contraceptive

Which Menstrual conditions are related to length? What are the days?

Oligomenorrhea (cycle>35 days but less than 90) amenorrhea (cycle>90 days) polymenorrhea (cycle<21 days) metrorrhagia (bleeding in between cycles)

What is endometriosis

Pelvic inflammatory condition associated with growth of endometrial tissue outside of uterus

what are some symptoms of endometriosis

Dysmenorrhea, infertility, dyspareunia, chronic pelvic pain

prevalence of endometriosis

1 in 10 women

What is the most commonly supported cause of endometriosis

retrograde menstrual flow

First line of treatment of endometriosis

NSAIDs CHC progestins

2nd line of treatment for endometriosis

GnRH agonist/antagonist Danazol

3rd line of treatment for endometriosis

Aromatase inhibitors

What is danazol? How does it work? why is it not used as much?

2nd line of treatment for endometriosis suppresses FSH and LH intolerable side effects (weight gain, acne, hirsutism, lipid abnormalities)

black box warning for danazol and contraindication

Thromboembolism contraindicated in pregnant and nursing women

What are uterine fibroids and when are they most likely to develop

Common non cancerous growths in uterus (most common pelvic tumor) More liklely to develop before 50 yo

What are the causes of fibroids

1.Increased estrogen and progesterone increased mitotic rate increased likelihood of mutations 2. genetic predisposition 3.response to injury

How does response to injury cause uterine fibroids

Increased prostaglandins and vasopressins with onset of menses

Non pharmacologic treatment of uterine fibroids

Myomectomy-removal of fibroids -resolution of symptoms while preserving uterus, fertility preserved ( big chance fibroids will come back) hysterectomy

Do NSAIDs help with reduction in fibroid size dysmenorrhea HMB

no reduction in fibroid size helps with both HMB and dysmenorrhea

Do CHC help with reduction in fibroid size dysmenorrhea HMB

no reduction in fibroid size helps with both HMB and dysmenorrhea

Does levonorgestrel IUD help with reduction in fibroid size dysmenorrhea HMB

Helps all 3

does tranexamic acid help with reduction in fibroid size dysmenorrhea HMB

Only HMB

Does GnRH help with reduction in fibroid size dysmenorrhea HMB

Helps with HMB and reduces fibroid size by 35-65%

Do SPRMs help with reduction in fibroid size dysmenorrhea HMB

Help with HMB reduces fibroid size by 25-50%

Which two drugs help with reduction in fibroid size

SPRMs and GnRH

What are some SPRM drugs

Mifepritone Ulipristal (NOT FDA APPROVED FOR BOTH)

Difference between GnRH and SPRMs for fibroid treatment

SORMs do not cause hypoestrogenic effects