menstrual disorders Flashcards
what is secondary amenorrhea
- in a woman who has previously menstruated, absence of menses for 3 months
- in a women with irregular menses, it is 6 months absence of menses
what is primary amenorrhea with and w/out secondary sex characteristics
with: absence menstruation by age 16
w/o: absence menstruation by age 14
common cause of primary amenorrhea
pregnancy
women who fail to menstruate in the presence of estrogren stimuation of the endometrium…
are at increased risk for endometrial cancer
drug use, stress, big wt change, excessive exercise
think secondary amenorrhea
cause of secondary amenorrhea in a woman with nml estrogen
asherman syndrome(intrauterine synechiae) or PCOS
first line test for amenorrhea
B-hCG, TSH, prolactin
CNS tumor, stress, hyperprolactinemia, hypophysitis, sheenan syndrome, premature ovarian syndrome
causes of secondary amenorrhea in a hypoestrogenic women
what test to do determine the presence or absence of sufficient estrogen
progesterone challenge test
streak gonads, shield chest, amenorrhea, webbed neck, aortic coartatation, bicuspid aortic valve
turner syndrome
increased prolactin means what
inhibits the release of GnRH and thus LH and FSH; points to a pituitary pathology
etiology of hypogonadotrophic hypogonadism
hypothalmic or pituitary problem
etiology of hypergonadotrophic hypogonadism
ovaries have failed to produce estrogen
primary dysmenorrhea
- caused by what
- occurs when
- painful menstruation with no pathologic abnormality
- excess prostaglandin and leukotriene levels
- occurs within 2 years of menarche
primary dysmenorrhea symptoms
painful contractions/cramping in lower abdomen or pelvis radiating to back/thighs, n/v, diarrhea
primary dysmenorrhea tx
NSAIDs, heat, combined OCPs, progestin IUD
secondary dysmenorrhea causes; age
endometriosis, adenomysis, fibroids, adhesions, IUD, PID;
over 25 yrs of age
when does primary and secondary dysmenorrhea peak
primary: late teens and early 20s
secondary: incidence increases with age
secondary dysmenorrhea symptoms
similar to primary but also bloating, menorrhagia, dysparenunia
primary and secondary dysmenorrhea related to flow
primary: begins or at onset of menses and lasts 1-3 days
secondary: less related to first day of flow
primary dysmenorrhea
- breast development
- pubic and axillary hair
yes to breast development
no pubic or axillary hair
imperforate hymen
a completely sealed hymen will prevent menstrual flow
gonadal agenesis or dysgenesis
hypoplastic dysfunctional ovaries
turner syndrome
45, X
androgen insenstivity and tx
genetically male child who is phenotypically female
tx: removal of testis due to risk of testicular cancerhow
cervical agenesis
prevents menstrual flow
mullerian agenesis
uterus never develops
tumor of pituitary or hypothalamus
affect LH and FSH production
amenorrhea blood work
LH, FSH, B hCG, estrogen, prolactin, testosterone
amenorrhea imaging
pelvic, transvaginal, thyroid
CT/MRI hypothalamus and pituitary
how to define secondary amenorrhea in a pt with oligomenorrhea
12 month period without menses
galactorrhea
milk from breast not associated with childbirth; think secondary amenorrhea
sheehan syndrome
damage to pituitary secondary to ischemia during childbirth, think secondary amenorrhea
asherman syndrome
intrauterine adhesions
main difference with primary and secondary amenorrhea
primary has no pathologic findings
PMS occurs when during the menstrual cycle
begin 1-2 weeks before menses(luteal phase), it ends 1-2 days after the onset of menses
PMS and symptom free period
monthly symptom free period during follicular phase(frpm day 1 of menses to ovulation)
tx for mastalgia
bromocriptine
menopause
cessation of menses for 12 months as as result of follicular depletion
average age 51 years
premature menopause
cessation of menses before age 40
age women stop menstruating
between 44 and 55
what happens to ovaries during menopause
they continue to produce testosterone and androstenedione; estrone is the predominant postmenopausal circulating estrogen
diagnostic lab for menopause
FSH greater than 30 is diagnostic
combine HRT increases what
risk for CV disease, breast cancer, and cognitive changes
contraindications to HRT
undiagnosed vaginal bleeding, acute vascular thrombosis, liver disease, hx of endometrial or breast cancer
follicular phase ends with what
LH surge and ovulation
GnRH is from where? and causes an increase in what 2 things
from anterior pituitary; increases FSH and LH
FSH role
causes follicle growth
LH role
causes egg to be released and mature, breaks down follicle walls and helps follicle to turn into corpus luteum
what happens 24 -36 hrs after LH surge
dominant egg is released
ovum lives for how long
24 hrs
describe temperature with ovulation
decrease with basal body temp and increase in temp
proliferative phase is what cycle days
7 to 14
days 15-28 is what 2 phases
luteal and secretory
progestin challenge shows withdrawal bleed
(+) anovulation due to noncyclic gonadotropin secretion. think PCOS with inc LH
progestin challenge shows NO withdrawal bleed
(-) uterine abnormality or estrogen deficiency
