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Women's Health > Menstrual and Uterine Disorders (Exam 1) > Flashcards

Menstrual and Uterine Disorders (Exam 1) Flashcards

1
Q

What should always be ruled out during Amenorrhea

A

Pregnancy

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2
Q

What is Primary Amenorrhea

A

The failure of menses to occur by age of 15 in presence of normal secondary sexual characteristics

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3
Q

Possible Causation of Primary Amenorrhea

A

Outflow obstruction
Pregnancy
Gonadal dysgenesis
Turner’s syndrome

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4
Q

what is Secondary Amenorrhea

A

Cessation of menses for more than 3 cycle intervals or 6 consecutive months \
but you have had post menstruating

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5
Q

possible causes of Amenorrhea

A 
Pregnancy 
PCOS
Hypothyroidism 
Anorexia/wt loss
Cushing Syndrome
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6
Q

What are some of the things that can cause pituitary dysfunction

A 
Radiation
Sx
sheehan's syndrome
Postpartum....
Pituitary necrosis
Thalassemia-iron deposition
Pituitary adenomas- elevated prolactin levels 
Galactorrhea
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7
Q

Ovarian causes of Amenorrhea

A

Ovarian dysgenesis- failure of ovaries to develop

Premature ovariean failure- depletion of ova efore age 40

PCOS- Exact mechanism unknown; hyperinsulinemia= increased androgens

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8
Q

Anatomic Abnormalities that will cause Amenorrhea

A 
Mullerian dysgenesis 
Vaginal agenesis
transverse vaginal septum
Imperforate hymen
Asherman's syndrome
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9
Q

What needs to be done for screening and diagnoses of Amenorrhea

A 
HCG
Thyroid panel 
FSH, LH, estrodial, prolactin
Androgen testing
CBC with diff.    CMP, ESR
Pelvic US
MRI
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10
Q

What is a Progesterone Challenge

A

utilization of oral medroxyprogesterone acetate (provera) 10 mg daily for 5-10 days
Induces withdrawal bleeding if serum estradiol level is ≥ 50 pg/ml

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11
Q

Treatment of Amenorrhea

A

Treating the underlying causation of the amenorrhea

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12
Q

What is painful or difficult menstruation called

A

Dysmenorrhea

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13
Q

what percentage of postpubertal females will expereince Dysmenorrhea

A

50%

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14
Q

When is it common to expereince Dysmenorrhea as a woman

A

First few years of menstruation

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15
Q

Prevalence of dysmenorrhea is higher in what population

A

higher in smokers

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16
Q

Primary and secondary dysmenorrhea and differences

A

Primary- occurs in the absence of pelvic pathology

Secondary pelvic pathology is present (fibroids, endometriosis etc)

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17
Q

what is the hormone in association with dysmenorrhea

A

Prostaglandin F2alpha

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18
Q

Clinical presentation of Dysmenorrhea

A

Lasts 2-3 days
Labor-like cramping
Lower abdominal pain that radiates to back or thighs
Pelvic and rectal examinations are all within normal limits (WNL)

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19
Q

Clinical presentation of Secondary dysmenorrhea

A 
Begins between 20-40 typically 
Heavy irregular flow
dysparenunia
infertility 
bloating
back pain 
pelvic heaviness
no improvement with OCP or NSAIDs
Potential exam findings include vervical motion tenderness, palpable uterine mass, adnexal tenderness
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20
Q

Diagnosis of Dysmenorrhea

A

Primary- no specific tests

Secondary- CBC w/ diff. STI’s, HCG, ESR, UA, stool guaiac, US, CT, Laproscopy

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21
Q

Treatment of Dysmenorrhea

A

NSAID’s
Heat
Oral Contraceptive pills (OCP’s)
Smoking cessation

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22
Q

What is Premenstrual Syndrome (PMS)

A

Cyclical behavioral, psychological, and physical changes during the luteal phase

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23
Q

Pathophysiology of premenstrual syndrome

A

Unknown
rapid shift in hormonal levels
calcium and magnesium deficiency
decrease in serotonin levles

