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Women's Health > Menses > Flashcards

Menses Flashcards

1
Q

What is dysmenorrhea?

A

painful cramps

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2
Q

What cx primary dysmenorrhea?

A

d/t overproduction of prostaglandins

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3
Q

What are the sx/hx for primary dysmenorrhea?

A 
4-6hrs BEFORE menses
lasts 24-72 hrs
crampy/spasmodic pain in lower abdomen
HA, dizziness
N/V/D
bloating
syncope
breast tenderness 
backache
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4
Q

When is pelvic exam warranted for primary dysmenorrhea?

A

IF sx are NOT alleviated w/NSAIDs

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5
Q

What to check for during pelvic exam?

A 
cul de sac:
ovarian masses
tenderness
nodularity
may indicate endoemtriosis
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6
Q

When to run blood test in primary dysmenorrhea? What blood tests?

A

if sexually active
chlamydia + gonorrhea
HIV + RPR/VDRL

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7
Q

What are the nonpharmacologic tx for primary dysmenorrhea?

A 
heat
diet
vitamin - B, Ca
behavior modification
exercise, yoga
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8
Q

What drugs used for primary dysmenorrhea?

A

naproxen 1) 500mg 2) 250-500mg q8-12

ibuprofen 400-600mg q4-6hrs OR 800mg q8hrs: MAX 2400mg/day

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9
Q

How should NSAIDs be used for primary dysmenorrhea?

A

preloading

take w/food

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10
Q

When should OCP used for primary dysmenorrhea?

A

SEVERE cramps

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11
Q

How does OCP help w/ cramps?

A

thins endometrium which decreases prostaglandin production

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12
Q 
14yo female has severe dysmenorrhea for 6mo.
Menarche started 10mo ago. 
Reg menstruating w/ N/D + HA. 
Missed school d/t pain. 
Advil helps. 
Family hx pos for endometriosis. 
What PE would you do?
A

abdomen exam
NO pelvic - pt is “virgin”
DRE

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13
Q 
14yo female has severe dysmenorrhea for 6mo.
Menarche started 10mo ago. 
Reg menstruating w/ N/D + HA. 
Missed school d/t pain. 
Advil helps. 
Family hx pos for endometriosis. 
Dx? Why?
A

primary dysmenorrhea

family hx is positive but reg menstruating, sx are primary dysmenorrhea, beginning of menses

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14
Q 
14yo female has severe dysmenorrhea for 6mo.
Menarche started 10mo ago. 
Reg menstruating w/ N/D + HA. 
Missed school d/t pain. 
Advil helps. 
Family hx pos for endometriosis. 
Tx?
A

try different NSAID - advil –> aleve and advise HOW to take it
prob not OCP b/c of age
RTC to f/u

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15
Q

What are the different types of secondary dysmenorrhea?

A

endometriosis - extrauterine

uterine leiomyomata - intrauterine /intramural

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16
Q

Pathophysiology re: endometriosis?

A

lining of the uterus is OUTSIDE of the uterus which causes scarring

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17
Q

Cx of endometriosis?

A

family hx

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18
Q

Classic sx/hx of endometriosis?

A

Progressive dysmenorrheal + pelvic pain WORSENS w/ menses and ovulation + deep dyspareunia

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19
Q

What is dx for endometriosis?

A

Bx is NEEDED via laparoscopy

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20
Q

What would you find in pelvic exam for endometriosis?

A

tender pelvic w/ uterine movement
nodules
fixed, tender, enlarged adenxa

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21
Q

Tx for endometriosis?

A
  1. Watch and wait if pt insists
  2. OCP – refer
    a. Anovulation – hormones are regulated
  3. Surgery – refer
    a. ONLY the scarring to preserve fertility
    b. Hysterectomy
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22
Q

Prognosis for endometriosis?

A

nothing to prevent

infertility can happen d/t scarring

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23
Q

What is the pathophysiology re: uterine leiomyomata?

A

benign tumors –> smooth muscle cells of the myometrium (uterus or in the interior cavity)
single or clusters nodules w/in the wall of the uterus

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24
Q

What puts people at risk for uterine leiomyomata?

A 
AA
30-40yo
Family hx
obesity
hx of uterine infxn
>1 pregnancy
OCP
menopause
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25
Q

Sx/hx for uterine leiomyomata?

A

increased uterine bleeding

increased pelvic pressure/pain which causes urgency and frequency

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26
Q

What tests/exams would you do for uterine leiomyomata?

A

pelvic exam - enlarged, irregular, mobile uterus
blood - cbc, tsh, pap smear
imaging - +/-transvaginal US

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27
Q

Tx for uterine leimyomata?

A

Waiting – Tx the sx
OCP
GnRH analogs
Surgery – hysterectomy or myomectomy

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28
Q

Tx for uterine leimyomata if sx are problematic?

A

if sx are problematic -> refer: hysterectomy

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29
Q

What to be on the alert for postmenopausal women w/ uterine leimyomata?

