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RGU 1 > Menstrual Dysfunction > Flashcards

Menstrual Dysfunction Flashcards

1
Q

What is PRIMARY amenorrhea?

A 
no menses (period) by age 17
*aka girl never got her period
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2
Q

What is SECONDARY amenorrhea?

A

you had menses (period) and then you stopped having menses.

*number 1 cause= PREGNANCY!

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3
Q

What is oligomenorrhea?

A
  • cycles occurring at intervals greater than q 35 days.
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4
Q

What is polymenorrhea?

A

cycles occurring at intervals less than q 21 days

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5
Q

What is menorrhagia?

A

hypermenorrhea; heavy bleeding that occurs on a regular basis.

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6
Q

What is metrorrhagia?

A

non-cyclic bleeding; bleeding that occurs whenever it wants to.

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7
Q

What is menometrorrhagia?

A

bleeding all over the place

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8
Q

What is infertility?

A

no conception after one year of unprotected intercourse

*depends on age of the patient.

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9
Q

What problems should you associate with puberty?

A
  • coagulation disorders
  • genetic problems
  • congenital defects
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10
Q

What ob/gyn issues should you consider in women of reproductive age?

A
  • pregnancy
  • premature ovarian failure
  • hormonal or anatomic problems
  • hyperplasia or malignancy
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11
Q

What issues should you consider in post-menopausal women?

A
  • amenorrhea is normal
  • cancer
  • anatomic abnormalities
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12
Q

*** What is a good analogy to think about the endometrial lining?

A
  • estrogen is like the bricks of the lining to build it up!
  • progesterone is like the mortar between the bricks!
  • so when you pull away the motor, all the bricks fall out!
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13
Q

What is considered day 1 of normal menstrual cycle?

A

the first day you bleed (either spotting or discharge).

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14
Q

When is ovulation?

A

14 days (2 weeks) prior to menses (her period)

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15
Q

** So if a woman has a 21 day menstrual cycle, when did she ovulate?

A

day 7 (because this is 2 weeks prior to onset of menses)

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16
Q

Is normal menses a hormone withdrawal bleed?

A

YES

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17
Q

Does amount of flow vary from woman to woman?

A

YES

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18
Q

What 7 compartments should you think about when a pt has menstrual irregularities?

A
  1. hypothalamus
  2. pituitary
  3. thyroid
  4. adrenal glands
  5. ovaries
  6. uterus
  7. vagina
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19
Q

Which of the 7 compartments is responsible for amenorrhea caused by stress, exercise (runners may have seasonal variation), and anorexia nervosa?

A

the hypothalamus

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20
Q

What does the anterior pituitary secrete?

A

TSH, FSH, LH, and prolactin

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21
Q

What do elevated levels of prolactin suppress?

A

estrogen production

22
Q

What are some things that can cause elevated prolactin?

A
  • pituitary tumors
  • nipple stimulation (lactation). Aka when mom is breast feeding she doesn’t get her period.
  • drugs (psych meds)
23
Q

What does FSH do?

A

released in response to GnRH and causes follicle production and estradiol production.
*negative feedback from estrogen

24
Q

What is the main role of LH?

A

midcycle surge triggers ovulation

25
Q

Should we check LH level?

A

not unless you’re an endocrinologist (not cost effective).

26
Q

What can a pituitary infarct cause from post partum hemorrhage and hypotension?

A

Sheehan’s syndrome= post partum hemorrhage and hypotension leading to metabolic disorders and won’t be able to lactate bc she’s not making prolactin

27
Q

Is thyroid disease extremely common in women?

A

YES (can have too much or too little)

28
Q

What can happen if you are hypothyroid?

A

can elevate prolactin leading to amenorrhea

29
Q

If your thyroid stimulating hormone (TSH) is high, are you hypo or hyperthryoid?

A

HYPOthyroid (because there is little T3 and T4 to cause negative feedback on the hypothalamus and pituitary.).

30
Q

If your thyroid stimulating hormone (TSH) is low, are you hypo- or hyperthyroid?

A

HYPERthyroid (because there is too much T3 and T4 causing negative feedback on the hypothalamus and pituitary).

31
Q

What do we worry about involving the adrenal glands from a GYN view?

A
  • DHEAS= dehydroepiandrosterone (comes from ovaries) sulfate (comes from adrenal glands). This is a potent androgen that has negative feedback on FSH.
  • “S” is important.
  • very RARE
32
Q

When would you order a DHEAS?

