Menstruation Flashcards
What is primary amenorrhea?
failure of menorrhea to occur by age 15 in the setting of normal growth and development
If at age 13 and no menses has occurred and there is absolutely no secondary sexual characteristics then what should you do?
Evaluation for primary amenorrhea
Femal presents to you with a webbed neck and broad shoulders. What is your first though for a syndrome?
Turner syndrome
First thing to look for when evaluating primary amenorrhea?
XX karyotype
A female with low FSH and LH has XX karyotype and 46 chromosomes with amenorrhea most likely has an issue with what?
Hypothalamic pituitary
46 chromosomes, XY high testosterone and breast development only is what insensitivity?
Androgen insensitivity
When you have secondary sex characteristics but no uterus is called what?
Mullerian agenesis
describe Secondary amenorrhea
absence of meses for 3 months in a woman with previously normal menstruation for 6 months in a woman with a history of irregular cycles
what is the most common cause of secondary amenorrhea?
pregnancy
what labs should you always check when evaluating secondary amenorrhea?
B-HCG, can do TSH and prolactin
What is the progesterone challange?
This is when you give medroxyprogesterone 10mg PO x 7 days, if bleeding occurs then that mean anovulatory cycles
a 35-year-old woman with concerns about heavy menstrual periods for the past year that occur at irregular intervals. She explains that sometimes her menses come twice a month but other times will skip two months in a row. Her menses may last 7 to 10 days and require 10 to 15 thick sanitary napkins on the heaviest days. She admits to some fatigue, but she denies any lightheadedness. She has no pain with menses or intercourse and denies any vaginal discharge. She has had normal Pap smears in the past. She is in a stable monogamous relationship with her husband and denies a history of STIs. On physical examination, her blood pressure is 120/ 80 mm Hg and her body mass index (BMI) is 32. Her pelvic examination is normal.
Most likely diagnoses?
Dysfunctional uterine bleeding
menses that occur more frequently (menses < 21 days apart) is what?
Polymenorrhea
Hemorrhagic or hypermenorrhea, describe what this is?
menses that involve more blood loss (> 7 days or > 80 mL) during menses
Does menorrhagia have regular or irregular schedules?
has regular schedules, this is just prolonged/heavy bleeding >7 days or >80ml
someone has uterine bleeding that occurs during menses and frequent and irregular bleeding between menses what do they have?
menometorrhagia
Metorrhagia is what?
uterine bleeding that occurs frequently and irregularly between menses
oligomenorrhea is described as long intervals of menses greater than how many days?
greater than 35 days
Tx for dysfunctional uterine bleeding?
oral contraceptives and NSAIDs
what is the diagnoses of exclusion for dysfunctional uterine bleeding?
uterine dilation and curettage
What is dysmenorrhea?
uterine pain around the time of menses which can be primary or secondary
To be dysmenorrhea does the pain need to prevent normal activity and require medication?
yep
When does dysmenorrhea tend to peak?
peak 24 hr after the onset of menses
Dx for dysmenorrhea?
Pregnancy testing and pelvic ultrasonography
A 53 y.o woman has not had a period for 12 months what is she in?
Menopause
Is it normal for a woman to enter menopause in her 40s?
Yes, the Dx of menopause is one year of periods after age 40 with no pathologic cause.
Would you expect FSH levels to be high or low? How bout estradiol levels? When seeing if someone is in menopause
FSH>30 with decreased estradiol
What meds are used to treat hot flashes?
Estrogens
If the patient has a uterus what do you prescribe to help with menopause symptoms? No uterus?
Estrogen and progesterone.
No uterus is just estrogen
Why should woman not use estrogen alone if they have an intact uterus?
this will increase their risk of endometrial cancer
What do progesterones cause an increase risk of?
increased risk of breast cancer
What are three main menopause symptoms?
- hot flashes
- night sweat
- vaginal dryness
What are contraindications for HRT?
- Elevated triglycerides
- undiagnosed vaginal bleeding
- Endometrial cancer
- history of breast cancer
- CVD history
- DVT or PE history
What are some non-hormonal therapies for menopause symptoms?
- Cool temperatures
- avoid hot, spicy foods or beverages
- Exercise
- Soy
What are vasomotor symptoms of menopause?
hot flashes
night sweats
can you use SSRIs for vasomotor symptoms?
Yep, they for everything
What are the two phases of the menstrual cycle?
The follicular (proliferative phase) The luteal phase (secretory) phase
When does each menstrual phase begin?
on the first day of menstruation
What usually occurs 14 days prior to the first day menstruation?
The ovulation phase aka the release of the oocyte from the ovary
What days is the chance of fertilization the highest in a menstrual cycle?
days 11 and day 15
What is the first phase of the menstrual cycle called and how long does it last?
the follicular phase? last from day 0 to 14
First ______ is released from the hypothalamus which stimulates ______ and ________ release from the anterior pituitary.
The GNRH and FSH and LH
What elevates first during the follicular phase estrogen or FSH or LH
Estrogen is high during follicular phase.
What is needed to induce an LH spike?
high levels of estrogen
How long does the luteal phase last?
from day 15-28 to day 28
After ovulation what does the follicle become?
The corpus luteum
The corpus luteum secretes what?
this secretes progesterone
Does progesterone have a negative or positive feedback on FSH and LH?
negative feedback
What does the corpus luteum form into if pregnancy does not occur?
it forms into the corpus albicans
True or false the corpus albicans secretes estrogen but not progesterone?
False it doesn’t secrete either
What causes endometrial sloughing/menses?
a decrease in hormones
What gets releases to begin a new follicular phase of menstrual cycle?
GNRH
a 26-year-old patient is complaining of depression and anxiety just prior to her menses. The symptoms have been going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her physical examination and general laboratory profile showed no abnormalities.
What is this?
Premenstrual depression
What is the DSM-5 criteria for premenstrual dysphoric disorder?
In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.
What are the symptoms of premenstrual dysphoric disorder?
- marked affective lability- i.e mood swings, feeling sad or tearful increased sensitivity to rejection
- easily irritable or anger, increased interpersonal conflicts
- marked depressed mood
- anxiety
Tx for premenstrual dysphoric disorder?
- Fluoxetine 10mg
- Sertraline 50mg
Can also use SNRIs like effexor, OCP, TCAs and so on
If someone has severe refractory premenstrual dysphoric disorder what is a definitive Tx?
Ovariectomy
a 25-year-old female who complains of abdominal bloating, headache, irritability, depression, poor sleep quality, and breast tenderness. These symptoms occur on a monthly basis 5 days before menses. Her symptoms greatly improve within 4 days of the onset of menses.
What is this syndrome?
Premenstrual syndrome
What is the etiology of premenstrual syndrome?
caused by an imbalance of estrogen and progesterone along with excess prostaglandin production
What phase of the menstrual cycle do you typically see premenstrual syndrome?
Luteal phase (1-2 weeks before menses)
Symptoms of premenstrual syndrome?
Bloating, irritability, PMDD
When do symptoms for premenstrual syndrome resolve?
when menses starts
How do you Dx premenstrual syndrome?
History and physical
What criteria do you use for premenstrual syndrome?
ACOG criteria
What is the ACOG criteria?
Need one of the following symptoms present during the 5 days before menses and abates within 4 days of the onset of menses
Somatic: Breast tenderness, abdominal bloating, headache, edema
Affective: Irritability, depression, angry outbursts, anxiety, social withdrawal, confusion
Tx for premenstrual syndrome?
- Exercise and stress reduction is first choice
2. SSRIs are first line medications