A

new/enlarging fibroids

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30
Q

28yo female. Cannot conceive.
Never used OCP.
Menses are painful.
Chronic cyclical pelvic pain which worsens over the years.
Pain is lower abdomen and pelvis that goes to the back.
Periods are frequent and heavy.
Sister has painful menses.
What PE would you do? What would you find?

A

Pelvic exam - fixed, uterosacral ligaments are nodular, 5cm adnexal mass and tender

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31
Q 
28yo female. Cannot conceive. 
Never used OCP. 
Menses are painful. 
Chronic cyclical pelvic pain which worsens over the years. 
Pain is lower abdomen and pelvis that goes to the back. 
Periods are frequent and heavy. 
Sister has painful menses.
Dx? Why?
A

Endometriosis
painful menses + family hx
pain is getting worse over the years
PE - tender adnexal mass, fixed

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32
Q 
28yo female. Cannot conceive. 
Never used OCP. 
Menses are painful. 
Chronic cyclical pelvic pain which worsens over the years. 
Pain is lower abdomen and pelvis that goes to the back. 
Periods are frequent and heavy. 
Sister has painful menses.
PE: 5cm mass is palpated
Tx?
A

refer to get 5cm evaluated

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33
Q

What can cx pms?

A

genetic
ovarian steroids and serotonin
RELATED W/ HORMONES NOT OVULATION

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34
Q

What are sx of pms?

A 
happens 7-10days BEFORE menses
fatigue
breast tenderness
HA
LABILE MOOD - CRANKY, IRRITABLE
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35
Q

What are the dx for pms?

A

sx MUST resolve after the start of the flow

MUST be sx free during the first half of the menstrual cycle

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36
Q

What are nonpharmacologic tx for pms?

A 
education
decrease salt, sugar, fat
increase carbohydrate, fiber
primrose oil, vitamin
exercise
37
Q

What are pharmacologic tx for pms?

A

ibuprofen 400-800mg TID

naproxen 500mg BID

38
Q

What are the sx for PMDD?

A

worse labile mood

sx become problematic

39
Q

How to tx PMDD?

A

SSRI
OCP
tranquilizers for last resort

40
Q

What can cx primary amenorrhea?

A

dysfxn w/hypothalamus/pit
dysfnx w/ovaries
dysfuxn w/uterus/vagina

41
Q

What is dysfxn w/ hypothalamus/pituitary?

A

fxnal hypothalamic amenorrhea
stress
athletic

42
Q

What is dysfxn w/ovaries?

A

turner syndrome

43
Q

What are sx of amenorrhea?

A

no menses by 15yo w/NORMAL growth

no menses AFTER 2yrs of completing sexual maturation

44
Q

What can cause secondary amenorrhea?

A 
pregnancy
dysfxn w/hypothalamus 
thyroid dz
pituitary dz
ovarian dz
uteirne dz
45
Q

What does US look like for endometriosis?

A 
Bilaterally on the OVARIES
o	Small, clear/white lesions
o	Small dark red/brown 
o	Brown cysts
o	Dark red/blue domes
46
Q

What is the common indication for hysterectomy?

A

leiomyomata

47
Q

What are sx for secondary amenorrhea cx’d by pituary dz?

A

glactorrea + amenorrhea

48
Q

What are sx for polycystic ovary sx - secondary amenorrhea?

A

amenorrhea + hyperandrogenism + polycystic ovaries

49
Q

What labs for pituitary dz - secondary amenorrhea?

A

prolactin x2

50
Q

What blood test for ovarian failure?

A

FSH + TSh

51
Q

What labs for ashman’s sx?

A

progestin challenge

52
Q

Secondary amenorrhea - hCG negative, what blood test to do?

A

prolactin

53
Q

hCG neg - not elevated - secondary amenorrhea?

A

progesterone challenge

54
Q

hCG neg - decreased prolactin - progesterone challenge HAS withdrawal blood?

A

polycyst ovarian dz

55
Q

hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood?

A

check for asherman’s sx - pelvic US

56
Q

hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood - test for..?

A

hypogonadism - FSH

57
Q

hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood - FSH is elevated?

A

primary ovarian failure

58
Q

hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood - FSH is NOT elevated?

A

refer to endocrine

59
Q

How to classify abnormal uterine bleeding?

A 
PALM-COEIN
Polyp
Adenomyosis
leiomyoma
Malignancy + hyperplasia
Coagulopathy 
Ovulatory dsyfxn
Endometrial
Iatrogenic
Not yet classified
60
Q

What are sx for abnormal uterine bleeding?

A 
menstrual hx
drug hx
pregnancy
increased bleeding
OCP/IUD
wt hx
61
Q

What to check for in pelvic exam - abnormal uterine bleeding?

A

vaginal/cervical lesions
uterine size/shape
adnexal masses

62
Q

What tests to run for abnormal uterine bleeding?

