Menstrual Disorders Flashcards
How is primary amnorrhea defined?
Absence of menarche by age 15
How is secondary amenorrhea defined?
Absence of menses for 6 months or greater in a woman previously menstruating
What is the most common chromosomal cause of primary amenorrhea?
Turner’s Syndrome
What are the FOUR most common manifestations of Turner’s Syndrome?
Short Stature
Infertility
Primary Gonadal Failure
Osteoporosis
What are THREE structural causes of primary amenorrhea?
Absence of uterus, cervix, vagina
Transverse vaginal septum
Imperforate Hymen
The absence of a uterus, cervix, or vagina would result from __________ (mullerian/wolffian) abnormalities
Mullerian
What is another name for the syndrome that results in mullerian agenesis?
Mayer-Rokitansky-Kuster-Hauser Syndrome
Transverse vaginal septums occur from _______ (agenesis/apoptosis) of the vaginal plate
Apoptosis
Which is more common…..
Imperforate Hymen or Mullerian Abnormalities
Imperforate Hymen
How are sturctural causes of primary amenorrhea managed?
Resection (Imperforate Hymen, Vaginal Septums)
Hysterectomy (Absent Cervix)
Creation of a Neovagina
What are FOUR ‘conditions’ that may lead to hypothalamic malfunction that results in amenorrhea?
- Eating Disorders (Anorexia)
- Vigorous Exercise
- Low Body Fat
- High Stress
_________ Syndrome is described as a congenital GnRH deficiency classically associated anosmia
Kallmann Syndrome
What are TWO causes of ovarian caused primary amenorrhea?
PCOS
Premature Ovarian Failure
What is the name of the syndrome that results in primary amenorrhea in females and often is associated with the presence of testis in the labia?
Androgen Insensitivity Syndrome
46 XY with non functional androgen receptors
When working up primary amenorrhea what labs should you order if a uterus is present?
Absent Uterus?
Present: B-Hcg, FSH, FSH, Prolactin
Absent: Karotype, Serum Testosterone
What is the most common cause of secondary amenorrhea?
Pregnancy
What ALWAYS needs to be ruled out when working up secondary amenorrhea?
Pregnancy
What are the THREE most common ‘sources’ for secondary amenorrhea?
Hypothalamic
Pituitary
Ovarian
T/F: Secondary amenorrhea cannot be iatrogenic
False
It can be
(ex: OCPs, Metocloparmide, Antipsychotics)
How does functional hypothalamic amenorrhea occur?
Decreased GnRH secretion commonly due to anorexia, low body fat, or excessive exercise
T/F: Celiac disease can impact hypthalamic function leading to secondary amenorrhea
True
What is the most common pituitary adenoma?
Prolactinomas
Can secondary amenorrhea result from hypothyroidism or hyperthyroidism?
Both!
PCOS is the cause of about __% of amenorrhea
20%
What ovarian disroder is classified as a depletion of functional oocytes before the age of 40?
Premature Ovarian Failure
What is Asherman;s Syndrome?
Acquired scarring of the endometrial lining from prior surgery or infection
What is the first lab always ordered when working up amenorrhea?
Beta-Hcg
If a patient underwent the progestin withdrawal test for secondary amenorrhea and no bleeding occurred what would it indicate?
Asherman’s Syndrome
When working up secondary amenorrhea, why are the following ordered……
MRI?
Karyotype?
MRI: Pituitary Adenoma
Karyotype: If FSH elevated to r/o partial chromosome deletion
What is the mainstay of treatment for hypothalamic causes of secondary amenorrhea?
Lifestyle Changes
What is the mainstay of management for secondary amenorrhea due to hyperprolactinemia?
Dopamine Agonists (Bromocriptine, Cabergoline)
Surgery is large, unresponsive to medication
What is the mainstay of management for secondary amenorrhea due to premature ovarian failure?
