menstration concerns Flashcards
PCOS
CLINICAL
- androgen excess
- menstrual irregularities: anovulation or oligoovulation
- obesity
- polycystic ovaries on US
PATHOPHYS
- increased testosterone
- increased estrogen
- LH/FSH imbalance
- failure of follicle maturation
COMORBIDITIES
- metabolic syndrome
- OSA
- NAFLD
- endometrial hyperplasia/cancer
TREAT
- weight loss
- OCPs
- clomiphen citrate for ovulation induction
- metformin
DIAGNOSIS
- 2 of 3: irregular menses, polysictic ovaries on US, hyperandrogenism
- must exclude cushing, CAH, etc
primary ovarian insufficiency
CLINICAL
- amenorrhea at age less than 40 (no period for more than 6 months)
- hypostrogenic symptoms: hot flashes
- high FSH
- low Estrogen
- failed progesterone withdrawal test
CAUSES
- turner syndrome
- fragile x syndrome (carriers can have accelerated follicle depletion)
- autoimmune oophoritis
- pelvic radiation
- galactosemia
MANAGE
-estrogen therapy
Secondary causes of dysmenorrhea
CLINICAL
- onset age over 25
- unilateral non midline pelvic pain
- no systemic symptoms
- AUB
CAUSES
- PID
- endometriosis
- adnexal masses
- uterine anomaly
secondary amenorrhea
-amenorrhea for more than 3 months after having previously regular menses
CAUSES
- pregnancy
- HPO dysfunction
- endocrine abnormalities
EVAL
- pregnancy test
- FSH
- TSH
- prolactin levels
Primary dysmenorrhea
ETI
-excessive prostaglandin production
RISK
- age less than 30
- BMI less than 20
- tobacco use
- menarche less than 12
- heavy/long menstrual periods
- sexual abuse
CLINICAL
- pain first 2-3 days of menses
- nausea, vomiting, diarrhea
- normal pelvic exam
MANAGE
- NSAIDs
- OCPs
imperforate hymen
PATHOGEN
- incomplete degeneration of hymen
- isolated genital outflow tract defect
CLINICAL
- cyclic lower abdominal pain
- bulk symptoms: defecatory and urinary dysfunction
- primary amenorrhea
- suprapubic mass (uterus)
- blue tinged vaginal mass
MANAGEMENT
-hymenal incision and drainage
androgen insensitivity syndrome
PATHO
- X linked mutation in androgen receptor
- nonfunctioning receptor
- antimullarian hormone still works, so no female internal structures form
CLINICAL
- genotypically male
- phenotypically female
- breast development
- absent or minimal pubic hair
- female external genitalia
- absent uterus, cervix, and upper 1/3 of a vagina
- cryptochorid testes
- primary amenorrhea and male range testosterone
MANAGE
- gender identity/assignment counseling
- gonadectomy for malignancy prevention
physiologic leukorrhea
- cervical discharge -composed of cervical mucus, normal flora, and vaginal squamous cells
- occurs mid-cycle
- no manifestations of infection
- rare polymorphonuclear leukocytes
Hyperandrogenism
CLINICAL
- hirsutism
- nodulocystic acne
- androgenic alopecia
- increased serum testosterone
DDx
- PCOS
- androgen-secreting tumor
- cushing syndrome
- nonclassical CAH
immaturity of developing hypothalamic-pituitary gonadal axis
- inadequate proportions of GNRH and therefore FSH and LH
- annovulation
- endometrium builds up due to estrogen
- estrogen breakthrough bleeding due to lack of progesterone
- resolves after 1-4 years
TREAT
-progestin only or OCPs if bleeding is disruptive, heavy, or results in anemia
Progesterone withdrawal bleeding test
-confirms normal estrogen production and proliferative endometrium
ELIMINATES
- estrogen deficiency (primary ovarian insufficiency)
- endometrial abnormalities (intrauterine adhesions)
- outlet tract abnormalities (imperforate hymen)
Nonclassic congenital adrenal hyperplasia
PATHOPHYS
- AR
- low 21 hydroxylase activity
- normal gluco and mineralocorticoids
- increased androgens
CLINICAL
- early pubic/axillary hair growth
- severe acne
- hirsutism and oligomenorrhea in girls
- increased growth velocity and bone age
- increased 17 hydroxyprogesterone level
TREATMENT
-hydrocortisone
Side effects and risks of combination oral contraceptives
- breakthrough bleeding
- breast tenderness, nausea, bloating
- amenorrhea
- hypertension
- venous thromboembolic disease
- decreased risk of ovarian and endometrial cancer
- increased risk of cervical cancer
- liver disorders
- increased triglycerides
endometrial polyp
- premenoapusal patient
- regular monthly menses plus intermenstrual bleeding
- typically develop in women in their 30s and 40s
- small, nontender uterus on exam
- no visible cervical or vaginal lesions
- treat with hysteroscopic polypectomy
estrogen-progestin contraceptives: benefits and risks
BENEFITS
- pregnancy prevention
- endometrial and ovarian cancer risk reduction
- menstrual regulation
- hyperandrogenism treatment
RISK
- venous thromboembolism
- HTN
- hepatic adenoma
- stroke, MI
- cervical cancer
