Menstrual disorders Flashcards
What is the MCC of amenorrhea
Unrecognized pregnancy
beta HCG should be the first test always!!
What treatment is indicated for hypoestrogenic conditions associated with primary and secondary amenorrhea
Estrogen (with progestin)
Causes of menorrhagia include
systemic disorders or specific uterine abnormalities
-Uterine fibroids, adenomyosis, endometrial polyps. gynecologic disorders
What is anovulatory bleeding
Bleeding form endometrium as a result of a dysfunctional menstrual system
Must exclude anatomic lesion of the uterus
PCOS is characterized by
Amenorrhea
Menorrhagia
Anovulatory bleeding
(an androgenic disorder)
What medication can be given in PCOS to improve glucose tolerance
Metformin (off label use)
What conditions can cause amenorrhea
congenital uterine abnormalities
premature ovarian failure
meds (antipsychotics, verapamil)
anovulation/PCOS
What conditions can cause anovulatory bleeding
adolescence perimenopause hyperandrogenic anovulation (PCOS) hyperprolactinemia hypothyroidism premature ovarian failure
Because PCOS is an androgenic disorder, treatment should include
an anti-androgenic progesterone (3 or 4 gen)
If pregnancy is an immediate goal for a woman with PCOS, treatment should include
weight loss
Clomiphene citrate
+/- metformin (if with reduced insulin sensitivity)
If amenorrhea is 2/2 anorexia or excessive exercise, and increasing weight/decreasing exercise/psychotherapy are not effective, try
Estrogen (oral contraceptives or the patch)
Primary/Secondary amenorrhea treatments include
CEE (conjugated estrogen equine): Premarin
Ethinyl estradiol patch: Alora, Estraderm
Combination OC
Secondary amenorrhea treatments include
Oral MPA (medroxyprogesterone acetate): Provera
Progesterone vaginal gel
Norethindrone
Micronized progesterone
Treatment for amenorrhea related to hyperprolactinemia includes
Bromocriptine*
Cabergoline
Treatment for anovulatory bleeding includes
Combination OC (Desogen, Yaz, etc.)
How do Bromocriptine and cabergoline work
Dopamine agonists; they suppress prolactin production from pituitary tumors so normal FSH and LH production occurs
ADE of dopamine agonists include
hypotension nausea constipation anorexia Raynaud's fatigue HA
How do combination OC’s work
exogenous estrogen and progesterone suppresses FSH and LH, and inhibits ovulation
Reduces menstrual flow
controls menstrual cycle
ADE of COC’s include
VTE breast enlargement breast tenderness bloating nausea upset stomach HA peripheral edema
What drugs can interact with COC’s
St John’s Wort: contributes to altered menstrual bleeding
Rifampin: induce estrogen metabolism, causing Tx to fail
Sulfa drugs: Increased photosensitivity
How do CEE work
Estrogen replacement for hypoestrogen states
Causes anovulatory bleeding
How MPA work
Suppresses FSH and LH= suppress estrogen and progesterone
Inhibit usual growth of endometrium
ADE of MPA include
Edema anorexia depression weight gain insomnia increased total cholesterol and LDL reduce HDL
Good treatments for women with dysmenorrhea include
Mirena: decrease contractility and effect of fibroids
NSAIDS as prophylaxis
Treatment options for dysmenorrhea include
COC's Depo-Provera LNG-IUD NSAIDS Celecoxib
How does LNG-IUD work
Suppresses FSH and LH= suppress estrogen and progesterone
Inhibit usual growth of endometrium
Why do NSAIDs work in treating dysmenorrhea
Inhibit prostaglandin release= reduce inflammatory response that contributes to dysmenorrhea
ADE of NSAIDs include
GI upset stomach ulcer nausea vomiting heartburn indigestion rash dizziness
What treatments can you use for Menorrhagia
COC’s
LNG-IUD
Oral MPA
Tranexamic acid
What is tranexamic acid
Reversibly blocks lysine binding sites on plasminogen= prevents fibrin degredation= reduced menstrual blood loss
AKA: anti-fibrinolytic
Should be noticeable in the first month of therapy, with improved H&H after 3 months
ADE of Tranexamic acid are
nausea
vomiting
diarrhea
dyspepsia
How do you dose Tranexamic acid
1300 mg TID up to 5 days during monthly menses
PCOS treatments include
Injectable MPA
COC’s
Oral MPA
Metformin
How does metformin work in treating PCOS
Inhibits hepatic glucose production
increases insulin sensitivity= reduced insulin resistance
*Start low (500 mg) and titrate up slowly!
Metformin is contraindicated in
CrCl <30, can cause lactic acidosis IV contrast (dye can increase risk of lactic acidosis): stop metformin 1 day prior to IV contrast
What treatments can be used for PMDD
Clomipramine (mechanism unknown) Drospirenone Leuprolide SSRI's (ONLY during luteal phase) SNRI's
How does Drospirenone work in treating PMDD
Progesterone with anti-androgen properties (fourth gen) = decreased emotional lability
How does Leuprolide treat PMDD
GnRH agonist= suppress FSH/LH= decrease estrogen and progesterone
Inhibit normal menstrual cycle
(ned 1-2 months of therapy to see improvement)