A

pelvic exam, Pap smear, bx, blood tests

63
Q

What blood tests for abnormal uterine bleeding?

A 
CBC w/ platelets
PT/PTT/bleeding time
hCG
TSh
CG+Chlamydia
FSh/LH + androgen
64
Q

How to tx abnormal uterine bleeding in young?

A

tx the infxn

65
Q

How to tx older female w/ abnormal uterine bleeding?

A

hysterscopy w/ bx or D&C

endometrial ablation

66
Q

What is the cx of endometrial hyperplasia + cancer - abnormal uterine bleeding?

A

endometrial hyperplasia d/t chronic unopposed estrogen stimulation (unbalance of estrogen and progesterone)

67
Q

What is a RF for endometrial hyperplasia + cancer?

A

family hx

68
Q

Abnormal uterine bleeding in postmenopausal 50-60yo woman?

A

endometrial hyperplasia + cancer

69
Q

What are subgroups for leiomyomata?

A
  • Intramural
  • Submucosal
  • Subserosal – outer shell of the uterus
  • Pedunculated – stalk growth
70
Q

Sx for chronic pelvic pain?

A 
•	Noncyclic pain for >6mo in the pelvic
•	Anterior abdominal wall OR below umbilicus
•	Lumosacral back OR buttocks 
AND
•	Functional disability
71
Q

What is Carnett sign?

A

used for chronic pelvic pain
o (+) Myofascial pain
o (-) Visceral/organ involvement

72
Q

What must you do for abnormal bleeding?

A

always r/o cancer

73
Q

What is uterine corpus cancer?

A

endometrial hyperplasia

74
Q

What is the pathophys re: uterine corpus cancer?

A
  • Endometrial cavity → invades myometrium → endocervical canal → lymphatics
  • Overgrowth of endometrium IN RESPONSE to excess unopposed estrogen
75
Q

What are the endogenous and exogenous cx of unopposed estrogen?

A 
endo- chronic anovulation
-glandular
-peripheral
-tumor
exo - systemic estrogen
-conjugated estrogen
-lyophilized estradiol
-patches
-vaginal creams
76
Q

What are the types of uterine corpus cancer?

A

estrogen dependent

estrogen independent - does not need the unopposed estrogen - turns atrophic

77
Q

Sx for uterine corpus cancer?

A

abnormal bleeding in postmenopausal
• >35yo
• <35yo + RF: hx of cancer, obesity, anovulation, tamoxifen/estrogen therapy

78
Q

How to tx uterine corpus cancer?

A
  • Progesterone
  • Surgery – hysterectomy + lymphadenectomy
  • (+) Lymph nodes → RADIATION
  • (+) Lymph nodes but does NOT want radiation → Speculum + rectovaginal exam q3mo x3yrs + 2yrs to detect pelvic recurrent dz
79
Q

What is menopause?

A
  • PERMANENT cessation AFTER ↓ estrogen
  • 12mo w/ NO bleeding
  • GENETICS AND LIFESTYLE (smoking/drinking) influences age of menopause
  • The END of reproductive life
  • Females have a FIXED number of gametes
  • Follicular maturation induced and stimulated by the pituitary release of FSH and LH
80
Q

What sx are indications for low estrogen production - menopause?

A

• Hot flushes*
• Vasomotor instability*
o Fluctuating BP, skin changes, body temp control/fever
• Osteoporosis – must be addressed for future dz

81
Q

What are other sx for menopause?

A
  • Changes of frequency and length of menstrual cycle
  • Mood/memory changes
  • Skin/hair/nail changes
  • Sleep disturbances
  • Vaginal dryness
  • Lipid changes
82
Q

What are tx for menopause?

A
  • E2 → E1 (estrone) in the liver when given orally (it does not change to E1 if given NON orally)
  • Combo estrogen/progesterone
83
Q

Who are at risk for osteoporosis/start screening?

A

• Start @ 65yo OR earlier w/ RF

84
Q

Pathophys re: osteoporosis?

A

• Progesterone/estrogen receptors are in osteoblasts and clasts which affect the development of the cortical and trabcular bone – trabcular bone is most effected

85
Q

Who are at risk for osteoporosis?

A
  • Hx of fragility fx
  • Wt < 127lbs
  • Meds that cx bone loss
  • Parental medical hx of hip fx
  • Smoker/drinker
  • RA
86
Q

How to read results for DEXA-t score?

A
  • > -1: normal
  • -1-2.5: osteopenia
  • < -2.5: osteoporosis
87
Q

How to tx osteoporosis?

A
  • Ca + Vit D3
  • Biphosphonates – up to 5yrs
  • SERMS (Selective Estrogen Receptor modulators)
88
Q

What is premature ovarian failure?

A

30

89
Q

What is perimenopause?

A
  • BEFORE menopause or transition form reproductive to non-reproductive
  • Ovarian estrogen production fluctuates → moods fluctuate

Women's Health (10 decks)

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