Menstrual Disorders

Question 1

Primary Amenorrhea is? (2)

Answer 1

1) No period by 15 e/t 2° characteristics N

2) No period by 13 and no 2° characteristics

Question 2

Primary Amenorrhea caused by? (5)

Answer 2

1) Gonadal dysgenesis from chromosome abnormality
2) Hypothalamic hypogonadism
3) No mullerian duct as embryo, no women parts
4) Transverse vag septum, imperf hymen
5) Pituitary dz

Question 3

Primary Amenorrhea: Hypothalmic/Pituitary Disorders caused by? (4)

Answer 3

1) Functional: Low GnRH secretion due to low nutrition, excess exercise, stress
2) Congenital: Low GnRH from hypogonad
3) Hyperprolactinemia
4) Infiltrate/tumors

Question 4

Kallmann’s Synd is?

Answer 4

hypogonadotropic hypogonadism with loss of sense of smell (anosmia)

Question 5

Primary Amenorrhea: Ovarian Disorders caused by? (2)

Answer 5

1) Gonadal dysgenesis (e.g. Turner’s)

2) Polycystic Ovary Synd (U causes 2° amenor)

Question 6

Primary Amenorrhea: Receptor Abnormalities/Enzyme Deficiencies?

Answer 6

Androgen Insensitivity Synd:
Male w/ outer vagina,
no uterus/fallop tubes,
high testosterone

Question 7

Primary Amenorrhea: Initiate eval when? (3)

Answer 7

1) 15yo w/o bleeding
2) 13yo w/o breast development (thelarche)
3) 13yo w/o bleed within 2 yrs of breasts

Question 8

Primary Amenorrhea: Hx questions? (11)

Answer 8

1) Timeline of puberty
2) FHx age of menarche
3) Height compared to family
4) Neonate/childhood health
5) Sxs of virilization (male char)
6) Stress, wgt ∆, diet, exercise, illness
7) Galactorrhea
8) Anosmia
9) HA, visual ∆, fatigue, polyuria/dipsia
10) Hx of head trauma
11) Sex activity

Question 9

Primary Amenorrhea: Physical exam should always include?

Answer 9

Cardiac, pulmonary, pelvic, breasts

Along w/ vitals, general, skin

Question 10

Primary Amenorrhea: Labs? (6)

Answer 10

hCG (ALWAYS)
FSH/LH
Karotype
Prolactin
TSH
Testost

Question 11

High FSH indicates?

Low/N FSH indicates?

Answer 11

gonadal dysgenesis

hypo/hypogonadism

Question 12

Primary Amenorrhea: Possible Imaging?

Answer 12

Pelvic sonogram

CT or MRI (pituitary)

Question 13

2° Amenorrhea is?

Answer 13

Previous menstruaters w/ no period for 3 cycles or 6 consecutive months

Question 14

2° Amenorrhea: Caused by? (5)

Answer 14

1) PREGNANCY
2) Ovarian dysf
3) Hypothalamic dysf
4) Pituitary dysf
5) Uterine dysf

Question 15

2° Amenorrhea: Hypothalamic/Pituitary Disorders caused by?

Answer 15

1) Fxn’l hypothalamic (same as w/ primary, celiac)
2) Puititary dz
3) Hyperprolactinemia

Question 16

2° Amenorrhea: Hx questions? (11)

Answer 16

1) Bleed hx
2) Pregnancies
3) Meds
4) PMH/recent illness
5) Weight ∆
6) Exercise
7) Skin ∆s (oil, acne, hair)
8) Galactorrhea
9) E2 deficiency sxs
10) Endocrine ROS
11) Asherman sxs (intrauterine adhesions)

Question 17

2° Amenorrhea: Physical exam should include?

Answer 17

same as primary

+ HEENT (parotid swelling, enamel erosion

Question 18

2° Amenorrhea: Labs?

