Menstruation Flashcards
Primary amenorrhea
Failure to begin menstruating
Secondary amenorrhea
Absence of menses for 6 months in a previously menstruating patient
Etiology of primary amenorrhea
Ovarian insufficiency due to genetics
Etiology of secondary amenorrhea
Pregnancy
PCOS
Pituitary disease
Sheehan’s syndrome
Postpartum pituitary necrosis
Mullerian dysgenesis
Congenital absence of uterus and upper 2/3 of vagina
Asherman’s syndrome
Uterine adhesions
Primary amenorrhea with low FSH and LH
Issue with the HPO axis
- Get an MRI
Primary amenorrhea with high FSH
Ovarian failure
- Check karyotype for genetic issues
Treatment of amenorrhea if desiring pregnancy
Ovulation induction with Clomid or Letrozole
Treatment of amenorrhea if not desiring pregnancy
Estrogen/progesterone
Dysmenorrhea
Painful menstruation
Treatment of dysmenorrhea
NSAIDs
Hormonal contraceptives
S/S of PMS and PMDD
HA
Fatigue
Breast tenderness
Bloating
Abdominal pain
Mood swings
Irritability
PMS vs PMDD
PMDD: clear functional impairment with predominant psych symptoms
Treatment of PMS/PMDD
Mild: behavioral modifications and symptomatic tx
Severe: SSRIs and OCPs
Menorrhagia
Heavy bleeding
Hypomenorrhea
Light bleeding
Metrorrhagia
Bleeding between normal menses
Polymenorrhea
Menses occurring too frequently
Menometrorrhagia
Bleeding with irregular intervals and amount
Oligomenorrhea
Menses occurring too infrequently
Evaluation of dysfunctional uterine bleeding (DUB)
Pelvic US
Endometrial biopsy
Hysteroscopy
Treatment of premenopausal DUB
Observation
Hormone therapy
Treatment of postmenopausal DUB
Hormones
US
Hysteroscopy
Menopause
No period for 12 months
Hormone levels in menopause
Low inhibin
Increased FSH and LH
Decreased estrogen
Decreased progesterone
S/S of menopause
Hot flashes
Mood swings
Vaginal dryness
Hair loss
Treatment of menopause
Vaginal moisturizer
Estrogens
Known risks of hormone replacement
Endometrial cancer
Breast cancer
Clots
1st line tx for vasomotor menopause sx
Transdermal hormones
Pros and cons of combination hormone therapy
Pro: adding progesterone to estrogen decreases risk of endometrial cancer rather than just unopposed estrogen
Con: addition of progesterone to estrogen increases risk of breast cancer
If patient has intact uterus ___
Must do combo estrogen and progesterone
Actions of estrogen
Endometrial proliferation
Development of secondary sex characteristics
Increased vaginal lubrication
Actions of progesterone
Decrease uterine contractility
Promotes breast development
Falling levels trigger menses and lactation
Major hormone of pregnancy
Progesterone
What hormone leads to ovulation
LH surge/peak
Mittelschmerz
Mid-cycle pain
Pre-ovulatory phase of ovarian cycle
Varying length
Several follicles enlarge until one becomes dominant and grows rapidly and the others regress
Mid-ovarian cycle
Mature follicle ruptures
Post-ovulatory phase of ovarian cycle
Always 14 days
Corpus luteum makes progesterone and estrogen
If pregnancy does not occur, LH and FSH decline and corpus luteum atrophies
Decreased progesterone leads to shedding of uterine lining
Why does progesterone trigger menses?
Progesterone controls blood supply to endometrium, so when it drops, the endometrium sheds
Days 1-5 of uterine cycle
Menstrual phase
Proliferative phase of uterine cycle
Estrogen rises causing endometrium to regenerate
Uterine glands lengthen
Secretory phase of uterine cycle
Progesterone causes endometrium to mature
Corpus luteum regresses leading to decreased estrogen and progesterone
Hormone effect on cervical mucus
Estrogen: thins and creates fern-like pattern
Progesterone: thickens
When is cervical mucus thinnest and thickest?
Thinnest: ovulation
Thickest: following ovulation and pregnancy
