Menstrual disorders Flashcards
primary or secondary amenorrhea?
- Absence of menarche by age 15 despite nl growth and secondary sexual development
- Absence of menarche by age 13 in absence of nl growth or secondary sexual development
Primary amenorrhea
primary or secondary amenorrhea?
Absence of menses for more than 3 months (previous regular cycles), or 6 months (previously irregular cycles) in women who were previously menstruating
secondary amenorrhea
MC cause of primary amenorrhea?
chromosomal abnormality causing gonadal dysgenesis
What syndrome is a/w gonadal dysgenesis (primary amenorrhea)?
what syndrome is a/w secondary amenorrhea?
primary= Turner’s syndrome
secondary= Polycystic Ovary Syndrome
Hypogonadotrophic hypogonadism disorders:
- functional or hypothalamic amenorrhea
- congenital GnRH deficiency
- Infiltrative disease/or tumors
- hyperprolactinemia
- hypothyroidism
Primary or Secondary amenorrhea?
Primary
Primary or secondary amenorrhea?
- vaginal agenesis (Mullerian agenesis)
- imperforate hymen
- transverse vaginal septum
Primary
If a pt has an absent upper vagina, uterus and Fallopian tubes on PE and pelvic US; high serum testosterone, and male (XY) karyotype,
what syndrome do they have and is it primary or secondary amenorrhea?
Androgen Insensitivity syndrome
primary
When do you start clinical evaluation for primary amennorhea? (3)
- 15 if no uterine bleeding has occurred
- 13 if no evidence of breast development
- 13 if pt has not menstruated w/in 2 yrs of breast development
What lab studies can you check in primary amenorrhea? (1 you must always do)
-urine or serum HCG- ALWAYS
-Serum FSH/LH (high FSH= gonadal dysgenesis, low FSH= hypogonadotrophic hypogonadism) -Karyotype -serum prolactin and TSH -serum testosterone
1 cause of secondary amenorrhea?
PREGNANCY
Polycystic Ovarian syndrome causes primary or secondary amenorrhea?
secondary
What is Sheehan’s syndrome? Primary or secondary amenorrhea
postpartum amenorrhea from postpartum pituitary necrosis
secondary
What is Asherman’s syndrome? Does it cause primary or secondary amenorrhea?
Acquired scarring of the endometrial lining, usually 2/2 postpartum hemorrhage or endometrial infection followed by instrumentation such as dilatation and curettage
Secondary
if a pt presents w/ complaints of not getting her period in over one year & on PE you notice dental enamel erosion, what do you suspect to be the cause of amenorrhea?
secondary amenorrhea 2/2 bulimia
What is the progestin challenge test?
Performed to assess estrogen status when initial lab studies are WNL
-Medroxyprogestrone 10 mg x 10 d
if pt have adequate estrogen, should have withdrawal bleeding in 2 weeks.
if no withdrawal bleeding- pregnancy, severe hypoestrogenism, or uterine defect
What imaging do you start w/ in secondary amenorrhea?
Pelvic sonogram
Abnormally frequent menses at intervals <24 days
Polymenorrhea
Excessive and/or prolonged menses occurring at normal intervals
Menorrhagia
heavy and irregular uterine bleeding
Menometrorrhagia
Causes of abnormal uterine bleeding
PALM-COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified
When all identifiable causes for abnormal uterine bleeding are ruled out, what is it called?
Dysfunctional uterine bleeding
What labs do you check for AUB?
HCG, CBC, Iron studies
possible also: coagulation studies, bleeding time, TSH, LFTs, FSH
What are treatment options for AUB?
- observation
- hormonal tx
- endometrial ablation
- hysterectomy
What is primary vs secondary dysmenorrhea?
primary= no identifiable cause secondary= due to pelvic dz
Describe the process that causes primary dysmenorrhea
- regression of corpus luteum
- Prostaglandins released from endometrium at time of menstruation as a result of cell lysis
- occurs in ovulatory cycles
- uterine contractions w/ ischemia
Typical sx of primary dysmenorrhea
- cramp-like, intermittent
- lower abd, may radiate to lower back
- Assoc. sx- N/V/D, HA, fatigue
conservative tx options from primary dysmenorrhea
-decrease caffeine intake
-heat
gently massage lower abd
-sleep
-exercise
-yoga
Primary pharmacologic tx for primary dysmenorrhea
NSAIDS (ex. Ibuprofen 400 mg, 1 po q6hrs x3-4 days)
If pt is not desiring pregnancy, what pharmacologic tx can be started for primary dysmenorrhea?
hormonal contraceptives
If a pt has tried NSAIDS and hormonal contraceptives but still has primary dysmenorrhea, what pharmacologic tx can be given?
calcium channel blocker (nifedipine)
What is different about secondary dysmenorrhea compared to primary is regards to pain onset and age
Secondary= less related to 1st day of menses
Usually in women ages 30-40
Some potential underlying causes for secondary dysmenorrhea
- PID
- uterine fibroids
- ovarian cysts
- pelvic congestion
- endometriosis
Tx options for secondary dysmenorrhea
- COCs for almost all cases
- complicated cases may require pelvic surgery
What phase are PMS and PMDD in relation to?
Luteal phase
What is given to women to distinguish PMS from PMDD?
Daily Record of Severity of Problems (DRSP)
What is the differentiating factor between PMS and PMDD?
PMDD= >5 sx and one is an affective sx
What questions on the Daily Record of Severity of Problems (DRSP) are about affect?
- Depressed, sad, “down” or felt hopeless; or felt worthless or guilty
- anxious, tense, “keyed up” or “on edge”
- modd swings, sensitive to rejection or feelings easily hurt
- angry or irritable
Tx options for PMS/PMDD (nonpharmacologic and pharmacologic)
- aerobic exercise
- stress reduction techniques
- SSRIS: fluoxetine, sertraline, citalopram, paroxetine, escitalopram
- (+/-) ovulation suppression: ECOCs, GnRH agonists
