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Special Pops Exam 1 > Menstrual Disorders -> > Flashcards

Menstrual Disorders -> Flashcards

1
Q

What part of the female reproductive system is shed during menstruation?

A

Lining of uterus (endometrium)

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2
Q

What is menarche?

A

Onset of menses (10-15 y/o)

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3
Q

What is menorrhagia?

A

Heavy/prolonged menstrual bleeding (>80mL)

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4
Q

What does menorrhagia frequently cause?

A

Anemia

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5
Q

What is metrorrhagia?

A

Bleeding between periods

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6
Q

What is polymenorrhea?

A

Frequent menses (interval <21 days)

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7
Q

What is oligomenorrhea?

A

Infrequent menses (interval >35 days)

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8
Q

What is amenorrhea?

A

Absence of menses

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9
Q

What axis is a tightly regulated system for reproduction/menstrual cycle regulation via hormonal control?

A

HPO (hypothalamic-pituitary-ovarian) axis

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10
Q

What is GnRH (Gonadotropin Releasing Hormone) released from?

A

Hypothalamus

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11
Q

FSH (follicle stimulating hormone) stimulates the development of what?

A

Ovarian follicle

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12
Q

___________ secretion from ovarian follicles are dependent on ______ and _______

A

Estrogen dependent on FSH & LH

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13
Q

Which hormone stimulates estrogen and progesterone production from the ovary, triggers ovulation, and stimulates the corpus luteum to produce progesterone?

A

LH (luteinizing hormone)

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14
Q

Average cycle length?

A

28-35 days (day 1=first ay of period, last day of cycle = day before next period starts)

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15
Q

Normal length of menstrual bleeding?

A

5 days

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16
Q

Mean blood loss per cycle?

A

40mL

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17
Q

What is the ovarian cycle?

A

prepares for release of egg from ovary/builds lining of uterus

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18
Q

What is the uterine cycle?

A

prepares uterus/body to accept fertilized egg or start of next cycle if pregnancy does not occur

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19
Q

Follicular phase (proliferative) of cycle?

A

Days 1-14, estrogen predominates, includes menses (day 1) and ovulation (days 12-14)

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20
Q

Luteal phase (secretory) of cycle?

A

Days 14-28, progesterone predominates

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21
Q

Phase 1- follicular phase?

A

estrogen/progesterone levels low –> menstruation, FSH levels slightly inc/stimulate development of several follicles in ovaries (each follicle contains an egg), later FSH levels decrease & only one follicle continues to develop (this follicle produces estrogen), endometrium thickens under estrogen influence, in the ovaries –> dominant follicle matures leading to ovulation, GnRH from the hypothalamus increases causing FSH/LH release from pituitary to stimulate ovaries

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22
Q

Ovary response in phase 1 - follicular phase?

A

Inc. FSH causes follicle/egg maturation in ovary, Inc. LH stimulates maturing follicle to produce estrogen

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23
Q

Uterus response in phase 1 - follicuar phase?

A

Estrogen builds endometrium

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24
Q

What does estrogen cause in the HPO axis during phase 1 - follicular phase?

A

Negative feedback

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25
Q

Phase 2 - luteal phase?

A

After ovulation, ruptured follicle becomes corpus luteum, secreting progesterone which enhances lining of uterus to prepare for implantation, if it does not occur –> corpus luteum degenerates (steep inc. in estrogen and progesterone) –> menstruation

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26
Q

Ovarian cycle contains what phases?

A

Follicular phase, Ovulation, Luteal phase

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27
Q

Uterine cycle contains what phases?

A

Menstruation, Proliferative, Secretory phases

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28
Q

The follicular phase is variable in length from cycle to cycle, causing what?

A

Overlap w/ uterine proliferative phase

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29
Q

What happens in the follicular phase?

A

One ovarian follicle containing an egg matures w/in ovary

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30
Q

Hormones responsible for follicular phase?

A

Rise in FSH during first few days, cycle stimulates one dominant follicle
Follicles secrete estradiol as maturing

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31
Q

Length of ovulation phase?

