menstrual disorders

Question 1

normal menses cycle occurs every

Answer 1

24-35 days

Question 2

Menorrhagia:

Answer 2

excessive flow or duration

Question 3

Metrorrhagia:

Answer 3

irregular intervals

Question 4

Oligomenorrhea:

Answer 4

intervals > 35 days

Question 5

Polymenorrhea:

Answer 5

intervals < 24 days

Question 6

Primary amenorrhea:

Answer 6

no menses by 16 years

Question 7

Secondary amenorrhea:

Answer 7

no menses for 3 cycles or 6 months

Question 8

PALM-COEIN classification

Answer 8

for abnormal uterine bleeding

Polyp
adenomyosis
leiomyoma
malignancy and hyperplasis

Question 9

hypothalamic hypogonadism

Answer 9

altered GnRH secretion that decreases gonadotropins, ovarian hormone production and impaired ovulation

think of the female triad

Question 10

treatment for functional hypothalamic suppression

Answer 10

1. reverse the underlying cause

2. estrogen replacement by OCP

Question 11

hypothalamic suppression can lead to a hypo-estrogenic state which leads to

Answer 11

decreased BMD and increased risk of fracture

Question 12

hypo/hyper- thyroidism

Answer 12

interferes with the feedback in axis

Question 13

kallman syndrome

Answer 13

congenital GnRH deficiency due to failure of GnRH neurons to develop and migrate

Question 14

prolactin enhances/supresses GnRH secretion

Answer 14

suppresses

Question 15

prolactinoma

Answer 15

most common pituitary tumor 50% and secretes prolactin thus there is a decrease in GnRH secretion

Question 16

what does dopamine do to prolactin?

Answer 16

decreases it

Question 17

prolactin levels in infertility

Answer 17

might indicate something

higher levels might be associated with infertility

Question 18

Sheehan’s syndrome

Answer 18

Ischemia and infarction of pituitary which cuases GnRH cannot pituitary/pathway blocked

• occurring after partum
• there will difficulty in breastfeeding due to no prolactin being released to stimulate lactation

Question 19

most common disorder of the ovaries

Answer 19

PCOOS- affects 6-10% of reproductive aged women

Question 20

PCOOS

Answer 20

excess androgen and arrested follicle ovaries

• insulin resistance

Question 21

PCOOS increases endometrial cancer

Answer 21

yep, there is a loss of progesterone and thus there is a building of the endometrial lining without any of the stabilization effects that progesterone has.. no protection

Question 22

string of pearls

Answer 22

the way that cysts look in PCOOS

Question 23

Rotterdam criteria:

Answer 23

1. hyperandrogenism
2. ovulatory dysfunction
3. polycystic ovaries on utrasound

Question 24

hyperthalamic hypogonadism

Answer 24

elevated gonadotropins (high FSH) and hypoactive (or inactivated) ovaries

Question 25

premature ovarian insufficiency causes

Answer 25

1. absent x chromosome or mutations/deletions
2. cancer treatments
3. autoimmune such as Ab to theca cells

Question 26

endometriosis

Answer 26

Presence of endometrial tissue outside uterus. affects 6-10% of reproductive aged women

*estrogen sensitive

Question 27

endometriosis etiology (3)

Answer 27

1. retrograde mensturation
2. lymphatic or vascular dissemination
3. metaplasia

Question 28

empiric treatment for endometriosis

Answer 28

1. NSAIDs to reduce inflammation

2. hormal treatments such as increasing progesterone to supress endometrium

Question 29

endometriosis treatments for difficult to treat disesase

Answer 29

1. GnRH agonist such as leuprolide but can lead menopause and decrease bone mineral density
2. surgery

Question 30

bromocriptine, cabergoline

Answer 30

dopamine agonists