Menstrual Disorders Flashcards
1
Q
What is the average duration of a normal menstrual cycle?
A
24-38 days (28 days on average)
2
Q
What is considered the average blood loss during menstruation?
A
35-50 mL
3
Q
What are the two phases of the ovarian cycle?
A
- Follicular phase
- Luteal phase
4
Q
What hormone influences the maturation of the dominant follicle during the follicular phase?
A
Estrogen
5
Q
What characterizes the luteal phase of the ovarian cycle?
A
Transformation of granulosa and theca cells into luteal cells under progesterone
6
Q
What is the length of the luteal phase after ovulation?
A
A constant 14 days
7
Q
What are the two phases of the uterine cycle?
A
- Proliferative Phase
- Secretory Phase
8
Q
What triggers the growth of the endometrium during the proliferative phase?
A
Estrogens
9
Q
In a 46-day menstrual cycle, when is ovulation most likely to have occurred?
A
Day 31
10
Q
What age range is most commonly associated with the onset of Premenstrual Syndrome (PMS)?
A
20-30 years old
11
Q
List some clinical features of Premenstrual Syndrome (PMS).
A
- Pain
- Dyspareunia
- Breast tenderness
- Headaches
- Back pain
- Abdominal pain
- GI changes
- Bloating
- Weight gain
- Mood swings
12
Q
What is the severe form of PMS characterized by?
A
Prominent mood symptoms with clear functional impairment
13
Q
What lifestyle changes can be beneficial for managing PMS?
A
- Regular exercise
- Healthy diet
- Avoiding triggers like alcohol, caffeine, or nicotine
14
Q
What is the first-line treatment for PMS?
A
- NSAIDs (e.g., naproxen)
- OCPs
- SSRIs (e.g., fluoxetine) for severe cases
15
Q
What are menstrual migraines?
A
Headaches occurring before or during menstruation
16
Q
What defines menorrhagia?
A
Abnormally high-volume menstrual bleeding
17
Q
What is oligomenorrhea?
A
Infrequent menstruation with cycle intervals > 38 days
18
Q
What is the definition of amenorrhea?
A
No menses for > 90 days
19
Q
What is postmenopausal bleeding?
A
Bleeding 12 months or more after menses cease
20
Q
What are common causes of abnormal uterine bleeding (AUB) in adolescents?
A
- Anovulation
- Coagulation defects
- Pregnancy
- STDs
- Sexual abuse
21
Q
What is the purpose of a pelvic ultrasound in evaluating AUB?
A
To identify endometrial polyps, fibroids, cancers, and adnexal masses
22
Q
When should an endometrial biopsy be performed?
A
- Patients ≥ 45 years
- Patients < 45 years with persistent bleeding
- Unopposed estrogen
- Other risk factors like type 2 diabetes
23
Q
What surgical treatment can be used for AUB caused by fibroids?
A
Transcatheter uterine artery embolization
24
Q
What is the function of hysteroscopy in the evaluation of AUB?
A
Allows direct visualization of the intrauterine cavity
25
What is the recommended treatment for heavy menstrual bleeding due to endometrial polyps?
Hysteroscopic polypectomy
26
Define polymenorrhea.
Frequent menstruation with cycle intervals < 24 days
27
What does the term 'breakthrough bleeding' refer to?
Unscheduled bleeding associated with hormone administration
28
What characterizes catamenial epilepsy?
Seizures occurring around specific points in the menstrual cycle
29
What is hysteroscopic polypectomy or myomectomy used for?
May provide acute and long-term control of bleeding due to endometrial polyps or uterine fibroids
## Footnote
Preserves fertility
30
What is the purpose of dilation and curettage (D&C) with hysteroscopy?
Used to identify intrauterine pathologies, take tissue samples, and remove excess uterine lining
## Footnote
Preserves fertility
31
When is endometrial ablation indicated?
Only indicated if other treatments have been ineffective or are contraindicated
## Footnote
Provides long-term improvement of uterine bleeding symptoms by destroying the endometrium
32
What are the contraindications for endometrial ablation?
* Desire to have children
* Pregnancy
* Endometrial hyperplasia
* Endometrial cancer
33
What is hysterectomy reserved for?
Reserved for AUB that does not respond to any other treatment
## Footnote
Does not preserve fertility
34
What are the symptoms described by the 39-year-old woman in the practice question?
6-month history of vaginal bleeding for 2–5 days every 2–3 weeks with heavy flow and passage of clots
35
What is the most appropriate next step in management for the 39-year-old woman?
