Menstrual Abnormalities: PCOS, PMS, Dysmenorrhea, etc. Flashcards
1
Q
Terms for abnormal menses, and 2 main groups of causes
A
- Amenorrhea: lack of menses
- Metrorrhagia: irregular bleeding (btw menses)
- Menorrhagia: heavy but regular bleeding
- Dysmenorrhea: painful menses
Causes:
1. Hormonal
2. Structural
2
Q
Ovulatory dysfunction
A
- anovulatory cycles; hormonal problem where there’s enough estrogen but insufficient progesterone
- hx of irregular, occasionally heavy bleeding
- in adolescents - it’s a nuisance but will likely normalize; tx with progesterone
- in perimenopausal women they may be at risk for neoplasia - must rule out; tx with progestin only
- in women of repro age - may be due to PCOS, pregnancy, anorexia, premature ovarian insufficiency, hypothyroidism, hyper-Prl
- other causes of irregular bleeding in general: cervical cancer, endometrial cancer, cervicitis, endometrial polyp
3
Q
Polycystic Ovarian Syndrome (PCOS)
A
- a metabolic disorder associated with insulin resistance (IR), inc. androgens (contributes to IR; will also see acanthosis nigracans which is related to IR), and anovulation
- clinically there’s the classic triad: anovulation/amenorrhea, hirsutism/acne, and polycystic ovaries
- thought to be related to obesity/amount of adipose and estrone produced there, which inc. LH, more androstenedione which gets converted to testosterone
- tx depends on goals:
- -> regular pd: tx with OCPs
- -> fix hirsutism: tx with OCPs (anti-androgenic) or dipilatories
- -> get pregnant: use ovulatory agents, metformin
4
Q
Premature Ovarian Insufficiency
A
- loss of varian function before age 40
- triad for dx includes amenorrhea, hypergonadotropism, and hypoestrogenism
- note that secondary ovarian insufficiency is from the hypothalamus failing to produce FSH
5
Q
Endometrial polyps
A
- polyp in the endometrium just made from normal cells
- usually asx, but sx may include extra bleeding, or the polyp is a source of blood for spotting
- may also cause dysmenorrhea if it protrudes into vagina
6
Q
Ovarian cancer and hirsutism
A
these tumors produce abnormally high levels of testosterone, which can cause virilization/hirsutism
7
Q
How to rule out cancer as a source of irregular bleeding?
A
- pap smear
- endometrial biopsy
- ultrasound
8
Q
Dysmenorrhea
A
- severe pain during menses; peak age is 20-24
- all about PGs: progesterone suppresses PG receptors, and when prog falls PGs are produced; menstrual fluid has higher levels of PGF2alpha and PGE2; infusions of PGs cause uterine contractions and pain; NSAIDs are effective at pain relief (stop PG production process)
- can be primary (no known cause) or secondary (to things like PID, endometriosis, ovarian cysts)
9
Q
Endometriosis
A
- endometrial tissue anywhere outside the uterus (endometrial cavity), most often on surface of tube, ovary, or peritoneal surfaces; small vs. large
- benign but can be painful because it responds to hormones–bleeds cyclically, causes dysmenorrhea, pelvic pain/mass, dyspareunia, and infertility; clinically apparent in 30s
- theories for etiology: retrograde menstrual flow, totipotent cells differentiate there, hematologic spread?
- can tx with OCPs and NSAIDs; if no relief then do laparoscopy for biopsy/dx/removal vs. cautery vs. hysterectomy
- pathology: has 2 components - glands and stroma, plus hemosiderin
10
Q
Premenstrual syndrome
A
- unknown etiology, pain worsens with age but only in ovulating women
- sx include bloating, wt gain, irritability, difficulty concentrating, tiredness, moodiness
- tx with NSAIDs, diuretics, OCPS, diet, SSRIs
11
Q
Premenstrual dysmorphic disorder (PMDD)
A
- extreme form of PMS with the regular symptoms, plus at least one: sadness/hopelessness, anxiety/tension, extreme moodiness, marked irritability/anger
- likely an underlying behavioral disorder that worsens when PMS is added on
- tx with SSRIs, OCPs, diet/exercise, nutritional supp. of Ca, B6, Mg, L-tryptophan; avoid stressors
