Menstrual Disorders Flashcards
Primary Amenorrhea is? (2)
1) No period by 15 e/t 2° characteristics N
2) No period by 13 and no 2° characteristics
Primary Amenorrhea caused by? (5)
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
Primary Amenorrhea: Hypothalmic/Pituitary Disorders caused by? (4)
1) Functional: Low GnRH secretion due to low nutrition, excess exercise, stress
2) Congenital: Low GnRH from hypogonad
3) Hyperprolactinemia
4) Infiltrate/tumors
Kallmann’s Synd is?
hypogonadotropic hypogonadism with loss of sense of smell (anosmia)
Primary Amenorrhea: Ovarian Disorders caused by? (2)
1) Gonadal dysgenesis (e.g. Turner’s)
2) Polycystic Ovary Synd (U causes 2° amenor)
Primary Amenorrhea: Receptor Abnormalities/Enzyme Deficiencies?
Androgen Insensitivity Synd:
Male w/ outer vagina,
no uterus/fallop tubes,
high testosterone
Primary Amenorrhea: Initiate eval when? (3)
1) 15yo w/o bleeding
2) 13yo w/o breast development (thelarche)
3) 13yo w/o bleed within 2 yrs of breasts
Primary Amenorrhea: Hx questions? (11)
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
Primary Amenorrhea: Physical exam should always include?
Cardiac, pulmonary, pelvic, breasts
Along w/ vitals, general, skin
Primary Amenorrhea: Labs? (6)
hCG (ALWAYS) FSH/LH Karotype Prolactin TSH Testost
High FSH indicates?
Low/N FSH indicates?
gonadal dysgenesis
hypo/hypogonadism
Primary Amenorrhea: Possible Imaging?
Pelvic sonogram
CT or MRI (pituitary)
2° Amenorrhea is?
Previous menstruaters w/ no period for 3 cycles or 6 consecutive months
2° Amenorrhea: Caused by? (5)
1) PREGNANCY
2) Ovarian dysf
3) Hypothalamic dysf
4) Pituitary dysf
5) Uterine dysf
2° Amenorrhea: Hypothalamic/Pituitary Disorders caused by?
1) Fxn’l hypothalamic (same as w/ primary, celiac)
2) Puititary dz
3) Hyperprolactinemia
2° Amenorrhea: Hx questions? (11)
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)
2° Amenorrhea: Physical exam should include?
same as primary
+ HEENT (parotid swelling, enamel erosion
2° Amenorrhea: Labs?
same
+ progestin challenge if other labs are N
Progestin challenge test is?
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
2° Amenorrhea: Imaging?
Pelvic sonogram
CT adrenal gland
CT/MRI pituitary
Polymenorrhea is?
frequent bleeds <24 days apart
Menorrhagia is?
heavy or prolonged at N intervals
Menometrorrhagia is?
heavy and irregular
Metrorrhagia is?
irregular
Abnormal Uterine Bleeding (AUB) caused by?
PALM COEIN
Polyp
Adenomyosis
Leiomyosis
Malig/Hyperplasia
Coagulopathy Ovulatory dysf Endometrial Iatrogenic (caused by tx) Not classified
Dysfunctional Uterine Bleeding is?
Dx of exclusion
Use when all other P causes are r/o
AUB initial eval includes? (3)
1) confirm blood from uterus
2) confirm pre- or postmenopausal
3) exclude pregnancy
AUB 2° eval includes? (5)
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?
AUB hx questions? (9)
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
AUB physical exam purpose?
r/o all possible causes for bleeding
AUB labs? (4) and (4 possibles)
hCG
CBC
Fe
Pap/Cx
(P) coag TSH LFT FSH
AUG imaging/studies? (2)
pelvic sonogram
endometrial bx
AUG management?
E2
endometr ablation
hysterectomy
Dysmenorrhea: Primary is?
2° is?
no identifiable cause
organic pelvic dz
Primary Dysmenorrhea: Begins?
Pain description?
Pain location?
Assoc sxs?
Pelvic exam results?
at onset of menst, lasts 12-72 hrs
intermitt cramping
low abd, (P) low back/up thighs
N/V/D, HA, fatigue
N pelvic
Primary Dysmenorrhea: Tx for resistant cases?
CCB (nifedipine)
2° Dysmenorrhea: Management?
Treat cause
COC help in most cases
PMS is?
physical, mood, behavioral ∆s that occur in relationship to LUTEAL PHASE, resolve w/ menses
Premenstrual Dysmorphic Dis (PMDD) is?
PMS w/ severe emotional sxs
PMS diagnostic criteria?
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
PMDD diagnostic criteria?
slide 62
Non pharm mgmt for PMSs?
↓ salt, caffeine, EtOH
↑ exercise
↑ Ca2+/Mg
Pharm mgmt for PMSs?
NSAIDs
Spironolactone (bloating)
SSRI
(P) ovulation suppression
