Menstrual Disorders Flashcards
What are some causes of amenorrhea?
- anorexia, weight loss
2. no known cause
Dx for amenorrhea?
3 missed cycles or
6 months of no bleeding in a previously menstruating women
How can you tx a amenorrhea in anorexia?
correct weight or decrease exrecise
or
use estrogen replacement -higher dose
conjugated estrogen ( not a contraceptive dose)
ethinyl estradiol patch ( not contraceptive dose)
How can you tx menstrual irregularity of unknown cause?
progestrone challenge: withdrawal bleed 7 days after the last dose, HPA axis is intact but issue probability with anovulation and lack of progestrone
What is menorrhagia?metorrhagia? polymenorrhea?
heavy bleeding
girl is ovulating, abnormal uterine bleeding
metorrhagia: bleeding within cycle
polymenorrhea: cycle less than 21 days
What is tx for menorrhagia?
If women does want to have kids: use NSAID —>tranexamic acid–>luteal phase progestrone–> HC or LNG-IUS
or
LNG IUS—> OC–>endometrial ablation surgery
What are some complications fro HBMB?
vWF
low platelets/dysfunction
hypothyrodism
What is the clinical use of tranexamic acid
use when HC not a choice
MOA of tranexamic acid?
reverisbly blocks lysine site on plaminogen and
ADE of TA?
N/V/D
What is MCC of AUB-O?
PCOS
LH:FSH >2, followed by DHEA or testoterone=PCOS
LH and FSH high with hoit flashes = menopause
How do you tx anoculation from PCOS?
weight loss
clomiphene citrate
metformin
if they dont want to have kids:
-use weight loss, metformin, OC with progestrone and reduced androgenetic effects
drusg for tx PCOS?
MPA-depo
Comination OC: drospirenone
Metformin?
reduces insulin resistance
ADE: anorexia, N/V/D,
Monitor for ovualtion after 3-6 mo of therapy
What is dysmenorrhea?
painful menstruation
What is 1st tx to try for dysmenorrhea?2nd line?3rd line? 4th line?
Heat pad
NSAID-begin at time of symptom onset,
HC x2-3 cycles
MPA or LNG-IUS
What is PMS?PMDD?
PMS: mood disturbance, physical symptoms during cycle,
PMDD: pysche disorder
patho: decrease stimulation in HPA axis response while in MDD it is increased
How do you tx PMS and PMDD?
non-pharmacological: for mild cases: decrease caffeine, sugar, sodium
increase exercise
Pharmacology: SNRI’s, SSRi, HC, GnRH agonist
PMDD drugs to use
Clomipramine: anti-psychotic, only used during the luteal phase
drospperinone: Yasmin
Leuprolide: GnRH agonist- IM injection
SSRi: Citalopram-can be dosed during the luteal phase or continously
SNRI: Venlafaxine , can be dosed during the luteal phase or continously
MOA of Clomipramine, SSRI, SNRI?
unknown
MOA of leuroplide?
suppresees FSH and LH and reduces estrogen and progestrone
ADE: hot flashes, night sweats, HA
