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Special Pops - Women's Health > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Variability in length of the menstrual cycle is greater in what ages of women?

A

Under 25

Over 40

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2
Q

Variability in length of the menstrual cycle is less in what ages of women?

A

35-39 yo

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3
Q

Two cycles of menstruation and their phases

A
  • Ovarian (follicular, ovulation, luteal)

- Uterine (menstruation, proliferative, secretory)

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4
Q

Describe follicular phase of ovarian cycle

A
  • Most variable phase of menstruation
  • Ovarian follicles mature within the ovary and get ready to release an egg
  • Only 1 dominant follicle will grow to maturity (containing the egg)
  • Overlaps with uterine proliferative phase
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5
Q

What do ovarian follicles secrete as they mature?

A

Estradiol (form of estrogen)

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6
Q

Describe ovulation phase of ovarian cycle

A
  • Estradiol stimulates LH surge which starts around day 12

- Mature egg released from follicle

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7
Q

What is Mittelschmerz?

A

Ovarian follicle that ruptures fills with blood and there may be some bleeding into abdominal cavity causing peritoneal irritation and lower abdominal pain

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8
Q

Describe how fraternal twins occur

A

Both ovaries release and egg and both eggs are fertilized

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9
Q

What happens after the egg is released from ovarian follicle?

A
  • Travels to Fallopian tube
  • If not fertilized within 1 day, it will disintegrate
  • If fertilized, embryo will take 3 days to reach uterus and another 3 days to implant into endometrium
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10
Q

Describe luteal phase of ovarian cycle

A
  • FSH and LH cause remaining parts of follicle that released the egg to transform into corpus luteum
  • Corpus luteum secretes progesterone which induces the production of estrogen
  • Estrogen/progesterone suppress FSH/LH
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11
Q

What does the corpus luteum secrete?

A

Progesterone (which induces production of estrogen)

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12
Q

If fertilization occurs, what happens to the corpus luteum?

A

Corpus luteum persists because the embryo produces hCG (similar to LH and preserves the corpus luteum)

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13
Q

If fertilization does NOT occur, what happens to the corpus luteum?

A

It degenerates because of low levels of LH/FSH which triggers menstruation

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14
Q

Describe menstruation phase of uterine cycle

A
  • First phase

- Average duration 3-5 days

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15
Q

Describe proliferative phase of uterine cycle

A
  • 2nd phase (length is variable!)
  • Restoration of endometrium from preceding menstruation
  • Lining of uterus proliferates/grows
  • Ovarian follicles secrete estrogen which initiates formation of new layer
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16
Q

Describe secretory phase of uterine cycle

A
  • 3rd phase (corresponds to luteal phase of ovarian cycle)
  • Preparation of uterus for implantation of fertilized egg
  • Corpus luteum produces progesterone to increase BF to uterus, increase uterine secretions, raises body temp (all for proper environment for pregnancy)
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17
Q

The proliferative phase of the uterine cycle corresponds to which phase of the ovarian cycle?

A

Follicular

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18
Q

The secretory phase of the uterine cycle corresponds to which phase of the ovarian cycle?

A

Luteal

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19
Q

Patient A has a cycle length of 24 days. When does she ovulate?

A

Day 10 (subtract 14 days to account for luteal/secretory phase)

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20
Q

What is required to have regular spontaneous menstruation?

A
  1. Functional hypothalamic-pituitary-ovarian endocrine axis
  2. Competent endometrium
  3. Intact outflow tract from internal to external genitalia (uterus, cervix, vagina)
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21
Q

What are the cervical mucus changes that occur within menstrual cycle?

A
  • Estrogen makes mucus thinner and more alkaline (promotes transport and survival of sperm)
  • Progesterone makes mucus thicker
  • Mucus is thinnest at ovulation and more elastic
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22
Q

When is cervical mucus thinnest in menstrual cycle?

A

At ovulation (to promote survival of sperm)

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23
Q

How does progesterone affect cervical mucus?

A

Makes mucus thicker

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24
Q

How does estrogen affect cervical mucus?

A

Makes mucus thinner and more alkaline (promotes transport and survival of sperm)

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25
Q

Breast changes that occur within the menstrual cycle?

A
  • Estrogen causes proliferation of mammary ducts
  • Progesterone causes growth of lobules and alveoli
  • Brest swelling, tenderness, pain may occur 10 days before menstruation
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26
Q

How does estrogen affect breasts during menstrual cycle?

A

Causes proliferation of mammary ducts

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27
Q

How does progesterone affect breasts during menstrual cycle?

