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Foundations III > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

Primary amenorrhea

A
  • no menarche (first menses) by age 15 despite normal growth and secondary sexual characteristics
  • no menarche by age 13 + not growing normally or hasn’t developed secondary sex characteristics
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2
Q

Secondary amenorrhea

A
  • No menses for 3 months (previously regular cycles)

- No menses for 6 months (previously irregular cycles)

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3
Q

Primary amenorrhea: ovarian disorders

A

Gonadal dysgenesis (ex. Turner’s 45, XO)

  • short stature
  • webbed neck
  • widely spaced nipples
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4
Q

Primary amenorrhea: Hypothalamic/pituitary disorders

A
  1. Hypothalamic (abnormal GnRH secretion)
  2. Congenital GnRH deficiency (ex. Kallmann syndrome with anosmia)
  3. Hyperprolactinemia
  4. Hypothyroidism
  5. Tumor
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5
Q

Primary amenorrhea: uterus absent

A
  1. Mullerian agenesis (46- XX) (vaginal agenesis)

2. Androgen Insensitivity Syndrome (46 XY) - male but testosterone isn’t having its intended effect

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6
Q

What is the first thing to screen with lack of menses?

A

PREGNANCY TEST

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7
Q

What should be measured if the patient is not having periods and has not developed 2ndry sex characteristics?

A

LH and FSH

If low–> hypo-gonatotropic hypogonadism (hypothalamus or pituitary failure)

If high–> check karyotype

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8
Q

In primary amenorrhea, when do you start clinical evaluation?

A

At age 15 if no menarche
At age 13 if no breasts (thelarche)
At age 13 if no menstration within 2 years of thelarche

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9
Q

Primary amenorrhea: labs

A

-urine or serum beta hCG
-Serum FSH/LH
(if high FSH suggests gonadal dysgenesis- Turners)
(if low FSH suggests hypothal/pituitary failure)

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10
Q

Reasons for functional amenorrhea

A
  • weight loss, exercise
  • nutritional deficiencies
  • stress
  • celiac disease
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11
Q

Name 2 pituitary diseases that could cause secondary amenorrhea

A
  1. Prolactin secretin tumor

2. Sheehan’s syndrome (post-partum)

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12
Q

Secondary amenorrhea: ovarian causes

A
  1. Polycystic ovary syndrome (too much androgens)
    - hirsutism
    - acne
  2. Primary ovarian insufficiency (poop out too soon. Ex. Turner syndrome, or radiation or chemo)
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13
Q

Secondary amenorrhea: uterine disorders

A

Asherman’s syndrome - acquired scarring of the endometrial lining usually from postpartum hemorrhage, surgical proceedure or infection

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14
Q

Progestin challenge test (secondary amenorrhea)

A
  • helps assess estrogen status
  • Give medroxyprogestone for 10 days
  • If adequate estrogen levels, should have withdrawal bleeding within 2 weeks
  • If no bleed –>pregnant, uterine defect
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15
Q

What proportion of outpatient GYN visits are due to abnormal uterine bleeding?

A

1/3

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16
Q

What is the most common reason for abnormal uterine bleeding?

A

anovulation

17
Q

Menorrhagia

A

excessive or prolonged menses occurring at normal intervals

18
Q

What is the diagnosis of exclusion for abnormal uterine bleeding if all other causes have been ruled out?

A

dysfunctional uterine bleeding (DUB)

19
Q

For a patient having uterine bleeding, what labs should be ordered?

A
  1. hCG*
  2. CBC*
  3. Iron studies
20
Q

For a patient with uterine bleeding, what is the best imaging modality?

A

Pelvic Ultrasound

21
Q

Mild uterine bleeding: tx

A

observation, consider oral contraceptives

22
Q

Severe uterine bleeding: tx

A

ablation

23
Q

Extreme uterine bleeding: tx

A

hysterectomy

24
Q

Primary dysmenorrhea

A

painful menstruation with no readily identifiable cause

-Young patients (17-22yrs)

25
Q

Secondary dysmenorrhea

A

painful menstruation due to organic pelvic disease

-more common with age

26
Q

Primary dysmenorrhea: clinical presentation

A
  • cramp-like intermittent pain
  • normal pelvic exam
  • begins just before or just after onset of menstruation
27
Q

For a patient with primary dysmenorrhea, what lab test is the most important to order?

A

beta-hCG

28
Q

Primary dysmenorrhea: conservative treatment approach

A
  • drink less caffiene
  • get enough sleep
  • exercise
  • yoga, acupuncture
  • calcium, magnesium, B-complex
  • stop smoking
29
Q

Primary dysmenorrhea: Pharmacologic therapy

A

NSAIDs**

or
oral contraception, Depo-Provera
or
CCBs

30
Q

Secondary Dysmenorrhea: key points

A
  • women 30-40yrs

- Pain not limited to start of menses

31
Q

Secondary dysmenorrhea: treatment

A

oral contraception

32
Q

Distinguish PMS from PMDD

A
  • both occur during the luteal phase
  • occur in most cycles
  • resolve with onset of menses

***PMDD has more severe emotional symptoms (affective/psychological)

33
Q

How do you assess for menstrual cycle associated disorders?

A

Daily Record of Severity of Problems (DRSP) form

-self rating questionnaire which helps distinguish PMS and PMDD

34
Q

Premenstrual dysphoric disorder (PMDD): Tx

A

Pharmacologic: SSRIs (ex. fluoextine, sertraline, citalopram, paroxetine, escitalopram)

Foundations III (34 decks)

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