A

One day

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32
Q

What happens in ovulation phase?

A

Follicle maturation is complete and estrogen is released from mature follicle –> swithces from positive feedback on GnRH causing increased estrogen/FSH/LH
*LH surge

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33
Q

What causes ovulation?

A

LH surge (causes egg to mature, weakens wall of follicle in ovary, follicle ruptures/releases oocyte), ovulation spotting may occur due to hormone changes

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34
Q

What is Mittelschmerz?

A

Lower abdominal pain w/ ovulation due to follicle filling with blood/bleeding into abdominal cavity causing peritoneal irritation

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35
Q

How many eggs normally release from one ovary?

A

1

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36
Q

What occurs if both ovaries release an egg and both eggs are fertilized?

A

Fraternal twins

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37
Q

What decides which of the two ovaries ovulate every month?

A

occurs at random

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38
Q

How long does an egg live after leaving the ovary?

A

12-24 hrs

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39
Q

When the egg is released/enters the fallopian tube, what happens if it is not fertilized?

A

Disintegrates into fallopian tube/absorbs into uterine lining

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40
Q

When the egg is released/enters the fallopian tube, what happens if it is fertilized?

A

Implantation usually occurs 6-12 days after ovulation

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41
Q

Duration of luteal phase?

A

Consistent from cycle to cycle (overlaps w/ uterine secretory phase)

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42
Q

What happens to FSH/LH levels during luteal phase?

A

Decrease

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43
Q

What forms at the site of a ruptured follicle?

A

Corpus luteum (secretes progesterone and some estrogen)

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44
Q

How does the corpus luteum prepare the uterus for fertilization/implantation?

A

Causes endometrium to thicken, fills w/ fluids and nutrients to nourish potential embryo, mucus thickens in cervix to protect from sperm/bacteria entering, body temp slightly increases

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45
Q

What happens in the ovarian cycle if fertilization occurs?

A

Corpus luteum continues to produce progesterone and some estroge until placenta takes over, endometrium maintained

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46
Q

What happens in the ovarian cycle if fertilization does not occur?

A

Corpus luteum degenerates, causing dec in progesterone and estrogen levels, endometrium no longer maintained/sloughs off (menstruation), negative feedback on GnRH subsides (inc. GnHR secretion, inc. FSH/LH, starts maturation process all over again)

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47
Q

Menstruation can be affected by what?

A

Thickness of endometrium, meds, underlying disease, etc.

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48
Q

What happens in the proliferative phase?

A

Lining of uterus proliferates/grows (restores from prior menses)

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49
Q

Hormones responsible for proliferative phase of uterine cycle?

A

Estrogen (being secreted by ovarian follicle) initiates formation of new layer of endometrium in uterus/stimulates cervix to produce cervical mucus

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50
Q

How long is the secretory phase of the uterine cycle?

A

Consistently 14 days

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51
Q

What happens in the secretory phase of the uterine cycle?

A

Uterus preps for implantation of fertilized egg

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52
Q

Hormones responsible for the secretory phase?

A

Progesterone produced by corpus luteum increases BF to uterus, increases uterine secretions, reduces contractility of SM in uterus & raises body temp *helps promote favorable environment for pregnancy

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53
Q

If fertilization does not occur in the secretory phase of the uterine cycle, what takes place?

A

Corpus luteum regresses, endometrium cannot maintain itself, resulting in vascular spasms and endometrial ischemia (menstruation)

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54
Q

Levels of estrogen and progesterone are ____ during menstruation

A

Low

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55
Q

Follicular phase overview?

A

Time between first day of period & ovulation, estrogen inc. to prepare for egg release

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56
Q

Proliferative phase overview?

A

After period, uterine lining builds back up

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57
Q

Ovulation phase overview?

A

Release of egg from ovary mid cycle, estrogen peaks just before then drops, LH surge triggers ovulation

58
Q

Luteal phase overview?

A

TIme between ovulation and before menstruation, body preps for possible pregnancy, Progesterone produced –> peaks –> drops

59
Q

Secretory phase overview?

