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women's health > menstrual > Flashcards

menstrual Flashcards

1
Q

cyclic bleeding occurs every how many days

A
  • 21-35 days
    • cycle day #1 (first day of bleeding) through cycle day #1 of next cycle
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2
Q

life cycle of corpeus luteum is

A

always 14 days

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3
Q

What is primary amenorrhea

A
  • lack of onset of menses by age 15 (with normal growth and secondary sex characteristics)
  • lack of onset of menses by age 13 with lack of normal secondary sex characteristics
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4
Q

lack of menses for 6 months after irregular or 3 months of regular menses

A

secondary amenorrhea

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5
Q

what should be checked on every patient who presents with amenorrhea

A

urine or serum HCG for pregnancy

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6
Q

What is DDX in a female patient who presents with primary amenorrhea and the patient is found to be genotypically male (XY)

A
  • 5α-Reductase deficiency
    • is an enzyme that converts testosterone to 5α-dihydrotestosterone (DHT) in peripheral tissues
  • Androgen insensitivity syndrome
    • resistant to male hormones (called androgens).
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7
Q

What is DDX in a female patient who presents with primary amenorrhea and you suspect defect of urogenital sinus development

A
  • vaginal agenesis
  • transverse vaginal septum
  • imperforate hymen
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8
Q

asherman’s syndrome etiologies

A
  • iatrogenic or infectious damage to endometrium
  • causes
    • aggressive surgical curetting
    • infectious disease (ex. TB)
    • h/o multiple cesarean sections
    • endometrial ablation
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9
Q

asherman’s syndrome can present as primary or secondary amenorrhea

A

can present as either primary or secondary amenorrhea

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10
Q

What are some causes of hypothalamic dysfunction -> GnRH deficiency

A
  • genetic
  • weight loss resulting in <10% body fat
  • extreme exercise
  • nutritional deficiencies
  • extreme stress
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11
Q

role of prolactin in amenorrhea

A
  • prolactin inhibits GnRH resulting in low gonadotropins and low gonadal hormones
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12
Q

if persistent hyperprolactinemia, review patient h/o of

A
  • pregnancy or breastfeeding
  • medications
  • excessive breast stimulation
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13
Q

What are some symptoms of prolactinoma

A
  • hyperprolactinemia
  • galactorrhea
  • HA
  • visual disturbances
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14
Q

What is sheehan syndrome associated with? What is the result?

A
  • associated with significant hemorrhage during childburth with resulting hypotension and decreased blood flow to pituitary causing ischemic damage
    • results in low gonadotropins (FSH, LH) as well as other pituitary hormones -> secondary amenorrhea
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15
Q

what condition should you consider in a women who goes through menopause before age of 40 yo with a h/o chemotherapy, radiation, or systemic illness

A

primary ovarian insufficiency (premature ovarian failure)

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16
Q

Dysfunction in what organ can lead to annovulatory cycles

A

thyroid

17
Q

what lab tests should be ordered for patient presenting with amenorrhea

A
  • HCG
  • CBC
  • TSH
  • LH, FSH, estradiol
  • Prolactin
  • Total testosterone
18
Q

What is prolonged or excessive, but regular bleeding

A

Menorrhagia

19
Q

what is irregular and frequent bleeding

A

Metrorrhagia

20
Q

what is intermenstrual bleeding

A

bleeding between otherwise regular cycles

21
Q

What is excessive irregular bleeding

A

menometrorrhagia

  • a combination of metrorrhagia and menorrhagia
22
Q

what is polymenorrhea

A

regular cycles shorter than 21 days

23
Q

List the causes of abnormal uterine bleeding

A

PALM-COEIN

  • Polyps
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia
  • Coagulation problems
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
24
Q

Workup for patients with abnormal uterine bleeding under age 15 yo

A
  • CBC, coags
25
Q

patients with abnormal uterine bleeding under age 15 yo, think about what disease as the cause

A

von Willebrand disease

26
Q

patients with abnormal uterine bleeding under age 15 yo often have what types of cycles

A
  • anovulatory cycles
  • responds well to withdrawal bleeding
27
Q

Workup for adult patients with abnormal uterine bleeding

A
  • TSH
  • pregnancy test
  • CBC
  • pelvic sonogram
  • Pap
  • Endometrial biopsy (over age 40)
    • r/o endometrial cancer
28
Q

What is primary dysmenorrhea

A
  • presence of recurrent, crampy, lower abd pain that occurs near or at the onset of menses and typically lasts 12-72 hours without evidence of pathology
29
Q

primary dysmenorrhea caused by

A
  • prostaglandins E2 and F2 released from endometrial sloughing which cause contractions to expel menstrual flow and uterine ischemia
30
Q

treatment of primary dysmenorrhea

A
  • trial with NSAID or OCP first step
    • NSAID tx prior to onset of cycle
31
Q

List differential for secondary dysmenorrhea

A
  • endometriosis
  • PID
  • uterine fibroids
  • adenomyosis
  • IBD
  • interstitial cystitis
32
Q

Secondary dysmenorrhea

A

pain that is caused by a disorder in the woman’s reproductive organs

33
Q

work up for secondary dysmenorrhea

A
  • pelvic sonogram
  • cervical cultures in sexually active patients
  • laparoscopy in pts who do not respond to NSAID or OCP
34
Q

Diagnostic criteria for PMS ( Premenstrual syndrome )

A
  • presence of < or = 4 emotional and/or physical symptoms which occur cyclically during the luteal phase of menstrual cycle
  • be present in the 5 days before period for at least three menstrual cycles in a row
  • end within 4 days after period starts
35
Q

what is Premenstrual dysphoric disorder

A
  • a more severe form of PMS with five or more PMS with > or = 5 PMS symptoms and at leas one clinically significant affective or emotional symptom such as mood swings, feeling of hopelessness or rate
    • lasting more than a year
    • luteal phase primarily
36
Q

diagnosis criteria for Premenstrual dysphoric disorder

A
  • symptoms occur during luteal phase
  • symptoms resolve with onset of menses
  • symptoms are associated with ovulatory cycles only
  • associated with gonadal steroids and serotonin
37
Q

treatment of mild symptoms of PMS and PMDD

A
  • exercise
  • limit salt
  • increase water
  • reduce ETOH
  • OTC analgesic
38
Q

treatment of moderate to severe symptoms of PMS and PMDD

A
  • SSRI
  • ovulation suppression
  • GnRH agonists
  • surgery

women's health (5 decks)

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