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GK F3E5 > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

What is primary amenorrhea?

A

No menarche by 15y/o w/ signs of puberty

OR

No menarche and no signs of puberty by 13y/o

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2
Q

What is the MC genetic cause of primary amenorrhea?

A

Turner’s syndrome

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3
Q

What is the 1st and 2nd MC causes of primary amenorrhea?

A

1- Chromosomal abnormalities causing gonadal dysgenesis (Turners)

2- Hypothalmic hypogonadism

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4
Q

If you have a patient with primary amenorrhea and low body weight what are you thinking is the cause

A

hypothalmic dysfunction

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5
Q

The following are possible causes of what?

  • Chrom abnormalities causing gonadal dysgenesis
  • Hypothalmic hypogonadism (functional/hypothalmic amenorrhea, tumors, hyperprolactinemia, hypothyroid)
  • Mullerian agenesis
  • Transverse vag septum
  • Imperforate hymen
  • Pituitary dz
  • Androgen insensitivity syndrome
A

Primary amenorrhea

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6
Q

If you have a patient with primary amenorrhea with cyclic pelvic pain and a perirectal mass, what are you thinking is the cause?

A

imperforate hymen

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7
Q

Primary amenorrhea:

What is functional/hypothalmic amenorrhea associated with?

A

eating disorders, times of extreme stress, excessive exercise, etc

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8
Q

What 5 labs should be ordered to evaluate for the cause of primary amenorrhea?

A
  1. HCG!!!!!
  2. Serum FSH/LH
  3. Serum prolactin and TSH
  4. Serum testosterone
  5. +/- Karyotype
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9
Q

What does an elevated FSH in a person with primary amenorrhea indicate?

A

Gonadal dysgenesis

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10
Q

What does an decreased or normal FSH in a person with primary amenorrhea indicate?

A

Hypogonadotropic hypogonadism

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11
Q

What are the 2 possible causes of a person with primary amenorrhea and normal puberty?

A
  1. Outflow tract obstruction
  2. H-P-O axis dysfunction
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12
Q

What are the 4 possible causes of primary amenorrhea w/ delayed puberty?

A
  1. Gonadal dysgenesis
  2. Mullerian agenesis
  3. Physiologic delay of puberty
  4. Genetic abnormality
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13
Q

What is secondary amenorrhea?

A

No menses x3 mo if previously regular cycles

OR

No menses x6mo if previously irregular cycles

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14
Q

What is the MCC of secondary amenorrhea?

A

Pregnancy!!

Then PCOS

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15
Q

If you have a patient with secondary amenorrhea and they have a history of uterine surgical procedure or infection, what shoudl you be thinking is the cause?

A

Asherman’s syndrome

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16
Q

If you have a patient with secondary amenorrhea along with worsening acne, weight gain and hirsutism, what shoudl you be thinking is the cause

A

PCOS

Hypothyroidism

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17
Q

If you have a patient with secondary amenorrhea along with HA, visual changes and nipple discharge what should you be thinking?

A

Pituitary disease/tumor

Sheehan Syndrome

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18
Q

If you have a patient with secondary amenorrhea along with h/o weight loss, strenuous exercise or eatind disorder, what should you be thinking?

A

Hypothalmic dysfunction

19
Q

What 6 labs could be drawn to evaluate secondary amenorrhea?

A

1. HCG!!!!!

  1. TSH
  2. Prolactin
  3. FSH/LH
  4. Total testosterone
  5. Progestin challenge ( not done often- looking to see if get withdrawal bleed)
20
Q

What is the Ddx for abnormal uterine bleeding? (PALM COEIN)

A

Polyp

Adenomyosis

Leiomyoma

Malignancy/hyperplasia

Coagulopathy

Ovulatory dysfunction

Endometrial

Iatrogenic

Not yet classified

21
Q

What is the MCC of abnormal uterine bleeding?

A

anovulatory cycle

22
Q

What is dysfunctional uterine bleeding?

A

dx of exclusion after identifiable causes of abnormal uterine bleeding are ruled out

23
Q

What are the 4 treatment options for abnormal uterine bleeding?

