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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
Sx/hx for uterine leiomyomata?
increased uterine bleeding | increased pelvic pressure/pain which causes urgency and frequency
26
What tests/exams would you do for uterine leiomyomata?
pelvic exam - enlarged, irregular, mobile uterus blood - cbc, tsh, pap smear imaging - +/-transvaginal US
27
Tx for uterine leimyomata?
Waiting – Tx the sx OCP GnRH analogs Surgery – hysterectomy or myomectomy
28
Tx for uterine leimyomata if sx are problematic?
if sx are problematic -> refer: hysterectomy
29
What to be on the alert for postmenopausal women w/ uterine leimyomata?
new/enlarging fibroids
30
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?
Pelvic exam - fixed, uterosacral ligaments are nodular, 5cm adnexal mass and tender
31
``` 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? ```
Endometriosis painful menses + family hx pain is getting worse over the years PE - tender adnexal mass, fixed
32
``` 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? ```
refer to get 5cm evaluated
33
What can cx pms?
genetic ovarian steroids and serotonin RELATED W/ HORMONES NOT OVULATION
34
What are sx of pms?
``` happens 7-10days BEFORE menses fatigue breast tenderness HA LABILE MOOD - CRANKY, IRRITABLE ```
35
What are the dx for pms?
sx MUST resolve after the start of the flow | MUST be sx free during the first half of the menstrual cycle
36
What are nonpharmacologic tx for pms?
``` education decrease salt, sugar, fat increase carbohydrate, fiber primrose oil, vitamin exercise ```
37
What are pharmacologic tx for pms?
ibuprofen 400-800mg TID | naproxen 500mg BID
38
What are the sx for PMDD?
worse labile mood | sx become problematic
39
How to tx PMDD?
SSRI OCP tranquilizers for last resort
40
What can cx primary amenorrhea?
dysfxn w/hypothalamus/pit dysfnx w/ovaries dysfuxn w/uterus/vagina
41
What is dysfxn w/ hypothalamus/pituitary?
fxnal hypothalamic amenorrhea stress athletic
42
What is dysfxn w/ovaries?
turner syndrome
43
What are sx of amenorrhea?
no menses by 15yo w/NORMAL growth | no menses AFTER 2yrs of completing sexual maturation
44
What can cause secondary amenorrhea?
``` pregnancy dysfxn w/hypothalamus thyroid dz pituitary dz ovarian dz uteirne dz ```
45
What does US look like for endometriosis?
``` Bilaterally on the OVARIES o Small, clear/white lesions o Small dark red/brown o Brown cysts o Dark red/blue domes ```
46
What is the common indication for hysterectomy?
leiomyomata
47
What are sx for secondary amenorrhea cx'd by pituary dz?
glactorrea + amenorrhea
48
What are sx for polycystic ovary sx - secondary amenorrhea?
amenorrhea + hyperandrogenism + polycystic ovaries
49
What labs for pituitary dz - secondary amenorrhea?
prolactin x2
50
What blood test for ovarian failure?
FSH + TSh
51
What labs for ashman's sx?
progestin challenge
52
Secondary amenorrhea - hCG negative, what blood test to do?
prolactin
53
hCG neg - not elevated - secondary amenorrhea?
progesterone challenge
54
hCG neg - decreased prolactin - progesterone challenge HAS withdrawal blood?
polycyst ovarian dz
55
hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood?
check for asherman's sx - pelvic US
56
hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood - test for..?
hypogonadism - FSH
57
hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood - FSH is elevated?
primary ovarian failure
58
hCG neg - decreased prolactin - progesterone challenge NO withdrawal blood - FSH is NOT elevated?
refer to endocrine
59
How to classify abnormal uterine bleeding?
``` PALM-COEIN Polyp Adenomyosis leiomyoma Malignancy + hyperplasia Coagulopathy Ovulatory dsyfxn Endometrial Iatrogenic Not yet classified ```
60
What are sx for abnormal uterine bleeding?