Endometrial biopsy
36
What symptoms does the 33-year-old woman experience during her headaches?
Lower abdominal pain and breast tenderness
## Footnote
She is often irritable at these times
37
What is the most likely method to confirm the diagnosis for the 33-year-old woman?
Maintaining a menstrual diary
38
What are the menstrual symptoms of the 14-year-old girl?
Excessive flow and duration of menses, irregular intervals, lasting 8–9 days
39
What is the most likely cause of the 14-year-old girl's symptoms?
Endometrial polyp
40
What hormonal changes regulate the menstrual cycle?
Roles of estradiol, progesterone, FSH, and LH in the ovarian and uterine cycles
41
What are common conditions associated with menstrual disorders?
* Dysmenorrhea
* Premenstrual syndrome (PMS)
42
Define abnormal uterine bleeding (AUB).
Different types of AUB include menorrhagia and metrorrhagia, differentiated based on patterns and causes
43
What procedures are used for endometrial sampling?
* Endometrial biopsy
* Hysteroscopy
* D&C
44
What diagnostic approaches are used for AUB?
* Imaging
* Lab tests
45
What treatment options are available for managing AUB?
* Hormonal therapy
* Surgical procedures
46
What is the definition of infertility?
Inability to conceive after one full year of unprotected intercourse of reasonable frequency while actively trying to conceive.
47
What are the two types of infertility?
* Primary: no prior pregnancies
* Secondary: infertility following at least one prior conception.
48
What is fecundability?
Ability to achieve pregnancy in one menstrual cycle, with a monthly probability of about 20-25%.
49
True or False: Most couples are considered infertile rather than subfertile.
False.
50
What are some disparities in access to infertility care?
* Diagnosis delays in men due to social factors
* Unequal insurance coverage between sexes
* Disparities noted for unmarried, homosexual, and transgender individuals.
51
What are the main factors contributing to successful conception?
* Ovulation
* Ovum pick-up by fallopian tube
* Fertilization
* Transport of fertilized ovum to uterus
* Implantation into receptive uterine cavity.
52
What percentage of infertility cases are attributed to female factors?
30-55%.
53
What are the categories of causes for male infertility?
* Abnormalities of sperm production
* Sperm function issues
* Sperm obstruction of the ductal outflow tract.
54
How long does normal spermatogenesis take?
Nearly 90 days.
55
What can negatively affect semen characteristics?
Any detrimental event in the prior 3 months.
56
What is Klinefelter syndrome?
Most common congenital abnormality causing primary hypogonadism, occurring in approximately 1 in 1000 live male births.
57
What is a varicocele?
Dilation of the pampiniform plexus of the spermatic veins, sometimes described as a 'bag of worms.'
58
What is the most important test in the evaluation of male infertility?
Semen analysis.
59
What are some effects of obesity on fertility?
* 2-fold increase in time to conception for BMI > 35
* 4-fold increase in time to conception for BMI < 19.
60
What is the most common cause of female infertility?
Ovulatory dysfunction.
61
What is polycystic ovary syndrome (PCOS)?
Most common cause of oligo-ovulation and anovulation, characterized by hyperandrogenism and polycystic ovarian morphology.
62
Fill in the blank: The evaluation of ovulation can include monitoring _______.
Basal body temperature.
63
What are the criteria for diagnosing PCOS according to ESHRE/ASRM?
* Clinical and/or biochemical hyperandrogenism
* Oligo-/anovulation
* Polycystic ovarian morphology.
64
What are some short-term consequences of PCOS?
* Obesity
* Infertility
* Sleep apnea
* Irregular menses.
65
What treatment is recommended for obese women with PCOS?
Important lifestyle changes focusing on diet and exercise.
66
What characterizes functional hypothalamic amenorrhea?
Decreased caloric intake, excessive exercise, and stress leading to decreased hypothalamic GnRH secretion.
67
What is hyperprolactinemia?
Physiologic during pregnancy, but can indicate a pituitary adenoma in premenopausal females.
68
What syndrome is characterized by a decrease in hypothalamic GnRH secretion?
Hypothalamic Dysfunction
## Footnote
This dysfunction leads to decreased pulses of gonadotropins, absent midcycle surges in LH secretion, and anovulation.
69
What are the common symptoms of hyperprolactinemia in premenopausal females?
* Oligomenorrhea or amenorrhea
* Galactorrhea
* Infertility
## Footnote
Hyperprolactinemia can be physiologic during pregnancy or caused by a pituitary adenoma.