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24
Q

Clinical presentation of PMS

A

Symptoms occur before menstrual period and resolve with menses

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25
What are the 5 categories of symptoms with PMS
Anxiety: Irritability, mood swings, tene, difficulty sleeping, clumsiness Cravings: Sweet foods, salty foods, other foods,HA Depression: Angry, easily upset, poor concentration/memory, decreased self worth, violent hydration: wt gn, bloating, swelling breast tendernesss Other: dysmenorrhea, frequent urination, hot flashes, cold sweats, nausea, acne, allergic reactions, URIs, bowel habits
26
DIagnosis of PMS
Does not exist there are no lab exams that can determine this. made on presentation and discussion
27
Treatment for PMS
No universally accepted TX Lifestyle and activity Leuprolide (lupron) for ovarian suppression - not a necessarily great option because basically forces menopause chemically NSAIDs Diruetics fluoxetine (prozac), Sertraline (Zoloft) Alprazolam (Xanax) Calcium, magnesium OCP to reuce LH and FSH from pituitary by decreasing GnRH
28
Premenstrual Dysphoric Disorder (PMDD)
Severe premenstrual distress inteferes with ocupational and social functioning in up to 8% of the women in US typically ages 30-50
29
Risk factors for PMDD
Sexual abuse domestic violence premenstrual mood changes/depression Personal or family history of mood disorders Pathophys- Serotonin decresed serotonergic activity sensitiity to serotonin flucuations altered premenstrually
30
Clinical presentation of PMDD
Irritability | mental status exam may be abnormal during the luteal phase
31
Diagnosis
rule out organic causes -Anemia, thyroid disorders, menopause Complete CBC with diff, TSH, FSH,
32
Tx of PMD
Acupuncture CBT Hysterectomy with bilateral oophorectomy Pharmacologics
33
Follow up for PMDD
Follow up every 2 weeks until stabilized | if there is no improvement in 2-3 cycles, try another therapy
34
Irregular uterine bleeding without pelvic pathology, pregnancy, or other medial disease
Abnormal Uterine Bleeding (AUB)
35
what percentage of women are seen in outpt visits with abnormal uterine bleeding
5-10% of women
36
______ percentage of women with Abnormal Uterine Bleeding are _______ years of age
50% are 40-50 years of age
37
what is AUB usually associated with
Anovulatory cycles , Diagnosis of exclusion
38
Causes of Abnormal Uterine Bleeding
Estrogen breakthrough bleeding Estrogen withdrawal bleeding Iatrogenic Bleeding disorders
39
What is the pathophys of Abnormal Uterine Bleeding (AUB)
Constant estrogen that stimulates proliferation of the endometrium constantly... the proliferation eentually leads to the point where the wall could no longer be maintained by blood supply random sloughing off due to dead tissues that outfrew the ability of the blood supply to provide for the cells
40
Clinical presentation of AUB
Unpredictable bleeding Heavy or light, splotching... etc. Chronic low estrogen- lgiht infrequent AUB Chronic high estrogen- high frequent AUB Pelvic exams will all be within normal limits (WNL)
41
diagnosis of AUB
``` R/o pregnancy R/o iatrogenic causes R/o bleeding disorders LFTs Pap smear Endometrial biopsy ```
42
TX of abnormal uterine bleeding
Low dose combination OCPs Levonorgestrel (IUD) Cyclic progestin therapy if medical therapy fails, consider further testing hystorectomy endometrial ablation
43
what is Endometriosis
The presence of endometrial tissue (glands and stroma) abnormally implanted in locations other than the uterine cavity Adenomyosis- ectopic endometrial tissue exists within and grows into myometria
44
Risk factors for Endometriosis
``` Family history Early age Short menstrual cycles <27 days) Long duration of menstrual flow (>7 days) heavy bleeding during menses Inverse relationship to parity Delayed childbearing Defects in the uterus or fallopian tubes ```
