Menstrual irregularities Flashcards
Age of pt w/ Primary amenorrhea in the absence of breast bud
14 y/o
Age of primary amenorrhea w/ breast
16 y/o
Secondary amenorrhea: No menses for ___ mos if prev menses were regular
3
Secondary amenorrhea: No menses for ___ mos if prev menses were irregular
6
Absent breast
Present uterus
hypo/hypergonadotropic hypogonadism
Isolated gonadotropin (GnRH) deficiency assoc w/ anosmia
Kallman’s syndrome
Give an example of a condition involving hypergonadotropic hypogonadism
Turner syndrome
Premature ovarian failure
Cessation of ovarian fx before 40 y/o
Premature ovarian failure
Tx for AUB secondary to Turner syndrome
Estrogen therapy w/ cyclic progestin
Failure of ovaries to respond to FSH and LH secondary to receptor defect
Savage syndrome/ ovarian resistance syndrome
46 XX, present breast, absent uterus
Mullerian agenesis
/ Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
46 XY, present breast, absent uterus
Androgen insensitivity
/testicular feminization
At what age should the gonads be removed in a patient with androgen insensitivity to prevent malignant transformation?
18 y/o
Cause of absent uterus in MRKH syndrome?
Failure of mullerian duct formation
Cause of absent uterus in androgen insensitivity
Mullerian inhibiting factor
Outflow tract abN in w/c the hymen fails to canalize
PE: bulging membranes w/ hematocolpos, cyclical abd and pelvic pain
Imperforate hymen
Outflow tract abN in w/c the mullerian duct fails to fuse with the urogenital sinus
Transvaginal septum
25% of patients with breast but without uterus has…
hyperprolactinemia and prolactinomas
Triad of PCOS
Hirsutism
Ammenorhea
Obesity
Expected lab finding of LH and FSH in PCOS
Inc LH (Androgens inhibit negative feedback) Dec FSH
Increase in LH that acts on theca cells may produce ___ in PCOS
Hirsutism
AACE 2015 Diagnostic criteria for PCOS
Chronic anovulation
Hyperandrogenism
Polycystic ovaries (>12 cysts)
1st line monotherapy for adolescent girls with PCOS
Metformin
Pituitary necrosis secondary to hypotensive episode during pregnancy
Sheehan’s syndrome
Pituitary cell destruction unrelated to pregnancy
Simmond’s Disease
Most frequent antecedent factor in Asherman’s syndrome
Endometrial currettage
Withdrawal bleeding w/in 7 days from progesterone challenge test is due to…
anovulation
Next dx test to order upon (+) withdrawal bleeding from progesterone challenge test
Prolactin and TSH
Consider prolactinoma and hypothyroidism
Next dx test to order after (-) withdrawal bleeding from progesterone challenge test
Estrogen-progesterone challenge test
(+) EPCT, high FSH
Ovarian failure
(+) EPCT, low FSH
HP failure
(-) EPCT
Outflow tract obstruction
Cervical stenosis
Endometrial adhesions
Pathology of primary dysmenmorrhea
Prostaglandin F2a
