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Women's health > menstrual disorders (15%) > Flashcards

menstrual disorders (15%) Flashcards

1
Q

normal menstrual cycle

A

24-38 days w menstruation x4-8 days

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2
Q

phases of menstrual cycle

A

follicular/proliferative (0-14)

luteal (14-28)

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3
Q

what occurs in the follicular phase

A

endometrium thickens under influence of ESTROGEN. dominant follicle in ovaries matures

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4
Q

what occurs during days 1-12 of cycle

A

pulsatile GnRH from hypothalamus releasing more FSH + LH –>

FSH causes follicle + egg maturation in ovary + LH causes follicle to produce estrogen –>

estrogen builds up endometrium + causes NEGATIVE FEEDBACK in HPO –>

inhibits hypothalamic GnRH release to inhibitt LH + FSH release so no more follicles grow at this time.

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5
Q

what occurs during days 12-14 of cycle

A

inc estrogen from follicle switches from negative to POSITIVE FEEDBACK on GnRH –>

inc estrogen, FSH + LH –>

LH surge causes OVULATION.

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6
Q

what occurs during the luteal phase

A

ruptured follicle becomes corpus luteum which secretes progesterone + some estrogen but PROGESTERONE PREDOMINATES) –>

Progesterone maintains endometrium to prep for implantation

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7
Q

what happens if pregnancy occurs

A

blastocyst keeps C.L functional –>

secretes progesterone + estrogen to keep endometrium from sloughing

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8
Q

what happens if pregnancy does not occur

A

C.L degenerates which decreases progesterone + estrogen –>

sloughing of endometrium (menstruation) + negative feedback on GnRH subsides –>

inc pulsatile GnRH –> starts cycle again

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9
Q

what are the 2 etiology types of DUB

A

chronic anovulation (90%)- in teenagers or perimenopausal, unopposed estrogen (PCOS) –> inc endometrial overgrowth –> irregular, unpredictable shedding

ovulatory (10%)- regular cyclical shedding + ovulation w prolonged progesterone secretion –> inc blood loss from endometrial vessel dilation + PGs –> menorrhagia

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10
Q

what is cryptomenorrhea

A

light flow/spotting

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11
Q

what is menorrhagia

A

normal intervals but heavy/prolonged bleeding

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12
Q

what is metrorrhagia

A

irreg bleeding

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13
Q

what is menometrorrhagia

A

irregular, heavy/long bleeding

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14
Q

what is oligomenorrhea

A

infreq periods (cycle length >35 days, <6mo)

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15
Q

what is polymenorrhea

A

freq periods (cycle <21 days)

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16
Q

tx of acute severe bleeding

A

high-dose IV estrogen or high-dose OCPs

D+C if failed

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17
Q

tx of DUB

A 
1st OCPs (Combo)- progesterone if estrogen CI
leuprolide (GnRH analog)
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18
Q

what is dysmenorrhea

A

painful menstruation

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19
Q

what is primary vs secondary dysmenorrhea

A

primary- no pelvic pathology but increased PGs –> painful uterine muscle wall activity (usu 1-2yrs after menarche in teenagers)

secondary- pelvic patho, MC >25yo (endometriosis, adenomyosis, leiomyomas, adhesions, PID)

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20
Q

tx of dysmenorrhea

A

nsaids- start before sx + give for 2-3 days
hormonal birth control

laparoscopy if meds fail to R/O 2ry causes (endometriosis if younger, adenomyosis if older)

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21
Q

definition of menopause

A

> 1yr w/o menses d/t loss of ovarian function

22
Q

average age of menopause

A

50-52yo

23
Q

premature menopause

A

<40yo

usu DMs, smokers, vegetarians, malnourished

24
Q

complications of menopause

A

inc CV events
HLD
osteoporosis

25
Q

dx of menopause

A

FSH assay most sensitive (inc FSH >30)
inc LH
dec estrogen

26
Q

tx of hot flashes in menopause

A

estrogen, progesterone, clonidine, SSRIs, gabapentin

27
Q

tx of vaginal atrophy in menopause

A

estrogen

28
Q

tx of osteoporosis in menopause

A 
Ca + Vit D
wt bearing exercise 
bisphosphonates
SERM (RAL, TAM)
calcitonin
estrogen
29
Q