A

Uterine secretions that either help support or prepare lining to break

60
Q

Regular spontaneous menstruation requires what?

A
  1. functional HPO axis
  2. competent endometrium
  3. intact outflow tract from internal to external genitalia
61
Q

When should absence of menses be a concern?

A

If persistently absent, one missed period is not a huge deal (sensitive to environmental stressors)

62
Q

Cervical mucus changes during cycle?

A

Estrogen makes mucus thinner/more alkaline (promotes sperm), Mucus thinnest at ovulation/more elastic, progesterone makes mucus thicker

63
Q

Breast changes during cycle?

A

Estrogen causes proliferation of mammary ducts, progesterone causes growth of lobules and alveoli, breast swelling/tenderness preceding menses

64
Q

When does a small change in body temp occur in cycle?

A

Luteal phase d/t progesterone

65
Q

Primary amenorrhea?

A

Failure of menarche by 13 in absence of normal growth/secondary sexual development or failure by age 15 in the presence of normal growth/secondary sexual development

66
Q

Cause of primary amenorrhea?

A

Usually genetic/anatomy abnormality

67
Q

Secondary amenorrhea?

A

Absence of menses for 3 consecutive months in previously menstruating woman

68
Q

Most common cause of secondary amenorrhea?

A

Pregnancy

69
Q

How can cervical stenosis cause amenorrhea?

A

obstruct flow, congenital or secondary to cervical surgery

70
Q

Sx of cervical stenosis?

A

amenorrhea, pelvic pain, dysmenorrhea, infertility, endometriosis possible, or asx

71
Q

Dx for cervical stenosis?

A

Clinical

72
Q

What is Mallerian agenesis?

A

46 XX karyotype, congenital absence of uterus and upper 2/3 of vagina

73
Q

Sx of Mallerian agenesis?

A

Amenorrhea, pelvic pain, or asx

May have small dimpling at vaginal introitus, normal ovary function

74
Q

Tx for Mallerian agenesis?

A

Multidisciplinary

75
Q

What causes an imperforate hymen?

A

Familial component, normal hymen covers part of vaginal opening but imperforate covers all

76
Q

Appearance of imperforate hymen as infant?

A

Bulging, yellow-gray mass at or beyond introitus, may put pressure on urethra, may present as mucocolpos

77
Q

Appearance of imperforate hymen as adolescent?

A

Primary amenorrhea, cyclic pelvic pain, difficulty defecating/urinating, blue-ish discoloration of hymen membrane (hematocolpos) and generally abdominal mass (vaginal pooling of blood)

78
Q

Dx and tx for imperforate hymen?

A

Clinical dx, surgical resection of hymen

79
Q

What is a transverse vaginal septum?

A

Congenital anomaly where horizontal wall of tissue blocks vaginal opening

80
Q

Dx of

A

U/S and MRI

81
Q

Tx of transverse vaginal septum?

A

Surgical resection of septal tissue

82
Q

What is Ashermans syndrome?

A

Acquired endometrial scarring from postpartum hemorrhage, after D&C **MC, or endometrial infection

83
Q

Sx of Ashermans?

A

Amenorrhea, +/- spotting, infertility

84
Q

Tx of Ashermans?

A

Surgical removal of scar tissue

85
Q

What is primary ovarian insufficiency (POI)?

A

Deplection of oocytes before 40/premature menopause (intermittent menses followed by amenorrhea)

86
Q

What is tuners syndrome?

A

Chromosome 45 X genetic disorder, oocytes/follicles undergo apoptosis in utero, ovaries replaced w/ fibrous tissue

87
Q

Signs of tuner syndrome?

A

Short stature, ovarian failure, shield chest, widely spaced nipples, short/webbed neck

88
Q

What is androgen insufficiency syndrome?

A

Chromosome 46 XY genetic disorder, X linked recessive, complete or partial androgen insensitivity failure of normal masculinization but lacking uterus and complete vagina (phenotypically female, genotype male), normal testes and testosterone function/conversion

89
Q

What is 46, XY-5-alpha reductase type 2 deficiency?

