Menstrual Disorders- Paulson Flashcards
When does puberty start?
Age 8-13
increase in androgens before the onset of puberty
Adrenarche
breast development
Thelarche
pubic hair development
Pubarche
What is precocious puberty?
pubertal development before age 8 in girls and age 9 in boys
Avg age to start menstruation?
12-13 years old
How long should periods last?
4-6 days
Regular interval between periods, excessive flow and duration
Menorrhagia
Decreased flow during normal duration of regular period
Hypomenorrhea
Irregular intervals of menses
Metorrhagia
shortened interval between periods , < 19-21 day interval
Polymenorrhea
Irregular or excessive bleeding during periods and between
Menometorrhagia periods
Lengthened interval between periods, > 35 days intervals
Oligomenorrhea
Bleeding following coitus
Post-Coital Bleeding
Absent period
Amenorrhea
What is primary vs secondary amenorrhea?
Primary- absence of spontaneous menstruation by 13 without normal growth and with secondary sex characterics
Secondary-absence of menses after 3 months of previous menses and after 6 months if irregular menses
Turner syndrome
congenital developmental disorder of the reproductive system. Does not develop properly – underdeveloped and malfunctioning.
Turner syndrome and hypothalamic pituitary insufficiency result in lifelong absence of menses whereas outflow obstruction: imperforate hymen does/does not result in lifelong absence of menses?
Does not result in lifelong (just needs to be surgically opened)
If a patient has primary amenorrhea and presence of secondary sex characteristics, with uterus present, what is the most likely cause?
Outflow tract obstruction
If a patient has primary amenorrhea and NO presence of secondary sex characteristics what is the most likely cause?
Karotype analysis should be done because could be genetic
What are common causes of secondary amenorrhea?
- ***Pregnancy
- PCOS
- Medications (IUD, birth control)
- Diabetes
- Hyperthyroidism/Hypothyroidism
- Surgery
What is the first thing you should work up a patient with secondary amenorrhea?
CHECK A PREGNANCY TEST
What is the progesterone challenge test?
Done by giving progesterone medication to a woman with absent or irregular periods to INDUCE a period (once progresterone withdrawn, the bleeding stops)
- *A + test = patient had period so just anovulation
- *A - test indicates low estrogen or outflow tract is blocked
A patient presents with irregular periods, overweight, hirtuism. What is the most likely dx? What imaging is helpful?
PCOS
Pelvic U/S to determine if ovaries are cystic
Treatment for acne in PCOS?
OCP or combo estrogen and progesterone pill
Treatment for hyperglycemia and/or weight loss for PCOS?
Metformin
What is the female athlete triad?
- Eating disorder
- Amenorrhea
- Low bone mineral density
What is mittleschmerz?
Pain w/ ovulation that occurs in the middle of menstrual cycle
How should you treat mittleschmerz?
NSAIDs
painful menstruation
Dysmenorrhea
Dysmenorrhea is reserved for women whose pain prevents normal activity and requires medication (OTC or prescription)
Difference between primary dysmenorrhea and secondary dysmenorrhea?
Primary is caused by excessive prostaglandins leading to cramping whereas secondary is due to pathologic cause like endometriosis or IUD or soemthing (pain that lasts longer than a normal period)
What is the #1 RF for dysmenorrhea?
Heavy periods
First line treatment for dysmenorrhea?
NSAID (Ibuprofen)
Menstrual flow outside of normal volume, duration, regularity, or frequency
Abnormal uterine bleeding
Best imaging to do for abnormal uterine bleeding?
Transvaginal U/S
Best tx for non-emergent AUB?
IUD or combo OCPs
Best tx for acute AUB?
IV estrogen
What is the treatment for premenstrual dysphoric disorder?
SSRIs are first line (fluoxetine, sertraline)
