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Summer 1 > Menstrual disorders > Flashcards

Menstrual disorders Flashcards

1
Q

What is the MCC of amenorrhea

A

Unrecognized pregnancy

beta HCG should be the first test always!!

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2
Q

What treatment is indicated for hypoestrogenic conditions associated with primary and secondary amenorrhea

A

Estrogen (with progestin)

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3
Q

Causes of menorrhagia include

A

systemic disorders or specific uterine abnormalities

-Uterine fibroids, adenomyosis, endometrial polyps. gynecologic disorders

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4
Q

What is anovulatory bleeding

A

Bleeding form endometrium as a result of a dysfunctional menstrual system
Must exclude anatomic lesion of the uterus

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5
Q

PCOS is characterized by

A

Amenorrhea
Menorrhagia
Anovulatory bleeding
(an androgenic disorder)

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6
Q

What medication can be given in PCOS to improve glucose tolerance

A

Metformin (off label use)

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7
Q

What conditions can cause amenorrhea

A

congenital uterine abnormalities
premature ovarian failure
meds (antipsychotics, verapamil)
anovulation/PCOS

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8
Q

What conditions can cause anovulatory bleeding

A 
adolescence 
perimenopause 
hyperandrogenic anovulation (PCOS) 
hyperprolactinemia 
hypothyroidism 
premature ovarian failure
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9
Q

Because PCOS is an androgenic disorder, treatment should include

A

an anti-androgenic progesterone (3 or 4 gen)

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10
Q

If pregnancy is an immediate goal for a woman with PCOS, treatment should include

A

weight loss
Clomiphene citrate
+/- metformin (if with reduced insulin sensitivity)

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11
Q

If amenorrhea is 2/2 anorexia or excessive exercise, and increasing weight/decreasing exercise/psychotherapy are not effective, try

A

Estrogen (oral contraceptives or the patch)

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12
Q

Primary/Secondary amenorrhea treatments include

A

CEE (conjugated estrogen equine): Premarin
Ethinyl estradiol patch: Alora, Estraderm
Combination OC

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13
Q

Secondary amenorrhea treatments include

A

Oral MPA (medroxyprogesterone acetate): Provera
Progesterone vaginal gel
Norethindrone
Micronized progesterone

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14
Q

Treatment for amenorrhea related to hyperprolactinemia includes

A

Bromocriptine*

Cabergoline

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15
Q

Treatment for anovulatory bleeding includes

A

Combination OC (Desogen, Yaz, etc.)

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16
Q

How do Bromocriptine and cabergoline work

A

Dopamine agonists; they suppress prolactin production from pituitary tumors so normal FSH and LH production occurs

17
Q

ADE of dopamine agonists include

A 
hypotension 
nausea 
constipation 
anorexia
Raynaud's
fatigue
HA
18
Q

How do combination OC’s work

A

exogenous estrogen and progesterone suppresses FSH and LH, and inhibits ovulation
Reduces menstrual flow
controls menstrual cycle

19
Q

ADE of COC’s include

A 
VTE 
breast enlargement 
breast tenderness 
bloating 
nausea
upset stomach 
HA
peripheral edema
20
Q

What drugs can interact with COC’s

A

St John’s Wort: contributes to altered menstrual bleeding
Rifampin: induce estrogen metabolism, causing Tx to fail
Sulfa drugs: Increased photosensitivity

21
Q

How do CEE work

A

Estrogen replacement for hypoestrogen states

Causes anovulatory bleeding

22
Q

How MPA work

A

Suppresses FSH and LH= suppress estrogen and progesterone

Inhibit usual growth of endometrium

23
Q

ADE of MPA include

A 
Edema 
anorexia 
depression 
weight gain 
insomnia 
increased total cholesterol and LDL 
reduce HDL
24
Q

Good treatments for women with dysmenorrhea include

A

Mirena: decrease contractility and effect of fibroids

NSAIDS as prophylaxis

25
Q

Treatment options for dysmenorrhea include

A 
COC's
Depo-Provera 
LNG-IUD 
NSAIDS 
Celecoxib
26
Q

How does LNG-IUD work

A

Suppresses FSH and LH= suppress estrogen and progesterone

Inhibit usual growth of endometrium

27
Q

Why do NSAIDs work in treating dysmenorrhea

A

Inhibit prostaglandin release= reduce inflammatory response that contributes to dysmenorrhea

28
Q

ADE of NSAIDs include

A 
GI upset 
stomach ulcer 
nausea
vomiting 
heartburn 
indigestion 
rash
dizziness
29
Q

What treatments can you use for Menorrhagia

A

COC’s
LNG-IUD
Oral MPA
Tranexamic acid

30
Q

What is tranexamic acid

A

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

31
Q

ADE of Tranexamic acid are

A

nausea
vomiting
diarrhea
dyspepsia

32
Q

How do you dose Tranexamic acid

A

1300 mg TID up to 5 days during monthly menses

33
Q

PCOS treatments include

A

Injectable MPA
COC’s
Oral MPA
Metformin

34
Q

How does metformin work in treating PCOS

A

Inhibits hepatic glucose production
increases insulin sensitivity= reduced insulin resistance
*Start low (500 mg) and titrate up slowly!

35
Q

Metformin is contraindicated in

A 
CrCl <30, can cause lactic acidosis 
IV contrast (dye can increase risk of lactic acidosis): stop metformin 1 day prior to IV contrast
36
Q

What treatments can be used for PMDD

A 
Clomipramine (mechanism unknown) 
Drospirenone 
Leuprolide 
SSRI's (ONLY during luteal phase) 
SNRI's
37
Q

How does Drospirenone work in treating PMDD

A

Progesterone with anti-androgen properties (fourth gen) = decreased emotional lability

38
Q

How does Leuprolide treat PMDD

A

GnRH agonist= suppress FSH/LH= decrease estrogen and progesterone
Inhibit normal menstrual cycle
(ned 1-2 months of therapy to see improvement)

Summer 1 (16 decks)

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