Menstruation

Question 1

What disease should also be worked up when considering PMS/PMDD symptoms?

Answer 1

Hypothyroidism

Question 2

How would you confirm that bilateral oophorectomy would help with a patient’s resistant PMS/PMDD?

Answer 2

Administer course of GnRH agonist to initiate menopause-like state

Question 3

Which SSRI would help with PMDD?

Answer 3

Fluoxetine

Question 4

Risk factors for PMS

Answer 4

Family history of PMS
Obesity
Poor diet

Question 5

What age PMS more common?

Answer 5

30s

Question 6

What to do if suspect adenomyosis?

Answer 6

Pelvic ultrasound and/or MRI
Definitive diagnosis made histologically after hysterectomy

Treatment: OCP or progestin-releasing IUD; hysterectomy if needed

Question 7

What are fertility treatments for PCOS?

Answer 7

First-line: Weight loss (to decrease peripheral conversion of androgen to estrogen in adipose tissue)
Second-line: Letrozole - aromatase inhibitor

Question 8

Patterns of bleeding in endometrial polyp vs hyperplasia vs adenomyosis vs fibroids

Answer 8

Polyp: regular menses with light intermenstrual bleeding
Hyperplasia: irregular, anovulatory menses plus risk factors
Adenomyosis: regular menses without intermenstrual bleeding and boggy uterus
Fibroids: regular but heavy, prolonged menses with irregular shaped uterus

Question 9

Primary dysmenorrhea - cause

Answer 9

Increased endometrial prostaglandin -> contraction, tonicity, vasoconstriction -> ischemia

Pain starts before menstruation
Prostaglandins cause nausea, diarrhea

Question 10

Endometrial ablation - contraindications

Answer 10

Minimal risk for endometrial cancer
No plans for future fertility

Question 11

PCOS LH/FSH ratio

Answer 11

> 2:1