A

if patient complains of acne, hair where you don’t want it, and amenorrhea. All due to excess androgen production from an androgen producing tumor.

33
Q

What should you think about in relation to the ovaries?

A
  • estrogen: too little or too much
  • progesterone: present or absent
  • androgen: too much (PCOS= polycystic ovarian syndrome); excess estrogen comes from excess androgen.
34
Q

What should you think about in relation to the uterus?

A
  • has no role in cycle control
  • is the uterus present or absent
  • is it normal or abnormal
  • endometrium (polyp)
  • myometrium (fibroid tumor)
  • mullerian defects
  • myometrial pathology
  • endometrial pathology
  • iatrogenic pathology (endometrial ablation…)
  • endometriosis
35
Q

What should you think about with regards to the vagina?

A
  • is it present or absent (congenital absence or imperforate hymen).
36
Q

What does menstrual cycle control with anovulation cause?

A
  • excess estrogen, no progesterone, and endometrial proliferation.
  • different parts of the endometrium will bleed at different times bc there is no progesterone (no mortar) and the endometrium (the bricks) begins to fall out as it grows too much. This will show as spot bleeding.
  • pathology would call this “DISORDERED PROLIFERATIVE ENDOMETRIUM= she’s not ovulating bc she’s not making progesterone.”
37
Q

What is polycystic ovarian syndrome (PCOS)?

A
  • excess androgen of ovarian origin
  • excess estrogen in a steady state
  • multiple follicles in arrested development
  • insulin resistance
  • infertility due to anovulation
  • amenorrhea due to abnormal bleeding
38
Q

Is there a blood test for the hypothalamus?

A

NO

39
Q

What happens when a woman comes in and says my periods are irregular?

A

Get her age and take a thorough history.

40
Q

Is menarche both genetic and environment?

A

YES

41
Q

Is menopause both genetic and environment?

A

NO, just genetic (the ovaries are like a battery that eventually dies; they only last so long).

42
Q

When can you start oral contraceptive use?

A

One year after menses.

*will help with cycle control, and if pt has excessive bleeding, this will help (bc side effect is clotting).

43
Q

How do you treat PCOS?

A
  • progesterone! because she has excess estrogen and no progesterone.
44
Q

Why do ladies on continuous progesterone (depo provera) not get their periods?

A

bc it thins the lining of the endometrium causing endometrial atrophy. This doesn’t allow the “bricks” (the endometrial lining) to build up.

45
Q

Why do some women who are on continued progesterone sometimes get spotting?

A

bc it’s so thin, giving it a raw service that it can easily bleed.

46
Q

Why then is there estrogen in birth control pills?

A

to prevent the spot bleeding of pure progesterone

*remember the last 7 days are placebo pills, allowing the normal cycle (withdrawal bleed from lack of progesterone).

47
Q

What should you think if you see a 17 y/o with no period and no uterus when you do your pelvic exam?

A
  • androgen insensitivity
  • rokitansky kuster hauser syndrome (congenital absence of uterus; mullerian agenesis)
  • test karyotype to see if she’s XX or XY. If she is XX and has ovaries (she has mullerian agenesis). If she’s XY, she has androgen insensitivity; aka she has testicles stuck in the inguinal canal and they need to be removed.
48
Q

What 4 things come from the mullerian system embryologically?

A
  1. fallopian tubes
  2. uterus
  3. cervix
  4. upper vagina
49
Q

What is the first visible change of puberty for a girl?

A

Breast development followed by pubic hair, underarm hair, then menses.
*Boobs, pubes, pits, pads in that order!

50
Q

Should you be worried if a 53 y/o woman comes to your office with irregular bleeding and hot flashes?

A

She could be going through menopause or it could be endometrial cancer. Do a biopsy to make sure.
*Treat with estrogen and progesterone, and this will stop her bleeding.

51
Q

What is an estrogen secreting tumor?

A

ovarian thecoma. Remember estrogen makes you bleed, so this will cause bleeding.

52
Q

What is the PALM-COEIN classification system?

A 
PALM= uterus:
- Polyps (AUB-P)
- Adenomyosis (AUB-A)
- Leiomyoma (AUB-L)
- Malignancy (AUB-M) 
COEIN= nonstructural causes:
- Coagulopathy (AUB-C)
- Ovulatory Dysfunction (AUB-O)
- Endometrial (AUB-E)
- Iatrogenic; drugs (AUB-I)
- Not yet classified (AUB-N) 
*AUB= abnormal uterine bleeding

RGU 1 (17 decks)

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