Menstruation Flashcards
premenstrual syndrome and premenstrual dysphoric disorder are marked by BOTH physical and behavioral symptoms that occur when?
Second half (luteal phase) of menstrual cycle
when are sx of premenstrual syndrome and premenstrual dysphoric disorder alleviated
onset of menses
Do mild sx count as premenstrual syndrome or premenstrual dysphoric disorder?
NO
dx premenstrual syndrome
at least one symptom associated with economic or social dysfunction during at least part of the 5 days before the onset of menses and recurring in at least three consecutive cycles
sx for premenstrual dysphoric disorder
at least one of the following symptoms: mood swings, sudden sadness, increased sensitivity, anger, irritability, depressed mood, anxiety, and tension. In addition, one or more of the following symptoms must be present: difficulty concentrating, change in appetite, diminished interest in usual activities, decreased energy, feeling overwhelmed, breast tenderness, bloating, weight gain, muscle aches, and sleep changes.
must be associated with significant distress or interference with usual activities, such as work, school, or social life
There must be at least five of the above symptoms in total
tx premenstrual disorder
selective serotonin reuptake inhibitors, such as sertraline or fluoxetine (first line)
COCs
Gonadotropin-releasing hormone agonists (leuprolide and nafarelin)
Bilateral oophorectomy
what tx for premenstrual disorder is a good option for people desiring contraception
COCs
what tx for premenstrual disorder is used in severe cases
Gonadotropin-releasing hormone agonists (leuprolide and nafarelin)
last resort tx for premenstrual disorders
bilateral oophorectomy
dosing for SSRIs in tx of premenstrual disorders
dosed continuously or only during the luteal phase
labs for natural menopause
decreased estrogen
elevated FSH
(more specifically estradiol level < 20 pg/mL and a follicle-stimulating hormone level of 21–100 mU/mL)
due to depletion of ovarian follicles
definition of menopause
12 consecutive months of amenorrhea without any other alternate causes
premature ovarian failure
Women who experience menopause before 40 years of age
perimenopausal period begins an average of how many years before final menstrual period
4 years
when should you do further workup for someone with irregular cycles
If a woman is < 45 years old, if she is > 45 years old reporting irregular cycles but no other symptoms of menopause
labs if you have to do workup for menopause sx
serum hCG to determine whether she is pregnant, serum prolactin to evaluate for hyperprolactinemia, and serum thyroid-stimulating hormone to screen for hyperthyroidism
is measurement of FSH needed to dx menopause
no
when might measurement of FSH be useful
for women who have undergone a hysterectomy or endometrial ablation and cannot manifest changes to menstrual bleeding
when is measurement of FSH unreliable
in women who are taking estrogen-progestin contraceptives
due to exposure of excess exogenous estrogen
would have to measure FSH 2-4 weeks after D/C BC
Secondary amenorrhea
cessation of menses for 3 consecutive months (in women who have had previously regular menses) or 6 months (in women who have had previously irregular menses) in women who have passed menarche
MC cause of secondary amenorrhea
pregnancy
testing for secondary amenorrhea
human chorionic gonadotropin hormone
follicle-stimulating hormone luteinizing hormone
prolactin
thyroid-stimulating hormone
what is warranted in someone with hyperprolactinemia or hypopituitarism
brain MRI
tx for secondary amenorrhea w no abnormal lab values
10 day course of progestin