A

XY at birth, autosomal recessive sex-linked condition resulting in inability to convert testosterone to dihydrotestosterone, genetic males born w/ ambiguous genitals (uterus/fallopian tubes absent), testes intact and in inguinal canal or scrotum

90
Q

What can cause acquired pituitary function leading to amenorrhea?

A

Previous local radiation or surgery, excess iron disposition, Sheehans syndrome (postpartum pituitary necrosis), hypothyroid (elevated prolactin)

91
Q

Most common pituitary cause of amenorrhea?

A

Hyperprolactinemia (prolactinoma tumor)

92
Q

Dx of Hyperprolactinemia (prolactinoma tumor)?

A

elevated prolactin level and imagine MRI/CT

93
Q

Tx for Hyperprolactinemia (prolactinoma tumor)?

A

Bromocriptine or Cabergoline (dec tumor size) or surgery (resection if large and desiring conception or rapidly enlarging w/ mass effect)

94
Q

Meds that can cause hyperprolactinemia?

A

Antipsychotics, antidepressants, Prokinetics (Reglan), anti-hypertensives, morphine, H2As

95
Q

Causes of defects in GnRH transport of hypothalamus leading to menagorrhea?

A

Trauma, compression, radiation, tumors, infiltrative disorders (sarcoid, Tb)

96
Q

Signs of defects in GnRH transport of hypothalamus?

A

Low LH and estradiol w/ normal FSH
stress, eating d/o, excessive exercise, wt loss
*at risk for osteoporosis d/t low estrogen

97
Q

Dx of defects in GnRH transport of hypothalamus?

A

Progesterone challenge (Medoxyprogesterone acetate x5-7d)
if menses: ovarian secretion of estrogen
if none: no estrogen

98
Q

What is the female athlete triad of defects in GnRH transport of hypothalamus?

A

Amenorrhea, eating disorder, ostopenia/osteoporosis

99
Q

What is congenital GnRH deficiency?

A

Idiopathic lack of GnHR secretion w/ low serum gonadotropins

100
Q

What is Kallman’s syndrome?

A

Identical to congenital GnRH deficiency w/ anosmia (no smell)

101
Q

PE for primary amenorrhea?

A

Assess breast development, growth, skin, physical features for turners syndrome, genital exam

102
Q

Labs and diagnostics for primary amenorrhea?

A

Pelvic US, Initial labs: Serum hCG, FSH/LH, TSH, Prolactin, Karyotype testing, testosterone levels

103
Q

PE for secondary amenorrhea?

A

Ht/wt/BMI, skin, breast exam, vulvovaginal exam for dryness, pelvic exam, parotid gland swelling/dental erosions

104
Q

Labs/diagnostics for secondary amenorrhea?

A

Pregnancy test***, Serum CG, FSH (high –> POI, Low-norm –> hypothalamic-piruitary or PCOS), LH, TSH, Prolactin

105
Q

Etiologies of abnormal uterine bleeding (AUB)?

A

PALM-COEIN:
Polyp, Adenomyosis, Leiomyoma, Malignancy, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, not yet classified
(other- pregnancy, structural lesions, hormonal contraception)

106
Q

Menagorrhea?

A

heavy, >80mL loss for >7 days

107
Q

Hypomenorrhea?

A

Unusually light flow, spotting

108
Q

Metorrhagia?

A

Bleeding between periods

109
Q

Polymenorrhea?

A

Frequent uterine bleeding menstrual interval <21 days

110
Q
A
111
Q

Oligomenorrhea?

A

Infrequent uterine bleeding menstrual interval >35 days

112
Q

Contact bleeding?

A

Post-sex bleeding

113
Q

Ovulatory dysfunction?

A

Irregular bleeding, non-ovulatory

114
Q

Initial workup for AUB?

A

Serum hCG r/o preg, CBC esp w/ heavy bleeding and sx

115
Q

Why do postmenopausal women require further workup for AUB?

A

More likely d/t secondary pathologic cause

116
Q

Additional tests for AUB?

