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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
Q

What are the 5 categories of symptoms with PMS

A

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

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26
Q

DIagnosis of PMS

A

Does not exist there are no lab exams that can determine this.

made on presentation and discussion

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27
Q

Treatment for PMS

A

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

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28
Q

Premenstrual Dysphoric Disorder (PMDD)

A

Severe premenstrual distress

inteferes with ocupational and social functioning

in up to 8% of the women in US

typically ages 30-50

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29
Q

Risk factors for PMDD

A

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

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30
Q

Clinical presentation of PMDD

A

Irritability

mental status exam may be abnormal during the luteal phase

31
Q

Diagnosis

A

rule out organic causes
-Anemia, thyroid disorders, menopause

Complete CBC with diff, TSH, FSH,

32
Q

Tx of PMD

A

Acupuncture
CBT
Hysterectomy with bilateral oophorectomy
Pharmacologics

33
Q

Follow up for PMDD

A

Follow up every 2 weeks until stabilized

if there is no improvement in 2-3 cycles, try another therapy

34
Q

Irregular uterine bleeding without pelvic pathology, pregnancy, or other medial disease

A

Abnormal Uterine Bleeding (AUB)

35
Q

what percentage of women are seen in outpt visits with abnormal uterine bleeding

A

5-10% of women

36
Q

______ percentage of women with Abnormal Uterine Bleeding are _______ years of age

A

50% are 40-50 years of age

37
Q

what is AUB usually associated with

A

Anovulatory cycles , Diagnosis of exclusion

38
Q

Causes of Abnormal Uterine Bleeding

A

Estrogen breakthrough bleeding

Estrogen withdrawal bleeding

Iatrogenic

Bleeding disorders

39
Q

What is the pathophys of Abnormal Uterine Bleeding (AUB)

A

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
Q

Clinical presentation of AUB

A

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
Q

diagnosis of AUB

A 
R/o pregnancy 
R/o iatrogenic causes
R/o bleeding disorders
LFTs
Pap smear
Endometrial biopsy
42
Q

TX of abnormal uterine bleeding

A

Low dose combination OCPs
Levonorgestrel (IUD)
Cyclic progestin therapy
if medical therapy fails, consider further testing

hystorectomy
endometrial ablation

43
Q

what is Endometriosis

A

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
Q

Risk factors for Endometriosis

A 
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
Q

Etiology of Endometriosis

A

Exact mechanism is unknown

46
Q

what are the most common locations for endometriosis

A

Posterior and anterior cul-de-sac
uterosacral ligaments, tubes, ovaries

but can occur in any organ system

47
Q

What happens in pts with endoetriosis

A

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
Q

Clinical presentation of pts with endometriosis

A 
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
Q

Endometriosis diagnosis

A

CT, US, and MRI are only useful in advanced disease

laparoscopy is the procedure of choice
Sens. 97% specificity 77%

50
Q

What does endometriosis look lke on inspection with laparoscopy

A

Powder-burned or black-blue lesions

51
Q

Tx of Endometriosis

A

OBGYN referral
Combined OCP’s
Progesterone (oral, injection, IUD)

Surgical intervention - removal of lesions
Conservative-maintain potentialy fertility

52
Q

What is the Recurrence rate of endometriosis

A

15%

53
Q

what is a leiomyoma

A

Uterine Fibroids

They are noncancerous uterine growths

54
Q

What is the leading cause of hysterectomy’s in the US

A

Leiomyomas

55
Q

Risk factors of leiomyoma

A

Obesity, nulliparity, menarche prior to age of 10, African American ethnicity

56
Q

what are the clinical presentations of leiomyomas

A

Usually asymptomatic,

Heavy bleeding (menorrhagia) 
Frequent urination
Constipation
Infertility
Bloating
Mass may be palpated during Pelvic Exam
57
Q

Diagnosis of Leiomyomas

A

US: abdominal, transvaginal, pelvic

MRI

58
Q

Tx of Leiomyoma

A

NSAIDs
Hormonal: OCP may help with bleeding
Progesterone may help with bleeding
leuprolide acetate shrinks fibroids (GnRH agonist)

Proceedures
myomectomy
Hysterectomy

59
Q

what is the most common gynecologic malignancy

A

Endometrial Cancer

60
Q

What percentage of pts that are diagnosed with Edometrial cancer are postmenopausal

A

75-80 percent

61
Q

What are a few risk factors for Endometrial Cancer

A

Obesity and nulliparity

62
Q

what decrease the risks of Endometrial Cancer

A

OCPs and Smoking

63
Q

Pathophysiology of Endometrial Cancer

A

Estrogen stimulates the endometrium
Endometrial hyperplasia
Endometrial cancer

64
Q

Clinical Presentation of Endometrial Cancer

A

Postmentapausal bleeding

  • investigate all bleeding during menopause unless the pt is on cyclic replacement therapy with normally anticipated withdrawal bleeding
65
Q

Endometrial Cancer Diagnosis

A

Vaginal US
Endometrial biopsy
Hysteroscopically directed biopsy

66
Q

Tx of Endometrial Caner

A

Refer to OBGYN and Oncology

SX
Chemotherapy
Radiation

67
Q

What is the prognosis of those who are diagnosed with endometrial cancer

A

Approximately 80% survival rate

68
Q

PCOS causes what

A

Menstrual dysfunction/anovulation, hyperandrogenism, polycistic ovaries

69
Q

Polycystic Ovarian Syndrome is not completely understood however what are considered risk factors

A

Heredity, obesity, insulin resistance

70
Q

Clinical Presentation of PCOS

A 
Amenorrhea
oligomenorrhea
chronic anovulation
hyperandorogensm: causes 
       excess body hair in a male
       distribution pattern 
Obesity
71
Q

PCOS can cause infertility and _______ ovulation

A

Sporadic ovulation

72
Q

Metabolic Syndrome is in what percentage of PCOS pts

A

43%

73
Q

What labs assist with finding the diagnosis (by exclussion) of PCOS

A

TSH, T4, T3, FSH, LH, androgen index, prolactin, HCG, lipid panel ,

Tests: Oral Glucose tolerance test,
Pelvic US test

74
Q

TX of PCOS

A

Diet and exercise

OCPs, metformin

Menstrual abnormalities/hirsuitism
OCPs spironolactone
Infertility
-Clomiphene, letrozole
Metabolic abnormalities
           Metformin 
Caution with statins

Women's Health (4 decks)

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