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Clin Med Final Material- Semester 2 > Menstrual Disorders: Paulson > Flashcards

Menstrual Disorders: Paulson Flashcards

1
Q

Puberty events:

  • Adenarche=
  • thelarche=
  • Pubarche=
A

= (increase in androgens before the onset of puberty, Typically 8-10 yo in girls

-Thelarche=breast development. **Requires estrogen and progesterone

-Pubarche (pubic hair development)=
Requires androgens

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2
Q

Puberty events:

-Menarche=

A

=first menstrual cycle
-Initial periods usually anovulatory
Preparation for fertilization and pregnancy

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3
Q

Menarche Requires: (list)

list 4 hormones required and their sources

A
  • GnRH from the hypothalamus
  • FSH/LH from the anterior pituitary
  • Estrogen and progesterone from the ovaries
  • Normal outflow tract
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4
Q 
Secondary Sexual Characteristics:
Tanner Stages (list?)
A
  • Breast development

- Pubic hair development

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5
Q

Other secondary sex characteristics:

A

-Accelerated growth spurt
-Body habitus:
Broader hips, rounded shoulders

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6
Q

Precocious puberty=

A

pubertal development before age 8 in girls and age 9 in boys

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7
Q

Normal menstrual cycle:

  • average age to start=
  • Definition=
A
  • 12-13yo…about 2.5 years after breast bud development . -GnRH Gonadotropin-releasing hormone – causes anterior pituitary to release FSH and LH
  • Normal Menstrual Cycle defined by ACOG – The menstrual cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by 7 days are considered normal.
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8
Q

Characteristics of Normal Menstruation:

-normal duration of flow=

A

4-6 days

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9
Q

abnormal duration of flow=

A

<2 days or >7 days

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10
Q

Normal volume of flow=

abnormal=

A

30 mL

> 80mL

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11
Q

Length of cycle:

  • normal?
  • abnormal?
A
  • 28 days +/- 7 days

- <21 days, > 35 days

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12
Q

mean cycle interval=

A

32.2 days in first gynecologic year

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13
Q

ACOG:

  • menstrual cycle interval=
  • Menstrual product use=
A

21-45 days

-3-6 pads or tampons per day

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14
Q

Menorrhagia=

Hypomenorrhea=

A

=Regular interval between periods, excessive flow and duration

=Decreased flow during normal duration of regular period

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15
Q

Metorrhagia=

polymenorrhea=

A

=Irregular intervals of menses

=shortened interval between periods , < 19-21 day interval

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16
Q

Menometorrhagia=

A

Irregular intervals and excessive bleeding during periods and between periods

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17
Q

Oligomenorrhea=

A

Lengthened interval between periods, > 35 days intervals

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18
Q

Post-Coital Bleeding=

Amenorrhea=

A

=Bleeding following coitus

=Absent period

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19
Q

Primary Amenorrhea=

A

-2.5% of population
=Absence of spontaneous menstruation by age 13 years in absence of normal growth/secondary sexual characteristics, or absence of menses by age 15 years in setting of normal growth and secondary sexual characteristic development

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20
Q

Secondary Amenorrhea=

absence of menses for:

A

-3 months in a previously menstruating female if cycles were NORMAL
OR
-Absence of menses for 6 months in a previously menstruating female if cycles were IRREGULAR

21
Q

List the 4 main categories of Primary amenorrhea

A
  • Ovarian Dysfunction
  • Pituitary Dysfunction
  • Hypothalamic Dysfunction
  • Outflow obstruction
22
Q

Describe ovarian dysfunction

A

Sex chromosome abnormality - ie Turners

23
Q

Pituitary Dysfunction=

A

Sheehan’s Syndrome (infarction of pituitary due to hemorrhage), Panhypopituitarism, Isolated gonadotropin deficiency, etc…

24
Q

Hypothalamic dysfunction=

A

Kallman’s Syndrome (delayed puberty and anosmia), Tumors of hypothalamus, Anorexia Nervosa, Severe weight loss/loss, Exercise

25
Q

Outflow obstruction=

A

Imperforate Hymen

26
Q

Gonadal dysgenesis/ Turner’s syndrome=

A

Gonadal dysgenesis – congenital developmental disorder of the reproductive system. Does not develop properly – underdeveloped and malfunctioning.

27
Q

Hypothalamic-pituitary insufficiency= defect of ____ OR congenital _____ deficiency

-interference with ______ transport
and _____

A

-Defects of GnRH (Gonadotropin-releasing hormone) pulse production:

-Congenital GnRH deficiency, also known as idiopathic hypogonadotropic hypogonadism
+ anosmia = (Kallman’s syndrome)

-Interference with GnRH transport
& GnRH pulse discharge

28
Q

Outflow Tract Obstruction: Imperforate Hymen:

  • dx with ?
  • Treatment?
A
  • dx on PE and with US
  • tx= Must be surgically opened
  • Normal breast development, dx on physical exam/ultrasound
  • **Not lifelong absence of menses as with other Primary amenorrhea processes
29
Q

Work-up for Primary amenorrhea:

1. Presence of ______

A
  1. Presence of secondary sexual characteristics – yes/no
    • Yes- Uterus Present -> outflow tract obstruction
    • No- Measure FSH/LH -> karyotype analysis
  2. Refer patient to GYN and Endocrinology
30
Q

Primary Amenorrhea - Tx?