estrogen-only HRT pros + cons

A

pros- most effective sx tx, transdermal or vaginal > PO, no inc breast CA

cons- inc endo CA, VTE

30
Q

estrogen-progesterone HRT pros + cons

A

pros- sx relief, dec heart + stroke risk, dec osteoporosis, protects against endo CA

cons- VTE, inc breat CA

31
Q

what differentiates PMS from PMDD

A

PMDD = anger + irritability + functional impairment

32
Q

when does PMS/PMDD occur

A

during luteal phase (1-2wks before menses)
relieved w.i 2-3 days of menses onset
7+ sx-free days during follicular phase

33
Q

what medication is approved for PMDD

A

drospirinone

34
Q

what is primary vs secondary amenorrhea

A

primary- no period by age 15yo (if 2ndary sex characteristics), 13yo (if none)

secondary- no period for >3mo in pt w previously normal menses or >6mo in pt w previous oligomenorrhea

35
Q

etiologies of primary amenorrhea if uterus + breasts present

A

outflow obstruction (transverse vaginal septum, imporforate hymen)

36
Q

etiologies of primary amenorrhea if uterus present+ breasts absent

A

elevated FSH/LH = ovarian causes - premature ovarian failure (46, XX), gonadal dysgenesis (45, XO)

normal/low FSH/LH = hypothalamus-pituitary failure or puberty play (athlete, illness, anorexia)

37
Q

etiologies of primary amenorrhea if uterus absent + breasts present

A 
mullerian agenesis (46, XX)
androgen insensitivity (46, XY)
38
Q

etiologies of primary amenorrhea if uterus + breasts absent

A

rare- usu defect in testosterone synthesis

will often have intraabdominal testes

39
Q

MC etiology of secondary amenorrhea

A

pregnancy

40
Q

other etiologies of secondary amenorrhea

A 
hypothalamus dysfunction
pituitary dysfunction (pituitary adenoma)
ovarian disorders
uterine disorders (ashermans)
41
Q

how does hypothalamus dysfunction cause amenorrhea

A

disruption of normal pulsatile GnRH secretion –> dec FSH +/or LH

42
Q

causes of hypothalamus dysfunction –> amenorrhea

A

hypothalamic disorder, anorexia, exercise, stress nutritional deficiency, systemic dz (celiac)

43
Q

diagnosis of hypothalamus dysfunction –> amenorrhea

A

normal/dec FSH/LH, low estradiol, normal PRL

44
Q

tx of hypothalamus dysfunction –> amenorrhea

A

clomiphene, menotropin (stimulate GnRH secretion)

45
Q

how does pituitary adenoma cause amenorrhea

A

prolactin-secreting pituitary adenoma –> suppresses GnRH –> dec FSH/LH

46
Q

dx of pituitary adenoma –> amenorrhea

A

low FSH/LH
inc PRL
MRI of pituitary sella

47
Q

tx of pituitary adenoma –> amenorrhea

A

transsphenoidal surgery

48
Q

what ovarian disorders can cause amenorrhea

A

PCOS, premature ovarian failure, follicular failure/resistance to LH/FSH, turners syndrome

49
Q

clinical presentation/dx of ovarian disorders –> amenorrhea

A

sx of estrogen deficiency (hot flashes, sleep + mood disturbances, dyspareunia, dry/thin skin, vaginal atrophy)

INC FSH/LH

progesterone challenge test- 10mg medroxyprogesterone x10 days –> withdrawal bleeding indicates ovarian issue, no withdrawal bleeding indicates HPO or uterine issue

50
Q

what uterine disorder causes amenorrhea

A

asherman’s syndrome (Scarring of uterine cavity 2ry to PP hemorrhage, s/p D+C or endometritis)

51
Q

how do you dx asherman’s syndrome

A

pelvic US = absence of uterine stripe

hysteroscopy

52
Q

tx of ashram’s syndrome

A

estrogen to stimulate endometrial regeneration

Women's health (7 decks)

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