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Women's Health > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

avg age of menarche…

A

12-13 yo

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2
Q

average menstrual cycle length (1st day of bleeding through next cycle of bleeding)

A

24-38 days

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3
Q

normal menstrual bleeding should be how long…

A

8 or fewer days

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4
Q

amount of blood loss in menstrual bleed?

A

5-80mL

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5
Q

The normal menstrual cycle depends on normal function of what three factors?

A

Hypothalamic-pituitary-ovarian axis

endometrial hormone response

intact outflow tract

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6
Q

Failure to reach menarche by age 15 with normal secondary sex characteristics

OR

by 13 without secondary sex development

A

primary amennorhea

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7
Q

absence of menses for more than 3 cycles or 6 consecutive months

A

secondary amenorrhea (cessation)

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8
Q

2 most common etiologies of primary amenorrhea…

A

gonadal dysgenesis and PCOS

ovarian dysfunction

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9
Q

what results in high FSH hypergonadotropic hypogonadism?

A

gonadal dysgenesis

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10
Q

what type of gonadal dysgenesis?

ovaries unable to respond to gonadotropins

MC cause of premature ovarian insufficiency

A

turner syndrome (45 XO)

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11
Q

What type of gonadal dysgenesis?

vanishing testes:
streak gonads don’t secrete AMH or T

A

46 XY

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12
Q

A patient presents with:

-premature depletion of oocytes and follicles

  • shield chest
  • webbed neck
  • side spaced nipples
  • streaked ovaries
A

Turner syndrome (45 XO)

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13
Q

A patient presents with:

indifferent gonads

female internal and external genetalia

no secondary male characteristics

rare d/o

A

46 XY, sawyer syndrome

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14
Q

46 XY is caused by…

A

SRY gene mutation

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15
Q

Patient presents with:

ovulatory dysfunction
hyperandrogenism

A

PCOS

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16
Q

If sxs of hypogonadotropic hypogonadism presents with anosmia, what should you suspect?

A

Kallman syndrome: congenital GnRH deficiency

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17
Q

Primary amenorrhea can be caused by hypothalamic disrutions. What is the female athlete triad?

A

insufficient calorie intake
amenorrhea
low bone density

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18
Q

2 pituitary causes of primary amennorhea

A

adenoma

hyperprolactinemia

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19
Q

This is an outflow tract d/o that is a common cause of primary amennorhea:

blind end vagina
cyclic pelvic pain and mass
normal gonadal function
breast development

A

mullerian agenesis

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20
Q

this is a congenital absence of oviducts, uterus and upper vagina with 46 XX genotype

A

mullerian agenesis

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21
Q

46 XY
female phenotype
high serum T

A

androgen insensitivity syndrome

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22
Q

testes make T and AMH but not responsive to T or DHT due to complete or partial androgen receptor insensitivity

A

androgen insensitivity syndrome

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23
Q

on US you notice absent upper vagina, uterus and fallopian tubes.

Physical exam reveals intra-abd or partially distended testes

A

androgen insensitivity syndrome

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24
Q

46 XY
can’t convert T to DHT
ambiguous genitalia at birth

A

5 alpha reductase deficiency

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25
Q

Phenotypic female with HTN and lack of pubertal development

decreased cortisol and sex steroids

A

17 alpha hydroxylase deficiency

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26
Q

which gene mutation causes 17 alpha hydroxylase deficiency?

A

CYP17

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27
Q

MC cause of secondary amennorhea…

A

pregnancy

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28
Q

initial workup of primary amenorrhea…

A 
HCG
FSH
TSH
Prolactin
Pelvic US
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29
Q

If primary amenorrhea and absent uterus, what two tests should be ordered?

A

karyotype

total T

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30
Q

3 tx goals of primary amenorrhea…

A

underlying cause
fertility
complication mgmt (osteoporosis)

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31
Q

Negative pregnancy test

history of wt. loss, strenuous exercise, eating d/o

A

hypothalamic dysfunction (anorexia, bulimia, exercise, stress)

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32
Q

negative pregnancy test

hx of uterine surgery or infx

scarred endometiral lining

A

asherman syndrome

33
Q

Negative pregnancy test

HA
Visual Changes
galactorrhea

(2)

A

sheehan syndrome

infiltrating pituitary dz/tumor

34
Q

negative pregnancy test

worsening acne
hirsutism
wt. gain
insulin resistance
abnormal ovaries on US
androgen excess
A

PCOS

35
Q

negative pregnancy test

recent or recurrent meds (OCPs, danezol, andipsychotics)

A

post pill amenorrhea

DA/gonadotropin/releasing hormone antagonists

36
Q

negative pregnancy test

hx of: renal failure, CA, infx, RA

A

amenorrhea due to systemic illness

37
Q

negative pregnancy test

worsening acne
hirsutism
wt. gain

A

hypothyroidism

38
Q

Evaluate for cause of primary amenorrhea when? (3)

A

no uterine bleeding by 15

no menses/thelarche by 13

no menarche w/in 3 years of thelarche

39
Q

what DDx for primary amenorrhea?