A

-Treat the Underlying Disorder, if possible

-Let GYN and ENDO direct this
Ex)
--Cyclic estrogen/progestin
--Hormone replacement
--Surgical resection of intrauterine, cervical, and vaginal adhesions
31
Q

Secondary Amenorrhea is characterized by:

A

**cessation of previously regular menses for three months or previously irregular menses for six months and warrants evaluation.

32
Q

Secondary Amenorrhea - Causes(list Ex’s)

A

**PREGNANCY!!!
**PCOS
**Diabetes
**Hyperthroidism ir hypothyroidism
**Surgery
malnutrition
Asherman’s syndrome
Hypothalamic amenorrhea
Pituitary amenorrhea
Premature ovarian failure
Sheehan’s syndrome
**Medications (depo, etc…)

33
Q

More Causes of Secondary Amenorrhea

A 
Pituitary
Autoimmune disease
Cocaine
Cushing syndrome
Empty sella syndrome
Hyperprolactinemia
Infiltrative disease (e.g., sarcoidosis)
Medications
34
Q

More Causes of Secondary Amenorrhea

A 
Physiologic
Breastfeeding
Contraception
Exogenous androgens
Menopause
Did I mention…Pregnancy
35
Q

More Causes of Secondary Amenorrhea

A 
Hypothalamic
Eating disorder
Functional (overall energy deficit)
Gonadotropin deficiency (e.g., Kallmann syndrome)
Infection (e.g., meningitis, tuberculosis, syphilis)
Malabsorption
Rapid weight loss (any cause)
Stress
Traumatic brain injury
Tumor
36
Q

Secondary Amenorrhea:

-what is included in the Pts history?

A

-Menstrual History Onset and Patterns
Sexual History (LMP!!!!)
Presence of Psychosocial stressors
Body Weight Changes/Eating and Exercise Habits
Headaches/Visual changes – Pitutary? CNS?
Medication Use
Galactorrhea – Pituitary tumor
Chronic Illness – prior cancer treatment
Hyper/hypo androgenic sx’s – Hirsuitism, acne
Thyroid-related symptoms – Temp intolerance, palpitations, constipation, depression

37
Q

Secondary Amenorrhea – Physical Exam

A

Height, Weight, BMI

  • Thyroid Palpation
  • Tanner Staging
  • Breast development – marker for ovarian estrogen production
  • Skin – Acne, Hirsuitism – suggestive of hyperandrogenemia
  • Pulm/Cardiac/GI
  • Pelvic – Thin vaginal mucosa, missing pelvic organ
38
Q

Secondary Amenorrhea:

-Labs? (what is the first step**)

A

**First step in work up check a pregnancy test!! (KNOW)

  • Check TSH/Prolactin
  • Progesterone challenge test (determines if ovary producing estrogen)
  • Check FSH/LH
39
Q

Secondary Amenorrhea: imaging?

A

CT or MRI of hypothalamus, pituitary, or pelvis, genetic testing, and pelvic US

40
Q

Secondary Amenorrhea – Treatment

A

-Depends on the Underlying Cause:
-Thyroid supplementation or suppression
-OCA’s to normalize menstrual cycle
-Surgical resection of tumor
-HRT for menopausal women, if no contraindications, limited timeline
-Weight gain for Female Triad
Etc…

41
Q

Progesterone Challenge test is done by giving _____

A

progesterone medication to a woman with absent or irregular periods to INDUCE a period

42
Q

Progesterone Challenge test:

  • Give _____
  • A POSITIVE response=
A

-Give medroxyprogesterone (Provera) 5mg BID x 5-7 days

**A positive response is withdrawal bleed, usually occurs within 2-7 days

  • Indicates that If the patient experiences bleeding after the progestin she has estrogen present but is not ovulating (anovulation).
  • If no withdrawal bleeding occurs, either the patient has very low estrogen levels or there is a problem with the outflow tract such as uterine adhesions
43
Q

“Initial workup of primary and secondary amenorrhea includes:

A

a pregnancy test and serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone.

44
Q

Primary amenorrhea is often, but not exclusively, the result of:

A

chromosomal irregularities that lead to primary ovarian insufficiency (e.g., Turner syndrome) or anatomic abnormalities (e.g., Müllerian agenesis – uterus doesn’t develop properly). Most pathologic cases of secondary amenorrhea can be attributed to polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency

45
Q

Secondary Amenorrhea:

-tx goals:

A

Discovery and treatment of underlying disorder

Prognosis – usually good, usually not a life threatening condition

46
Q

PCOS:

  • how common ?
  • Etiology?
  • Use ______ criteria ?
A
  • MC endocrinopathy in females of childbearing age in U.S., 7%
  • Etiology not certain but seems to have an association with insulin resistance (consider screening for metabolic syndrome)
  • Use Rotterdam criteria for dx: must have 2 of the 3 following diagnoses
  • –hyperandrogenism, ovulatory dysfunction, and polycystic ovaries
47
Q

PCOS:

  • four fold increase in r/o _____
  • US reveals multiple _____
A
  • *DM

- cysts on the ovaries

48
Q

A polycystic ovary is defined as:

A

an ovary containing 12 or more follicles (or 25 or more follicles using new ultrasound technology) measuring 2 to 9 mm in diameter or an ovary that has a volume of greater than 10 mL on ultrasonography. A single ovary meeting either or both of these definitions is sufficient for diagnosis of polycystic ovaries

49
Q

PCOS: dx

A

-thorough hx (abnormal menstrual cycle

Clin Med Final Material- Semester 2 (22 decks)

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