A

Causes growth of lobules and alveoli

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28
Q

How is body temperature affected during menstrual cycle?

A

Small increase during luteal phase (due to progesterone)

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29
Q

Define menorrhagia

A

Heavy or prolonged menstrual flow (greater than 80 mL per cycle)

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30
Q

Define polymenorrhea

A

Bleeding at less than 21 day intervals

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31
Q

Define oligomenorrhea

A

Bleeding at greater than 35 day intervals

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32
Q

Define metrorrhagia

A

Bleeding that occurs anytime b/w menstrual cycles

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33
Q

Define menometrorrhagia

A

Bleeding that occurs at irregular intervals

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34
Q

Define dysmenorrhea

A

Painful menstruation

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35
Q

Define dysfunctional uterine bleeding (DUB)

A

Bleeding secondary to anovulation

36
Q

Define primary amenorrhea

A
  • Absence of menses by age 13 in absence of normal growth or secondary sex development
  • Absence of menses by age 15 in setting of normal growth and secondary sex development
37
Q

Define secondary amenorrhea

A

Absence of menses for more than 3 cycle intervals or 6 consecutive months in previously menstruating woman

38
Q

What is the MC cause of secondary amenorrhea?

A

Pregnancy

39
Q

Uterine causes of amenorrhea

A
  • Pregnancy

- Asherman’s syndrome

40
Q

Cervical causes of amenorrhea

A

Stenosis/scarring

41
Q

Vaginal causes of amenorrhea

A
  • Mullerian aplasia (vaginal agenesis)
  • Transverse vaginal septum
  • Imperforate hymen
42
Q

Ovarian causes of amenorrhea

A
  • Menopause
  • Premature ovarian failure
  • PCOS
  • Turner’s syndrome
  • Testicular feminization
43
Q

What is Asherman’s syndrome?

A
  • Uterine scarring that causes amenorrhea
  • MC occurs after surgery
  • Tx by surgical removal of scar tissue
44
Q

What is Mullerian aplasia?

A
  • Congenital absence of uterus and upper 2/3rd’s of vagina causing amenorrhea
  • May have normal external genitalia OR only a small dimple at vaginal introitus
  • Normal functioning ovaries
45
Q

What is imperforate hymen?

A
  • Vaginal cause of amenorrhea
  • Hymen does not perforate as it should in late fetal life
  • Hereditary component
46
Q

How does imperforate hymen present in infants?

A

Mucocolpos (accumulation of vaginal secretions behind hymen makes it appear shiny, thin bulge)

47
Q

How does imperforate hymen present in adolescents?

A
  • Primary amenorrhea
  • Cyclic pelvic pain
  • Difficulty w/defecation or urination
  • Purplish-red hymenal membrane bulging outward
  • Hematometra (accumulation of blood above it)
48
Q

What is a transverse vaginal septum?

A
  • Vaginal cause of amenorrhea
  • MC in upper vagina
  • Presents similar to imperforate hymen
49
Q

What conditions can cause premature ovarian failure?

A
  • Fragile X syndrome
  • Surgery
  • Autoimmune disorder
  • Mumps
50
Q

How does Turner’s syndrome cause amenorrhea?

A

Ovaries fail to develop

51
Q

What is testicular feminization?

A
  • Phenotypically female, but lacking a uterus and complete vagina
  • May have non-functioning testes
52
Q

Pituitary causes of amenorrhea

A
  • Acquired dysfunction (Sheehan’s syndrome)
  • Surgical ablation and irradiation
  • Thalassemia major
  • Hyperprolactinemia
  • Hypothyroidism
53
Q

What is Sheehan’s syndrome?

A

Amenorrhea resulting from postpartum pituitary necrosis 2/2 severe hemorrhage and hypotension (RARE)

54
Q

What is Thalassemia major?

A
  • Pituitary cause of amenorrhea
  • Hematologic condition
  • Iron deposits in pituitary result in destruction of the cells that produce LH and FSH
55
Q

Hypothalamus causes of amenorrhea

A
  • Defects in GnRH transport
  • Defects in GnRH pulse production (female athletes)
  • Congenital GnRH deficiency
56
Q

Causes of menorrhagia

A
  • Pregnancy
  • IUD
  • Uterine fibroids
  • Cancer
  • DUB (MC is PCOS)
  • Endometrial hyperplasia
  • Hyperthyroidism
  • Bleeding disorders
57
Q

How to treat moderate menorrhagia?

