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Ambulatory Care of Women > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What is primary amenorrhea?

A

13 y.o. without secondary sex characteristics

15 y.o. with secondary sex characteristics

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2
Q

Number one cause of amenorrhea?

A

Pregnancy

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3
Q

What is secondary amenorrhea?

A

3-6 months or more than 3 menstrual cycles missed

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4
Q

What is Oligomenorrhea

A

Cycles > 40 days

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5
Q

Abnormal levels for prolactin?

A

Greater than 20-200

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6
Q

Primary- no uterus, no breast cause

A

agondaism, XY genotype androgen insensitivity syndrome

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7
Q

Primary- yes uterus, yes breast

A

hyperprolacenemia, structural defects

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8
Q

Primary- No uterus, yes breast

A

congential absence of uterus, androgen insensitivity syndrome

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9
Q

Primary- Yes uterus, no breast

A

Hypothalmic or pituitary dysfunction, gonadal dysgensis

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10
Q

Labs- normal E2, FSH, LH

A

PCOS

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11
Q

Labs- Decreased E2 and FSH

A

Pituitary problem

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12
Q

Labs- decreased E2 elevated FSH

A

Gonadal dysgenesis or POF

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13
Q

Labs- elevated DHEA

A

Adrenal tumor

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14
Q

Labs- elevated 17-hdyroxyprogesterone

A

Congenital adrenal hyperplasia

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15
Q

What does progesterone test tell you?

A

If there’s a structural abnormality. If it’s a deficit of estrogen, just check the E2 level

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16
Q

Causes of outflow tract obstruction

A 
Imporfate hyman, transverse septum
Mullarian agenesis
Complete androgen insensitivity (XY genotype)
Asherman Syndrome (D/C and infection)
Cervical Stenosis
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17
Q

Causes of ovarian failure

A

Gonadal Dysgenesis (do karyotype)
Turner Syndrome
FSH and LH receptor mutations
POF

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18
Q

Causes of Hypothalamic Dysfunction

A 
Stress, weightless, illness, exercise
Kallman Syndrome (ansomnia)
Congenital GnRH deficiency
GnRH receptor deficiency
Craniopharyngioma- most common, visual defecits
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19
Q

Causes of Pituitary Dysfunction

A

Prolacenmoa
Sheehan Syndrome
Hemochromocytosis
Isolated FSH/LH deficency

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20
Q

Causes of non gonadotropic amenorrhea

A

PCOS, congenital adrenal hyperplasia, cushing syndrome, hyperprolacinoma, thyroid disease

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21
Q

What is 17-hydroxyprogesterone associated with and why does it cause amenorrhea?

A

Associated with congenital adrenal hyperplasia. Causes amenorrhea because it activates progesterone receptors (decreasing release of FSH and LH)

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22
Q

Why does DHEAS cause amenorrhea?

A

Don’t know

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23
Q

What is irregular bleeding refer to as?

A

Anovulatory bleeding

24
Q

What must be present for anovulatory bleeding?

A

Estrogen

25
Q

What are the three factors for irregular bleeding?

A
  1. irregular 2. Not predictable 3. not associated with ovulatory cycles
26
Q

What is mid cycle spotting associated with?

A

Rapidly dropping estrogen. Is normal

27
Q

What is the luteal phase defect?

A

corpus luteum does not produce adequate progesterone

28
Q

What are structural causes? PALM

A

Polyp, adenomyosis, leiomyoma, malignancy and hyperplacsia

29
Q

What are non structural causes?Coein

A

Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

30
Q

What happens to unopposed estrogen?

A

Endometrial hyperplasia and risk for endometrial cancer

31
Q

What is goal in treatment of anovulatory bleeding?

A

Give oral contraceptives to shed endometrium or suppress endometrial growth.

32
Q

What is metrorrhagia and menorrhagia

A

Metrorrhagia- irregular bleeding

Menorrhagia- heavy bleeding

33
Q

What to check for in perimenopausal bleeding?

A

Anovulation, structural abnormality, malignancy, TSH, PRL, and FSH

34
Q

What to check forin post menopausal women?

A

Endometrial and vaginal atrophy. 7-10% have endometrial cancer

35
Q

What’s the gold standard for evaluating endometrial cavity?

A

Hysteroscopy

36
Q

What’s the first line test for >45 y.o.?

A

Endometrial sampling

37
Q

What to do for abnormal uterine bleeding and positive pregnancy test?

A

Evaluate for ectopic pregnancy, problem with fetus, or an abortion.

38
Q

What is dysfunctional uterine bleeding?

A

Diagnosis of exclusion with unopposed estrogen without progesterone

39
Q

What contraceptive should you give smokers?

A

Progesterone only

40
Q

What is screening test for coagulation problems associated with vWD?

A

Restoceitin factor only in those with problems beginning at menarche.

41
Q

What are drugs associated with dysfunctional uterine bleeding

A

digitalis, phenytoin, steroids

Dopamine antagonists.

42
Q

Normal FSH level?

A

5-30

43
Q

Normal LH Level?

A

5-20

44
Q

Normal Prolactin Level?

A

Less than 20

45
Q

Normal LH/FSH ratio?

A

Less than 2

46
Q

Normal testosterone Level?

A

70-120

47
Q

Abnormal DHEAS?

A

Greater than 400

48
Q

What are drugs associated with amenorrhea?

A

Phenothiazines, SSRIs, TCAs, antihypertensives, estrogen (COC), amphetamines, marijuana

49
Q

Criteria for PCOS?

A

Polycystic ovaries
Anovulation or oligoovulation
Serum or clinical signs of increased androgenism. Exclusion of other androgen disorder

50
Q

NSAIDS for dysfunctional uterine bleeding and dysmenorrhea

A

Mefanamic- 500 mg tid
Naproxen 550 then 275 q 6 hours
Ibuprofen 600 mg TID

51
Q

Physiologic causes of amenorrhea? x4

A

Pregnancy, menopause, post partum, breast feeding

52
Q

Drugs that cause amenorrhea?

A

SSRIs, TCAs, antihypertensives, estrogens, amphentamines, marijuana, phenothiazines

53
Q

What age is premature ovarian insufficiency diagnosed?

A

Before age 40

54
Q

First two tests to do in amenorrhea?

A

TSH and Prolactin

55
Q

What do you do if you don’t get withdrawl bleeding from progesterone challenge?

A

Check FSH. could be POF/Menopause if FSH high. If low give E and P, if bleeding occurs, do pituitary work up. If it doesn’t occur, refer

56
Q

Drugs for management of glactorea?

A

Parlodel (bromocriptine) and dostinex (cabergoline). These are dopamine agonists

57
Q

What is the cause of galactorrhea with normal prolactin?

A

Usually medications

Ambulatory Care of Women (8 decks)

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