70
What is the common age definition for Primary Ovarian Insufficiency (POI)?
Menopause before age 40
## Footnote
POI is also referred to as Premature Ovarian Failure (POF).
71
What laboratory findings are indicative of Primary Ovarian Insufficiency (POI)?
Two elevated serum FSH levels in the menopausal range
## Footnote
These levels must be obtained at least 1 month apart.
72
What are some common symptoms associated with Primary Ovarian Insufficiency (POI)?
* Hot flashes
* Night sweats
* Dyspareunia related to vaginal dryness
## Footnote
A commonly used definition of POI is 4 months of amenorrhea.
73
What diagnostic tool is used to assess tubal patency?
Hysterosalpingogram
## Footnote
Laparoscopy is considered the gold standard for diagnosing tubal/peritoneal disease.
74
What are some abnormalities in the fallopian tubes that can lead to infertility?
* Pelvic infections
* Previous surgery
* Endometriosis
* Previous ruptured ectopic pregnancy
## Footnote
Functioning fallopian tubes are essential for the transport of the ovum and successful fertilization.
75
What are uterine factors that can contribute to infertility?
* Endometrial polyps
* Fibroids
* Intrauterine synechiae
* Congenital anomalies
## Footnote
These factors are usually associated with pregnancy loss.
76
What is Asherman Syndrome?
Intrauterine adhesions accompanied by symptoms such as infertility and amenorrhea
## Footnote
Diagnosis may involve multiple imaging techniques, including hysteroscopy.
77
What is the classic presentation of endometriosis?
Pelvic pain, dysmenorrhea, dyspareunia, infertility, or an ovarian mass
## Footnote
Common sites for endometriosis include the ovaries and fallopian tubes.
78
What is the initial treatment for most anovulatory infertile women?
Clomiphene citrate (Clomid)
## Footnote
It induces gonadotropin release from the pituitary, stimulating follicle development.
79
What is the mechanism of action of Clomiphene citrate?
It competitively inhibits estrogen binding to receptors at the hypothalamus and pituitary
## Footnote
This results in anti-estrogen effects that promote gonadotropin release.
80
What is the role of insulin sensitizing agents like metformin in treating infertility?
They reduce circulating insulin levels, potentially restoring normal reproductive endocrine function
## Footnote
This is particularly relevant for women with PCOS.
81
What are the risks associated with exogenous gonadotropins?
* Ovarian hyperstimulation syndrome (OHSS)
* 25% incidence of multifetal gestations
## Footnote
These injections require frequent monitoring of follicle growth.
82
What is the process of In Vitro Fertilization (IVF)?
* Ovarian stimulation to produce multiple follicles
* Retrieval of oocytes from the ovary
* Oocyte fertilization in vitro
* Embryo incubation in the laboratory
* Transfer of embryo into the uterus
## Footnote
IVF accounts for more than 99% of all ART procedures in the United States.
83
What is Intracytoplasmic Sperm Injection (ICSI)?
A technique where a single sperm is injected directly into the cytoplasm of a mature oocyte
## Footnote
ICSI is often used when there are male factor infertility issues.
84
What are the indications for IVF?
* Absent or blocked fallopian tubes
* Severe pelvic adhesions
* Severe endometriosis
* Poor response to stimulation
* Oligo-ovulation
* Severe male factor infertility
* Unexplained infertility
* Failure with less aggressive treatment
## Footnote
These factors help determine the need for advanced reproductive technologies.
85
What is the initial step in infertility treatment?
Identifying a primary cause and contributing factors
## Footnote
Treatment aims at direct correction, either medically or surgically.
86
What percentage of infertility cases are unexplained?
10% to 20%
## Footnote
This indicates a significant number of cases where the cause remains unidentified despite thorough investigation.
87
what hormone stimulates the development of several follicles in the ovaries?
FSH
88
what ovarian cells produce estrogen?
granulosa cells
89
T or F: rising estrogen correlates w/ decreasing FSH and increasing LH.