A

Exclude pregnancy first then one of following options:

  • OCP at 2-4x usual dose
  • Conjugated estrogen until bleeding stops then medroxyprogesterone acetate
  • Medroxyprogesterone acetate until bleeding stops
58
Q

How to treat severe menorrhagia?

A
  • Dilation and curretage

- Emergency hysterectomy

59
Q

What is endometrial ablation?

A
  • Another tx option for menorrhagia
  • Results in amenorrhea or reduced menses
  • Must be certain that pt does not want more children
60
Q

Causes of metrorrhagia

A
  • Midcycle or ovulatory
  • Endometrial polyps
  • OCP
  • Endometritis (occurs after pregnancy or with use of IUD)
  • Cancer
  • Endometrial hyperplasia
61
Q

Causes of postcoital bleeding

A
  • Cervical polyps
  • Cervicitis
  • Cervical cancer
  • Atrophy in menopausal female (due to low estrogen)
62
Q

Causes of oligomenorrhea

A
  • Pregnancy
  • Hypogonadotropic hypogonadism (stress, wt loss, excessive exercise)
  • Anovulation
  • Hypothyroidism
63
Q

Causes of polymenorrhea

A
  • Anovulation
  • Incorrect use of OCPs
  • Pregnancy
  • Fibroids
  • Polyps
64
Q

Causes of hypomenorrhea

A
  • Cervical stenosis

- OCPs

65
Q

Define dysmenorrhea

A

Painful menstruation that prevents normal activity and requires medication

66
Q

Types of dysmenorrhea

A
  • Primary (no organic cause)

- Secondary (pathologic cause)

67
Q

Physiology of dysmenorrhea

A
  • A/w ovulatory cycles (later in adolescence)
  • Secondary to abnormal and increased prostaglandins (induces contractions, reduces BF, leading to hypoxia)
  • Psych component suspected as well
68
Q

Treatment of dysmenorrhea

A
  • NSAIDs or acetaminophen for mild discomfort (best if taken 1-2 days prior)
  • Heating pad
  • OCPs (synergistic with NSAIDs)
69
Q

What makes up 60% of cases of abnormal uterine bleeding?

A

Dysfunctional uterine bleeding (DUB)

70
Q

Describe DUB

A
  • Bleeding not a/w ovulation after all other pathology has been excluded
  • 60% of abnormal uterine bleeding cases
  • Almost half are women over 40 yo
71
Q

How is DUB mostly caused in young women 20-30 yo?

A

Pathological causes are uncommon

72
Q

How does DUB mostly occur in postmenopausal women?

A

More likely secondary to a pathologic cause (requires further workup)

73
Q

Possible causes of DUB in postmenopausal women

A
  • HRT
  • Vaginal atrophy
  • Vulvar lesions
  • Tumors
74
Q

Work up for postmenopausal women with DUB

A
  • Pelvic US

- Endometrial sampling/biopsy

75
Q

Define adenomyosis

A

Extension of endometrial glands into uterine musculature

76
Q

How does adenomyosis present?

A

Severe secondary dysmenorrhea and menorrhagia OR may be asymp

77
Q

How is adenomyosis treated?

A
  • D&C

- GnRH agonist or hysterectomy

78
Q

Define endometriosis

A

Condition in which endometrial tissue grows outside endometrial cavity

79
Q

Who is MC affected by endometriosis?

A
  • Almost exclusively pre-menopausal

- 25-35% of infertile women

80
Q

Where is the MC site of implantation in endometriosis?

A

Ovary

81
Q

Positive risk factors for endometriosis

A
  • Fam hx
  • Early menarche
  • Long duration of menstrual flow
  • Heavy bleeding during menses
  • Shorter cycles
82
Q

Negative risk factors for endometriosis

A
  • Regular exercise
  • Higher parity
  • Longer duration of lactation
83
Q

MC s/s of endometriosis

A
  • Secondary dysmenorrhea
  • Dyspareunia
  • Infertility
84
Q

What is required to diagnose endometriosis?

A

Direct visualization of lesions/implants by laparoscopy

85
Q

1st line medical tx of endometriosis

A

6-9 month trial of:

  • NSAIDs
  • Hormonal (OCPs, progestins)
86
Q

2nd line medical tx of endometriosis

A
  • High dose progestin
  • Danazol (induces a pseudomenopause)
  • GnRH agonists
87
Q

Surgical treatments for endometriosis

A
  • Conservative (preserve fertility)

- Definitive (total abdominal hysterectomy, BSO)

Special Pops - Women's Health (11 decks)

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