Menstrual Cycle Flashcards
Primary amenorrhea
No menarche at 15 yrs despite nrml 2nd sexual characteristics
Or
No menarche at 13 plus no 2nd sexual characteristics
FSH stimulates?
Granulosa cells to prod progesterone & androstenedione
FSH inhibition by?
(Negative feedback) -Inhibin B & estradiol
In the menstrual cycle LH surge due to?
Positive feedback (estradiol secreted by maturing follicle)
Normal menstrual cycle length
24 - 38 days
Menses duration and blood loss?
3-7 days
35 - 50 ml
Follicular phase?
Day 1 - 14
Fate of Graffian follicle
Corpus Luteum
Length of Luteal phase
14-15 days
Primary dysmenorrhea
Lower abdominal/before or during menses
Absence of pathological findings
Primary dysmenorrhea diagnosis?
Diagnosis of exclusion
1mry dysmenorrhea treatment?
- NSAIDS
- hormonal contraceptives (COCP, IUD w/levonorgestrel)
Uterine causes of 2ndry dysmenorrhea?
-PID
-IUD
-Adenomyosis
•Leiomyoma
•Cervical Polyps
Extrauterine causes of 2ndry dysmenorrhea?
-ENDOMETRIOSIS
- Adhesions
- functional ovarian cyst
•IBD
Causes of Primary Amenorrhea
- Constitutional Growth delay
- Hypogonadotrophic hypogonadism
- Hypergonadotrophic hypohonadism
•Anatomic anomalies
•receptor enzyme abnormalities
Deficient GnRH syndromes
• Kallmann syndrome (anosmia)
• Prader willi syndrome (hyperphagia)
• Stress/sports eating disorders
-CNS tumors (craniopharyngioma)
Most common cause of 1ry amenorrhea
Gonadal dysgenesis
- Turner syndrome 45X0
- Swyer syndrome
- 46XY gonadal dysgen
Anatomic anomalies causing 1mry amenorrhea?
-Mulerian agenesis
- Imperforate Hymen
-Vaginal atresia
•Transverse vaginal Hymen
Receptor enzyme abnormalities causing 1mry amenorrhea?
- Complete androgen insensitivity syndrome
- 5 alpha reductase deficiency
- Congenital adrenal hyperplasia (17alpha hydrolase deficiency)
Abnormal lab result in primary ovarian insufficiency (hypergonadotrophic)
Elevated FSH
Lab finding in androgen secreting tumor?
Elevated dehydroepiandrosterone sulfate (DHEA-S)
Congenital adrenal hyperplasia clinical finding?
High blood pressure
2ndry amenorrhea definition
Regular cycle: Absent menses for > 3 months
Irregular cycle: Absent menses for > 6 months
Most common cause of 2ndry amenorrhea?
Pregnancy
Medications causing amenorrhea?
- antipsychotics
- chemo
- OCP
Pathology of hypothyroid amenorrhea?
dec. T3/T4 — ^TRH — ^Prolactin — dec. GnRH — dec. Estrogen
Syndromes causing 2ndry amenorrhea?
• Sheehan syndrome (ischemia)
• Asherman syndrome
• Cushing syndrome
- Adrenal insufficiency
Functional hypothalamic amenorrhea?
Etiologies?
Dysfunction in pulsatile secretion of GnRH
- excess exercise
- reduced calorie intake
- stress
- Female athlete triad syndrome*
Cause of.. • Menstrual dysfunction • Decreased bone density • Calorie deficit in Athletic adolescent?
Female athlete triad syndrome
(dec. Leptin / increased Cortisol)
Medical tax for prolactinoma?
Mechanism of drug?
- Bromocriptine
- Cabergoline
D2 agonist
Structural causes of AUB
- Polyps
- Adenomyosis
- Leiomyomas
- Malignancy and hyperplasia
Non-structural causes of AUB
- Coagulopathies
- Ovulation disorders
- Endometrial disorders
- Iatrogenic
- Not otherwise classified
Chronic AUB definition
Uterine bleed of abnormal frequency, regularity and or volume for > 6 months
Initial laboratory tests in AUB and reason
•CBC (rule out anemia)
•Beta hCG (r/o pregnancy)
•PT, PTT (r/o coauglopathy)
-TFT’s
Indications for endometrial biopsy in AUB
- Endometrial thickness >4mm
- > 45y with freq. heavy/ prolonged bleed
- < 45y, freq. heavy/prolonged bleed + risk of endometrial Ca.
- Obesity
- T2 DM
- PCOS
- tamoxifen therapy
- Lynch syndrome
Tx of acute AUB
Hemodynamically stable
High dose IV conjugated estrogen
Or
OCP, progestin, tranexamic acid (2nd line)
Non surgical tx of ovulatatory bleeding
- OCP’s, progestin
- NSAID
- Transxamic acid
Surgical tx options for AUB
- D&C
- Endometrial Ablation
- Transcatheter uterine artery embolizatiom (first line in AVM)
- Hysteroscopy (polyps)
- Hysterectomy
First line tx of PMS
NSAIDS (napronex)
OCP’s
