Menstrual Disorders

Question 1

Follicular Phase

Answer 1

14 days; increase in FHS = follicle production; dominate follicle remains; production of mature oocyte within follicle; increase in estrogen

Question 2

Ovulation Phase

Answer 2

LH surge; oocyte matures; dominate follicle releases mature oocyte; oocyte released from ovary; oocyte swept into fallopian tube

Question 3

Luteal Phase

Answer 3

14 days; luteinization of ruptured follicle; corpus luteum production

Question 4

Corpus luteum Production

Answer 4

Progesterone/Estrogen production; FSH/LH decline; corpus luteum atrophy; decreased levels of progesterone = endometrial shedding

Question 5

Primary Amenorrhea

Answer 5

Absence of menses by age 16

Absence of menses by age 14 + absence of sexual development

Question 6

Secondary Amenorrhea

Answer 6

Absence of menses for 3 cycles or 6 months

Previously menstruating

Question 7

Amenorrhea Diagnosis

Answer 7

Hypothalamus, pituitary, ovaries, uterus

Question 8

Amenorrhea S/Sx

Answer 8

Absence of menses, infertility, vaginal dryness, decreased libido, weight gain/loss, acne, hair loss, hirsutism

Question 9

Amenorrhea Nonpharm Tx

Answer 9

Weight gain/loss; reduction of exercise quantity/intensity

Question 10

Amenorrhea - Dopamine Agonists

Answer 10

Bromocriptine, Cabergoline; for hyperprolactinemia

Question 11

Dopamine Agonists MOA

Answer 11

Dopamine increased - prolactin concentration reduced - normal secretion of FSH and LH - resumption of menses

Question 12

Amenorrhea Tx - Unknown Etiology

Answer 12

Hormonal contraceptives; progestin (medroxyprogesterone acetate)

Question 13

Amenorrhea Tx - Ca + Vit D

Answer 13

Consider estrogen-containing contraceptive

Question 14

Primary Dysmenorrhea

Answer 14

Normal pelvic anatomy and physiology

Question 15

Secondary Dysmenorrhea

Answer 15

Underlying pelvic pathology

Question 16

Dysmenorrhea Pathophysiology

Answer 16

Prostaglandin and leukotriene release in menstruation; smooth muscle contraction in uterus; oxygen deprivation to nearby tissues, cramps

Question 17

Dysmenorrhea Tx

Answer 17

OC, medroxyprogesterone acetate, levonorgestrel IUD; ibuprofen; celecoxib

Question 18

Menorrhagia: S/Sx

Answer 18

Heavy menstrual flow, fatigue/lightheadedness, orthostasis, tachycardia, low hgb/hct, low ferritin

Question 19

Menorrhagia: Tx

Answer 19

Surgery, NSAIDs, OC/Progestin/Levonorgestrel, Tranexamic acid

Question 20

Tranexamic acid MOA

Answer 20

Reversible blocks lysine binding sites on plasminogen - fibrin degradation - reduces menstrual blood loss

Question 21

PMS Pharm Tx

Answer 21

Calcium, vitamin B, alprazolam, NSAIDs, SSRIs, spironolactone, OCs

Question 22

PMDD Diagnosis

Answer 22

Depression, anxiety, affective lability, anger/irritability, decreased interest, fatigue, difficulty concentrating, appetite changes, sleep disturbance, overwhelmed, physical symptoms - at least 5

Question 23

PMDD Tx

Answer 23

Vit B and calcium, SSRIs, SNRIs, TCAs, GnRH agonists, OCs

Question 24

Endometriosis Pathophysiology

Answer 24

Abnormal growth of tissue outside uterine cavity; common in reproductive aged women; lesions/implants on reproductive organs; stimulated by estrogen and progesterone

Question 25

Endometriosis S/Sx

Answer 25

Asymptomatic, pelvic pain, dyspareunia, infertility

Question 26

Endometriosis Tx - 1st line

Answer 26

OCs, transdermal contraceptives, vaginal contraceptives, POPs

Question 27

Endometriosis Tx - 2nd line

Answer 27

Levonorgestrel IUD, GnRH agonists (Goserelin, Leuprolide, Nafarelin), Danazol

Question 28

Endometriosis Tx - 3rd line

Answer 28

NSAIDs, Aromatase inhibitors (anastrazole), surgery

Question 29

Which drugs are pregnancy category X?

Answer 29

GnRH agonists, Danazole, Aromatase inhibitors