45
Etiology of Endometriosis
Exact mechanism is unknown
46
what are the most common locations for endometriosis
Posterior and anterior cul-de-sac uterosacral ligaments, tubes, ovaries but can occur in any organ system
47
What happens in pts with endoetriosis
tissue responds to cyclic hormonal fluctuations in much the same way as the intrauterine endometrium Metabolic products , including cytokines and prostoglandins, lead to altered inflammatory response
48
Clinical presentation of pts with endometriosis
``` if not asymptomatic (30%) Pelvic pain dyspareunia heavy/irregular bleeding lowe back pain lower abdominal pain pain with urination or defecation bloating, nausea, vomiting Exam WNL except for tenderness at site involved ```
49
Endometriosis diagnosis
CT, US, and MRI are only useful in advanced disease laparoscopy is the procedure of choice Sens. 97% specificity 77%
50
What does endometriosis look lke on inspection with laparoscopy
Powder-burned or black-blue lesions
51
Tx of Endometriosis
OBGYN referral Combined OCP's Progesterone (oral, injection, IUD) Surgical intervention - removal of lesions Conservative-maintain potentialy fertility
52
What is the Recurrence rate of endometriosis
15%
53
what is a leiomyoma
Uterine Fibroids | They are noncancerous uterine growths
54
What is the leading cause of hysterectomy's in the US
Leiomyomas
55
Risk factors of leiomyoma
Obesity, nulliparity, menarche prior to age of 10, African American ethnicity
56
what are the clinical presentations of leiomyomas
Usually asymptomatic, ``` Heavy bleeding (menorrhagia) Frequent urination Constipation Infertility Bloating Mass may be palpated during Pelvic Exam ```
57
Diagnosis of Leiomyomas
US: abdominal, transvaginal, pelvic MRI
58
Tx of Leiomyoma
NSAIDs Hormonal: OCP may help with bleeding Progesterone may help with bleeding leuprolide acetate shrinks fibroids (GnRH agonist) Proceedures myomectomy Hysterectomy
59
what is the most common gynecologic malignancy
Endometrial Cancer
60
What percentage of pts that are diagnosed with Edometrial cancer are postmenopausal
75-80 percent
61
What are a few risk factors for Endometrial Cancer
Obesity and nulliparity
62
what decrease the risks of Endometrial Cancer
OCPs and Smoking
63
Pathophysiology of Endometrial Cancer
Estrogen stimulates the endometrium Endometrial hyperplasia Endometrial cancer
64
Clinical Presentation of Endometrial Cancer
Postmentapausal bleeding * investigate all bleeding during menopause unless the pt is on cyclic replacement therapy with normally anticipated withdrawal bleeding
65
Endometrial Cancer Diagnosis
Vaginal US Endometrial biopsy Hysteroscopically directed biopsy
66
Tx of Endometrial Caner
Refer to OBGYN and Oncology SX Chemotherapy Radiation
67
What is the prognosis of those who are diagnosed with endometrial cancer
Approximately 80% survival rate
68
PCOS causes what
Menstrual dysfunction/anovulation, hyperandrogenism, polycistic ovaries
69
Polycystic Ovarian Syndrome is not completely understood however what are considered risk factors
Heredity, obesity, insulin resistance
70
Clinical Presentation of PCOS
``` Amenorrhea oligomenorrhea chronic anovulation hyperandorogensm: causes excess body hair in a male distribution pattern Obesity ```
71
PCOS can cause infertility and _______ ovulation
Sporadic ovulation
72
Metabolic Syndrome is in what percentage of PCOS pts
43%
73
What labs assist with finding the diagnosis (by exclussion) of PCOS
TSH, T4, T3, FSH, LH, androgen index, prolactin, HCG, lipid panel , Tests: Oral Glucose tolerance test, Pelvic US test
74
TX of PCOS
Diet and exercise OCPs, metformin ``` Menstrual abnormalities/hirsuitism OCPs spironolactone Infertility -Clomiphene, letrozole Metabolic abnormalities Metformin Caution with statins ```

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