MENSTRATION

Question 1

What is the cause of painful menstruation? What is painful menstruation known as?

Answer 1

dysmenorrhea

- Caused by excess prostaglandin and leukotriene levels

Question 2

When does dysmenorrhea usually start? (for age and day during menses)

Answer 2

within 2 years of menarche

- Usually just before or at the onset of menses (lasting 1-3 days)

Question 3

How do you treat dysmenorrhea?

Answer 3

NSAIDs, OCP’s, Vit B, Mg, heat, and regular exercise

Question 4

What is secondary dysmenorrhea, how do you treat it?

Answer 4

painful menstruation due to an identifiable cause (usually older than 25)

Question 5

What is dysfunctional uterine bleeding?

Answer 5

abnormal uterine bleeding, with an unremarkable PE in a very young or perimenopausal woman

Question 6

How would you workup DUB?

Answer 6

Make sure they’re not pregnant! (urinary beta-hcg)
CBC, iron studies, TSH, PT, PTT
Pap, endometrial biopsy, pelvic U/S

Question 7

How do you treat DUB?

Answer 7

Progestin trial
OCP’s (as long as no risk factors)
D&C

Question 8

What is the difference between primary vs secondary amenorrhea?

Answer 8

Primary = absence of spontaneous menstruation by age 16
Secondary = in a woman who previously mendtruated, the absence of menses x3 months if cycle were previously normal OR absence x6 months for females with irregular menses.

Question 9

How do you workup amenorrhea?

Answer 9

Start with Beta-hcg for preggo, TSH, and prolactin
FSH, estrogen, LH, and testosterone levels
*Progesterone challenge – determines the presence of absence of sufficient estrogen

Question 10

What is the definition of menopause? When does it normally occur?

Answer 10

cessation of menses x1 whole year

Avg. age = 51.5

Question 11

What are some of clinical features associated with menopause?

Answer 11

Vasomotor sxs
              Urogenital atrophy
              Accelerated bone loss
              Estrogen-related cardiovascular protection
              Changes in sleep cycle

Question 12

What are some of the contraindications to hormone replacement therapy?

Answer 12

undiagnosed vaginal bleeding, vascular thrombosis, liver dz, and hx of endometrial or breast CA
Any unopposed estrogen (even topical) in a female with a uterus will increase the risk of endometrial cancer

Question 13

What are the general rules for dosing hormone therapy?

Answer 13

Start low, titrate up as needed

Limit hormone therapy use to 5 years or less

Question 14

When should you discontinue hormone therapy?

Answer 14

Individualized, based on woman’s symptoms and risk-benefit ratio – regardless of age or duration of use

Question 15

What are some non-hormonal treatments for menopause?

Answer 15

Phytoestrogens (soy beans)

Herbal, vitamin E, acupuncture, lifestyle changes

Question 16

What are potential DDx for post-menopausal bleeding?

Answer 16

Polyps, endometrial atrophy endometrial hyperplasia, endometrial cancer
Other: Hormone therapy, infection, blood thinners
**ALWAYS R/O CANCER

Question 17

What are the 2 types of osteoporosis?

Answer 17

1 – post menopausal (MC)

2 – senile, occurs in men and women due to other diseases

Question 18

What is the MC reason type 1 osteoporosis occurs?

Answer 18

Because of the loss of estrogen – trabecular bone is effected

Question 19

What are some of the modifiable risk factors that can lead to osteoporosis?

Answer 19

alcoholism, smoking, low body weight, sedentary life, low calcium/vit d, corticosteroid use

Question 20

What is the drug class that we can use to treat osteoporosis?

Answer 20

bisphosphonates (take on an empty stomach, must stay upright x30-60mins)
(Fosamax or alendronate)