A
  1. Observation (less significant bleeding)
  2. Hormonal treatments (COCs)
  3. Endometrial ablation
  4. Hysterectomy (extreme cases)
24
Q

What is dysmenorrhea?

A

Painful menstruation

25
Q

What is the pathophys of dysmenorrhea?

A

The corpus Luteum causes pain by releasing prostaglandins which causes uterine contraction and ischemia

26
Q

Is primary or secondary dysmenorrhea due to organic pelvic disease?

A

secondary

Primary is due to an unidentifiable cause

27
Q

What age group is primary dysmenorrhea MC in? Secondary dysmenorrhea?

A

Primary: 17-20y/o

Secondary: 30-40y/o

28
Q

Primary or secondary dysmenorrhea?

  • Hours before or just after onset of menstruation
  • lasts ~12-72hrs
A

Primary

29
Q

What are the 2 main treatment options for primary dysmenorrhea

A
  • 1st line= NSAIDs
  • Hormonal contraceptives (COCs, ECOCs, Depo)
30
Q

How do you treat resistant primary dysmenorrhea?

A

CCBs

31
Q

In what 5 instances would you want to follow up or refer a patient with primary dysmenorrhea?

A
  1. Pain worsening with ea. menses
  2. Pain longer than the 1st 2 days of menses
  3. Meds no longer controlling pain
  4. Increased heaviness of bleeding
  5. Pain at times unrelated to menses
32
Q

Primary or secondary dysmenorrhea?

  • Pain NOT limited to menses but may worsen at this time
  • a/w other sxs (dyspaurenia, infertility, AUB)
  • less related to 1st day of menses
A

secondary dysmenorrhea

33
Q

What are the 4 causes of Secondary dysmenorrhea?

A
  1. Endometriosis
  2. PID
  3. Uterine fibroids
  4. Ovarian cysts
34
Q

What are the 3 tx options for secondary dysmenorrhea?

A

1. COCs (can use for almost all cases)

  1. If estrogens CI: Progestins or NSAIDs

3 +/- pelvic sx for complicated cases

35
Q

PMS is correlated with which phase of the menstrual cycle?

A

luteal phase

36
Q

What condition a/w luteal phase of menstrual cycle?

  • Abd bloating
  • fatigue
  • breast tenderness
  • HAs
  • irritability, depressed mood
  • etc
A

PMS

37
Q

PMDD must have > _____ sxs + at least 1 of what 4 affective disorders?

A

>5 sxs

+

at least 1 of the following affective disorders: depressed, anxious, mood swings/sensitive, angry/irritable

38
Q

How many sxs must be present to dx PMS? PMDD?

A

PMS: 1-4 sxs

PMDD: >5 sxs + at least 1 affective sx

39
Q

What questionairre helps distinguish PMS from PMDD?

A

Daily Record of Severity of Problems (DRSP) form

40
Q

The following are on the Daily Record of Severity of Problems form used to distinguish PMS from PMDD. What type of sxs are these considered and are they more helpful in distinguishing PMS or PMDD?

  1. Depressed/sad
  2. Anxious
  3. Mood swings, sensitive
  4. Angry/irritable
A

Affective sxs

PMDD

41
Q

What is the gold standard for treating PMDD? What is special about how patients can take these?

A

SSRIs (fluoxetine, sertraline, citalopram, paroxetine, escitalopram)

Can do cyclical tx (start when enter luteal phase)

42
Q

The following are some sxs of what? (must be present during week prior to menses, resolving witha few days after menses)

  • Mood swings
  • Anger/irritability
  • Depressed
  • Anxiety
  • Difficulty concentrating
  • Changes in appetite (increased)
  • Fatigue
  • Overwhelmed
  • Breast tenderness, bloating, joint/mm aches
  • Increased sleep
A

PMDD

(1 of the first 4 affective sxs MUST be present)

43
Q

Sxs of PMDD must be present when? When should they resolve

A

must be present during week prior to menses, resolving within a few days after menses

GK F3E5 (19 decks)

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