A

TSH, coagulation, androgen levels, prolactin, FSH/LH, Estradiol, pap/cultures, pelvic imaging (transvag US, hysteroscopy)

117
Q

When is an endometrial bx recommended for AUB?

A

> 45 w/ frequent heavy period, all postmenopausal bleeding, younger pts w/hx of unopposed estroigen, persistent AUB despite tx, <45 w/ obesity/DM/HTN

117
Q

MC etiologies of menagorrhea?

A

Fibroids and adenomyosis

117
Q

Acute hemorrhage management?

A

R/o pregnancy
if unstable: IV high dose estrogen, D&C, emergency hysterectomy last resort
if stable: PO estrogen until bleeding stops, Medoxyprogesterone acetate BID 7-10d (progestin if estrogen C/I), endometrial ablation

118
Q

What can control hemorrhage in setting of malignancy?

A

Radiation

119
Q

What is an irregular bleeding pattern?

A

Phases of no bleeding that may last 2+ months and other phases w/ either spotting or heavy bleedinf

120
Q

How can ovulatory dysfunction AUB be treated?

A

Estrogen-progestein OCPs 1st line, Progesterone if estrogen C/I

121
Q

When to admit for AUB?

A

Hemodynamic instability or acute hemorrhage (IV HIGH DOSE ESTROGEN GIVES RAPID RESPONSE)

122
Q

Primary dysmenorrhea is dx more often in what population?

A

Adolescents and young women d/t increased prostaglandin release (triggering uterine wall contractions)
prevalence dec w/ age

123
Q

Secondary dysmenorrhea (d/t underlying pelvic pathology) has what features?

A

Large uterus, dyspareunia, resistance to tx
*prevalence inc. w/ age

124
Q

Sx of primary dymenorrhea?

A

Recurrent, crampy midline lower abd or pelvic pain 1-2 days before menses or at onset of menses, HA, N/V
*gradually diminishes over 12-72hrs

125
Q

Signs of secondary dysmenorrhea?

A

Not resolved w/ NSAIDS or OCPS, vaginal d/c, dyspareunia, infertility, bloating, AUB

126
Q

PE for primary dysmenorrhea?

A

Unremarkable

127
Q

PE for secondary dysmenorrhea?

A

signs of PID, Fibroids, Adenomyosis

128
Q

Diagnosis of primary dysmenorrhea?

A

Dx of exclusion, detailed H&P, +/- transvag US

129
Q

If secondary suspicion for dysmenorrhea, what diagnostics?

A

HCG, CBC, GC/CHl screen, UA, guiac, US, laparoscopy

130
Q

Tx for primary dysmenorrhea?

A

NSAIDS or hormonal OCPs 1st line

131
Q

Tx for secondary dysmenorrhea?

A

Underlying cause (medical vs. surgical), sx relief w NSAIDS, heat, OCP

132
Q

PMS occurs when?

A

2nd half of menstrual cycle (luteal phase)

133
Q

PMDD prominent sx?

A

anger, irritability, internal tension (DSM V criteria for dx)

134
Q

Lab tests for PMS?

A

Serum TSH r/o thyroid cause of sx

135
Q

Patient should record a diary of PMS sx for how long?

A

> 2 cycles

136
Q

DSM-V criteria for PMDD?

A

1+ following:
mood swings, sudden sadness, increased sensitivity to rejection
anger, irritability
sense of hopelessness, depression
tension, anxiety, on edge
1+ follwing to reach 5 sx overall
difficulty concentrating
change in appetite
diminished interest in activities
easy fatigue
overwhlemed/out of control
breast tenderness, bloat, weight gain, aches
sleep changes

*must correlate w/ near menses, relieved at onset of menses, occurred in most menstrual cycles w/in the yr, not d/t other med condition

137
Q

Mild PMDD/PMS tx?

A

Lifestyle mods

138
Q

Mod/severe PMDD/PMS tx?

A

SSRIs 1st line, combined OCPs 1st line in women needing contraception (otherwise reserved for refractory), therapy, acupuncture, surgery is last resort

Other reserved for refractory: GnRH agonists

Special Pops Exam 1 (8 decks)

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