Low/normal FSH, (+) breast development and uterus present

A

PCOS/thyroid

40
Q

What tests should be ordered for primary amenorrhea for the below results and why?

L ow/normal FSH, (+) breast development and absent uterus:

A

DDx: mulerian agenesis

order karyotype, T r/o AIS

41
Q

What course of action?

L ow/normal FSH, ( (–) breast development

A

pituitary MRI

42
Q

if pituitary MRI is negative and normal prolactin… what two tests should be ordered?

A

transferrin saturation (hemochromotosis)

Progesterone challenge

43
Q

If low FSH/no estrogen or no withdrawal bleed on progesterone challenge, what type of amenorrhea should be considered?

A

functional hypothalamic

44
Q

If unopposed estrogen/high LH to FSH ratio and withdrawal bleed on estrogen challenge, what type of amenorrhea should be considered?

A

PCOS

45
Q

Initial workup for secondary amenorrhea

A 
HCG
FSH
TSH
prolactin
T
46
Q

the below are most common causes of..

anovulation
structural pathology
bleeding disorder
uterine neoplasia

A

abnormal uterine bleeding

47
Q

The PALM-COEIN Classification seeks to differentiate what?

A

structural/nonstructural cause of AUB

48
Q

The below are ____ causes of AUB

polyp
adenomyosis
leiomyoma (fibroid)
malignancy

A

structural

49
Q

The below are ____ causes of AUB

coagulopathy
ovulatary dysfunction
endometrial
iatrogenic
not classified
A

nonstructural

50
Q

MC cause of AUB for 13-18 yo

A

anovulatory bleeding via immature HPO axis

51
Q

common cause of AUB for 19-39

A

structural leisions

52
Q

common cause of AUB for 40 to menopause

A

anovulatory bleeding, carcinoma, hyperplasia

53
Q

unpredictable bleeding is suggestive of what type of AUB?

A

anovulatory

54
Q

regular cycle length and associated with sxs of ovulation is what type of AUB?

A

ovulatory

55
Q

heavy AUB is usually what cause?

A

uterine (fibroid, adenomyosis, coagulopathy)

56
Q

the below often cause what type of AUB?

polyp
contraception
PID
cervical d/o

A

intermenstrual

57
Q

post-coital bleed should be sugestive of _____ pathology

A

cervical

58
Q

irregular/anovulatory bleed is likely due to (3)

A

PCOS
thyroid
hyperprolactinemia

59
Q

T/F: any post-menopausal bleed is abnormal

A

tru

60
Q

if a patient with AUB is hemodynamically unstable, what is tx?

A

admit for IV estrogen

61
Q

the below is a cause of:

PGs released from endometrium

cause uterine contractions/ischemia

A

primary dysmenorrhea

62
Q

Patient presents w.

normal pelvic exam
cramp like, intermittent pain

onset hours before or just after onset of menstruation

A

primary dysmenorrhea

63
Q

how is primary dysmenorrhea diagnosed?

A

clinical (if h & p consistent)

64
Q

Tx for primary dysmenorrhea…

A

ibuprofen 400mg q 4-6 hours x 3-4 days

hormonal contraceptives

65
Q

The below complications are indications for…


Pain worsening with each menses

Pain lasts longer than first 2 days of menses

Medication is no longer controlling the pain

Menstrual bleeding becomes increasingly heavy

Pain accompanied by fever

Abnormal discharge or bleeding occur

Pain occurs at times unrelated to menses
A

referral

66
Q

resistant primary dysmenorrhea can be treated with…

A

laproscopy

GnRH analogue

67
Q

30-40 yo pt presents with:

pain not limited to menses
dyspareunia
infertility
AUB

A

secondary dysmenorrhea

68
Q

the below are common causes of…


Endometriosis (presence of endometrial tissue outside the uterus)

Adenomyosis (endometrium grows into the wall of the

Adhesions

Pelvic inflammatory disease (PID)

Leiomyomas (uterine fibroid
A

secondary dysmenorrhea

69
Q

tx for secondary dysmenorrhea…

A

underlying cause +/- hormone therapy

70
Q

PMS is related to the _____ phase

A

luteal phase

71
Q

what Nt is decreased in the luteal phase that may be responsible for PMS/PMDD due to progesterone’s increase of MAO

A

serotonin

72
Q

A patient presents with:

irritability, depression, anxiety, sensitivity

increased appetite

bloating

fatigue

breast tenderness

HA

A

PMS

73
Q

PMS can be diagnosed if what two factors…

A

1+ sx occurs during luteal phase

sxs remit at menses

74
Q

PMDD requires ____/11 sxs present during____

A

5 during most menstrual cycles

75
Q

the below are sxs of ____

mood swings
hopelessness
anger
anxiety

AND

sxs of depression (DIGFAST)

A

PMDD

76
Q

PMS, PMDD, or MDD?

+/- predominant mood sxs
+ physical sxs
- social impairment
monthly cycle

A

PMS

77
Q

PMS, PMDD, or MDD?

+ predominant mood sxs
+ physical sxs
+ social impairment
+ monthly cycle

A

PMDD

78
Q

1st line therapy for PMDD

A

SSRIs

Women's Health (10 decks)

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