True
90
Describe the hormonal mechanism for the formation of the corpus luteum.
granulosa cells start producing LH receptors after ovulation
LH then binds to these receptors to mediate the transformation of the Graafian follicle into the corpus luteum
91
the corpus luteum produces what hormone?
progesterone
92
T or F: rise in progesterone correlates with decrease in LH.
true
93
Premenstrual disorder is a more severe form of what condition?
premenstrual syndrome
94
what bioactive molecule plays a central role in the development of PMS?
serotonin
95
dietary depletion of what bio-molecule can exacerbate PMS?
tryptophan deficiency
96
T or F: whole blood serotonin concentrations are higher during the luteal phase in women w/ PMS.
false
lower during luteal phase
97
what bio-molecule is elevated during the luteal in women w/ PMS?
beta-endorphins
98
List the clinical criteria for diagnosing PMS.
diary of premenstrual episodes spanning at least 3 cycles
exclusion of other medical and psychiatric disorders
Analysis of daily urinary steroid metabolites
99
what dietary supplements can be implemented to improve mood swings of pts. w/ PMS
calcium
vit. E
vit. D
100
define primary dysmenorrhea.
precurrent lower abdominal pain shortly before or during menstration
101
what is the pathophysiology of primary dysmenorrhea?
increased endometrial PGs(PGF2 alpha) production leads to vasoconstriction, stronger, sustained uterine contractions and ischemia
102
define secondary dysmenorrhea.
same as primary except w/ secondary, there is an underlying condition to explain the lower abdominal pain
103
before making a DDx of secondary dysmenorrhea, what other conditions that present w/ similar symptoms MUST BE RULED OUT?
UTI, STDs, ectopic pregnancy, pelvic US
104
what is the biomarker for ectopic pregnancy screening?
B-HCG
105
What conditions should you consider if a female pt. tells you she has hemoptysis only when she is on her period?
thoracic endometriosis w/ possible hemothroax or a catamenial pneumothorax
106
what is the function of the basalis layer in the endometrium?
reservoir for regeneration of the functionalis layer following menses
107
what triggers enzymatic breakdown of the functionalis layer in the endometrium?
estrogen-progesterone withdrawal
108
define metrorrhagia.
abnormal bleeding b/t periods
109
define menometrorrhagia (men-oh-me-trah-age-ee-ah.
heavy and/or prolonged irregular menstruation
110
what is postcoital bleeding
intermenstrual bleeding prompted by vaginal intercourse
111
how is withdrawal bleeding defined?
predictable bleeding that results from an abrupt decline in progesterone levels
112
how are polyps defined histologically ?
abnormal growth of glandular tissues w/ supporting stroma (epithelium) around a vascular core
113
what is adenomyosis?
endometrial tissue growth in the myometrium
114
adenomyosis results in what histologic change of the myometrium?
myometrial hypertrophy
115
What is the pathologic term for fibroids?
leiomyoma
116
leiomyomas are derived from what and are typically caused by what?
sm. uterine cells
directed by estrogen or progesterone
117
a pelvic ultrasound can be used to detect what neoplasms?
fibroids
endometrial polyps
cancer
118
when would you order a hysterosalpinogogram?
if a pelvic US shows a visible abnormality
119
what kind of radiographic modality can be used to distinguish adenomyosis from leiomyomas
MRI
120
make sure to do the practice questions at the end of this ppt.
menstrual disorders
121
what external factors can temporarily impair sperm quality?
high fevers or chronic use of hot tubs
122
What are the most common congenital diseases assoc. w/ male infertility?
Kallman syndrome (congenital GnRH deficiency)
Iron overload syndrome
Prader-Willi syndrome
123
T or F: caffeine is assoc. w/ a 45% decrease in fecundability
true
124
oral temp of the follicular phase is what
97-98
125
oral temp during the luteal phase is what
98-99
126
what does the ovulation predictor kit measure?
urinary LH concentration
should be done 2-3 prior to the predicted LH surge and then continued daily
127
serum progesterone levels should be measured at which point in the cycle?
midluteal: 18-24 days after onset of menses
OR
7 days before the next menses is suspected
128
how is diminished ovarian reserve defined?
diminished oocyte quality and reproductive potential (# of healthy eggs)
129
what are the long-term consequences of PCOS?
DM
endometrial cancer
CVD
130
what are the parameters of biochemical hyperandrogenemia?
elevated total or free testosterone and SHBG
131
what is another term for functional hypothalamic amenorrhea?
hypogonadotropic hypogonadism
132
what are risk factors for FHA?
anorexia nervosa
bulimia
kallman syndrome
133
how is FHA characterized?
decrease in hypothalamic GnRH secretion
134
inhibition of LH and FSH inhibition of GnRH release has been assoc. w/ what other hormonal imbalance?
hyperprolactinemia
135
premature menopause is clinically defined by what parameters?
menopause before age 40
136
how are endometriosis lesion described histologically?
red/clear or yellow-brown discolorations described as "powder burns"