``` menstrual hx drug hx pregnancy increased bleeding OCP/IUD wt hx ```
61
What to check for in pelvic exam - abnormal uterine bleeding?
vaginal/cervical lesions uterine size/shape adnexal masses
62
What tests to run for abnormal uterine bleeding?
pelvic exam, Pap smear, bx, blood tests
63
What blood tests for abnormal uterine bleeding?
``` CBC w/ platelets PT/PTT/bleeding time hCG TSh CG+Chlamydia FSh/LH + androgen ```
64
How to tx abnormal uterine bleeding in young?
tx the infxn
65
How to tx older female w/ abnormal uterine bleeding?
hysterscopy w/ bx or D&C | endometrial ablation
66
What is the cx of endometrial hyperplasia + cancer - abnormal uterine bleeding?
endometrial hyperplasia d/t chronic unopposed estrogen stimulation (unbalance of estrogen and progesterone)
67
What is a RF for endometrial hyperplasia + cancer?
family hx
68
Abnormal uterine bleeding in postmenopausal 50-60yo woman?
endometrial hyperplasia + cancer
69
What are subgroups for leiomyomata?
* Intramural * Submucosal * Subserosal – outer shell of the uterus * Pedunculated – stalk growth
70
Sx for chronic pelvic pain?
``` • Noncyclic pain for >6mo in the pelvic • Anterior abdominal wall OR below umbilicus • Lumosacral back OR buttocks AND • Functional disability ```
71
What is Carnett sign?
used for chronic pelvic pain o (+) Myofascial pain o (-) Visceral/organ involvement
72
What must you do for abnormal bleeding?
always r/o cancer
73
What is uterine corpus cancer?
endometrial hyperplasia
74
What is the pathophys re: uterine corpus cancer?
* Endometrial cavity → invades myometrium → endocervical canal → lymphatics * Overgrowth of endometrium IN RESPONSE to excess unopposed estrogen
75
What are the endogenous and exogenous cx of unopposed estrogen?
``` endo- chronic anovulation -glandular -peripheral -tumor exo - systemic estrogen -conjugated estrogen -lyophilized estradiol -patches -vaginal creams ```
76
What are the types of uterine corpus cancer?
estrogen dependent | estrogen independent - does not need the unopposed estrogen - turns atrophic
77
Sx for uterine corpus cancer?
abnormal bleeding in postmenopausal • >35yo • <35yo + RF: hx of cancer, obesity, anovulation, tamoxifen/estrogen therapy
78
How to tx uterine corpus cancer?
* 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
What is menopause?
* 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
What sx are indications for low estrogen production - menopause?
• Hot flushes* • Vasomotor instability* o Fluctuating BP, skin changes, body temp control/fever • Osteoporosis – must be addressed for future dz
81
What are other sx for menopause?
* Changes of frequency and length of menstrual cycle * Mood/memory changes * Skin/hair/nail changes * Sleep disturbances * Vaginal dryness * Lipid changes
82
What are tx for menopause?
* E2 → E1 (estrone) in the liver when given orally (it does not change to E1 if given NON orally) * Combo estrogen/progesterone
83
Who are at risk for osteoporosis/start screening?
• Start @ 65yo OR earlier w/ RF
84
Pathophys re: osteoporosis?
• Progesterone/estrogen receptors are in osteoblasts and clasts which affect the development of the cortical and trabcular bone – trabcular bone is most effected
85
Who are at risk for osteoporosis?
* Hx of fragility fx * Wt < 127lbs * Meds that cx bone loss * Parental medical hx of hip fx * Smoker/drinker * RA
86
How to read results for DEXA-t score?
* >-1: normal * -1-2.5: osteopenia * < -2.5: osteoporosis
87
How to tx osteoporosis?
* Ca + Vit D3 * Biphosphonates – up to 5yrs * SERMS (Selective Estrogen Receptor modulators)
88
What is premature ovarian failure?
30
89
What is perimenopause?
* BEFORE menopause or transition form reproductive to non-reproductive * Ovarian estrogen production fluctuates → moods fluctuate

Women's Health (10 decks)

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