Answer 18

same

+ progestin challenge if other labs are N

Question 19

Progestin challenge test is?

Answer 19

Assess E2:

pt takes medroxyprogestone x 10 d,
if E2 levels are N, pt will bleed w/ withdrawl of med

if no bleed = hypoE2, pregnancy, uterine defects

Question 20

2° Amenorrhea: Imaging?

Answer 20

Pelvic sonogram
CT adrenal gland
CT/MRI pituitary

Question 21

Polymenorrhea is?

Answer 21

frequent bleeds <24 days apart

Question 22

Menorrhagia is?

Answer 22

heavy or prolonged at N intervals

Question 23

Menometrorrhagia is?

Answer 23

heavy and irregular

Question 24

Metrorrhagia is?

Answer 24

irregular

Question 25

Abnormal Uterine Bleeding (AUB) caused by?

Answer 25

PALM COEIN

Polyp
Adenomyosis
Leiomyosis
Malig/Hyperplasia

Coagulopathy
Ovulatory dysf
Endometrial
Iatrogenic (caused by tx)
Not classified

Question 26

Dysfunctional Uterine Bleeding is?

Answer 26

Dx of exclusion

Use when all other P causes are r/o

Question 27

AUB initial eval includes? (3)

Answer 27

1) confirm blood from uterus
2) confirm pre- or postmenopausal
3) exclude pregnancy

Question 28

AUB 2° eval includes? (5)

Answer 28

1) Determine bleeding pattern
2) Is endometrial sample needed?
3) Is coag eval needed?
4) Bleeding related to contraception method?
5) Concurrent factors to bleeding?

Question 29

AUB hx questions? (9)

Answer 29

1) Age of menarche
2) Bleed hx
3) Bleed pattern/amount
4) Molimina sxs (premenstrual sxs)
5) Birthcontrol
6) Meds
7) Hx/FHx of bleed dis
8) Weight ∆
9) Anemia sxs

Question 30

AUB physical exam purpose?

Answer 30

r/o all possible causes for bleeding

Question 31

AUB labs? (4) and (4 possibles)

Answer 31

hCG
CBC
Fe
Pap/Cx

(P)
coag
TSH
LFT
FSH

Question 32

AUG imaging/studies? (2)

Answer 32

pelvic sonogram

endometrial bx

Question 33

AUG management?

Answer 33

E2
endometr ablation
hysterectomy

Question 34

Dysmenorrhea: Primary is?

2° is?

Answer 34

no identifiable cause

organic pelvic dz

Question 35

Primary Dysmenorrhea: Begins?

Pain description?

Pain location?

Assoc sxs?

Pelvic exam results?

Answer 35

at onset of menst, lasts 12-72 hrs

intermitt cramping

low abd, (P) low back/up thighs

N/V/D, HA, fatigue

N pelvic

Question 36

Primary Dysmenorrhea: Tx for resistant cases?

Answer 36

CCB (nifedipine)

Question 37

2° Dysmenorrhea: Management?

Answer 37

Treat cause

COC help in most cases

Question 38

PMS is?

Answer 38

physical, mood, behavioral ∆s that occur in relationship to LUTEAL PHASE, resolve w/ menses

Question 39

Premenstrual Dysmorphic Dis (PMDD) is?

Answer 39

PMS w/ severe emotional sxs

Question 40

PMS diagnostic criteria?

Answer 40

1) 1 or more somatic and affective sxs 5 days before menses
2) sxs resolve w/i 4 days of meses
3) not caused by meds
4) dysfxn in social or economic life

Question 41

PMDD diagnostic criteria?

Answer 41

slide 62

Question 42

Non pharm mgmt for PMSs?

Answer 42

↓ salt, caffeine, EtOH
↑ exercise
↑ Ca2+/Mg

Question 43

Pharm mgmt for PMSs?

Answer 43

NSAIDs
Spironolactone (bloating)
SSRI
(P) ovulation suppression