Estrogen/Progestin Therapy to prevent bone loss and manage menopause symptoms
What is the mainstay of management for secondary amenorrhea due to Asherman’s Syndrome?
Hyterscopic lysis of adhesions
Long-term Estrogen supplementation
_________ (primary/secondary) dymenorrhea is described as pelvic pain that occurs during menstruation in the absence of pelvic pathology
Primary Dysmenorrhea
_________ (primary/secondary) dysmenorrhea is described as pain with menses that results from pathologic changes in the pelvic viscera
Secondary Dysmenorrhea
When do symptoms (cramping, nausea, emesis) of primary dysmenorrhea onset?
Just prior to flow onset and last for a few days
Primary dysmenorrhea is present in __% of teens
60%
Primary dysmenorrhea is due to what?
Excess production of endometrial prostaglandins
What are TWO indications for doing a pelvic examination when working up primary dysmenorrhea?
Severe Sx
Pt is sexually active
T/F: A pelvic examination can be omitted if the patient is not sexually active
True
What is the first step in managing primary dysmenorrhea?
NSAIDs
may need to start 1-2 days prior to menses
If NSAIDs are not successful in managing primary dysmenorrhea, what can be started next?
Combination OCPs
*If the patient is sexually active this should be strongly considered
If treatment of primary dysmenorrhea fails what needs to be considered?
Secondary Dysmenorrhea
What are FIVE red flags of primary dysmenorrhea?
Failure to improve with NSAIDs + OCs Symptoms that worsen on treatment Onset of sxs with menarche (rather than 1-2 y later) Pelvic pain outside of menses History of STI
What are some of the many causes of secondary amenorrhea?
Endometriosis Adenomyosis Uterine leiomyomata Ovarian cysts Pelvic adhesions Chronic PID Obstructive uterovaginal anomalies Cervical stenosis Copper IUD IBS Inflammatory bowel disease Interstitial cystitis
The prevalence of secondary dysmenorrhea __________ (increases/decreases) with age while the prevalence of primary dysmenorrhea _________ (increase/decreases) with age.
Secondary: Increases with age
Primary: Decreases with age
Would you expect dyspareunia with secondary or primary dysmenorrhea?
Secondary Dysmenorrhea
What are examples of pelvic examination findings in secondary dysmenorrhea?
Purulent cervical discharge Cervical motion and/or adnexal tenderness Nodularity of uterosacral ligaments Uterine enlargement or irregularity Adnexal mass
What are THREE management options for secondary dysmenorrhea?
- NSAIDs / Analgesics
- OCPs / IUDs
- Treat underlying disease
How is menorrhagia defined?
Menstrual blood loss greater than 80 mL
_______ menses is defined as menses for longer than 7 days
Prolonged menses
What is metorrhagia
Irregular bleeding between menses
___________ is defined ass excessive and irregular uterine bleeding
Menometorrhagia
How is dysfunctional uterine bleeding defined?
Abnormal bleeding not from an anatomic abnormality
A menstrual cycle that lasts less than 24 days is defined as what?
Polymenorrhea
T/F: Coagulation testing should be considered when working up menorrhagia
True
Why should a CBC be ordered when working up menorrhagia?
rule out anemia
What THREE ‘procedures’ should be considered when working up menorrhagia?
Endometrial Biopsy (r/o hyperplasia) Pelivc US (Polyps, Fibrosis) Hysteroscopy (Lesions)
What are THREE management options for menorrhagia due to anovulation?
- Cycling with combined OCPs
- Scheduled progestin withdrawal bleeds
- Medicated IUD
What are management options for menorrhagia due to anatomic abnormality?
Hysteroscopic resection of endometrial polyps, submucous myomas
OCs and medicated IUD may have some efficacy at controlling heavy bleeding from myomas and adenomyosis
Endometrial ablation
Myomectomy
Hysterectomy
How is anemia from menorrhagia corrected?
Iron Supplementation
