Menstruation Flashcards
a 15-year-old girl who comes to the office because she has missed her last three menstrual periods. History reveals she previously had regular periods, and menses began at the age of 12 years. She is very active and runs daily for the high school cross-country team. She says she is conscious of her dietary intake and eats a high-protein, low-fat diet. She has been sexually active for two years and reports using condoms most times. Vital signs reveal she is in the 75th percentile for her height and weight, and her heart rate is 55/min. Physical examination reveals normal Tanner stage 5 genitalia.
What is most likely to explain the amenorrhea in this patient?
Intrauterine pregnancy is the most common cause of secondary amenorrhea. The first step in the workup of amenorrhea should almost always be a pregnancy test.
what is primary amenorrhea
failure of menses to occur by age 15 years (some say 16years), in the presence of normal growth and secondary sexual characteristics
what type of Karyotype is Turners syndrome and how does it present
XO, webbed neck, broad chest, high FHS
how is secondary amenorrhea described
absence of menses for 3 months in a woman previously normal mensturation of 6 months in a woman with a hx of irregular cycles
what test can be used for secondary amenorrhea
progesterone challenge test - medroxyprogesterone 5-10mg orally once a day or another progestogen for 7 to 10 days.
if bleeding occurs = 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.
What is the likely diagnosis
dysfunctional uterine bleeding
what is polymenorrhea
menses that occur more frequently (menses < 21 days apart)
what is hemorrhagic or hypermenorrhea
menses that involve more blood loss (>7days or > 80mL) during menses
what is menorrhagia
prolonged/heavy bleeding. (>7 days or >80mL); regular intervals
what is metorrhagia
uterine bleeding that occurs frequently and irregularly between menses
what is menometorrhagia
more blood loss during menses and frequent and irregular bleeding between menses
what is oligomenorrhea
long interals > 35 days
how is dysfunctional uterine bleeding diagnosed
diagnosis of exclusion
uterine dilaterion and curettage is the gold standard
what is the treatment of AUB
Oral contraceptive and NSAIDs
a 19-year-old nulligravid college female who complains of dull, throbbing, cramping lower abdominal pain during menses for the past three years. She reports nausea and vomiting during menses but denies irregular or heavy periods, pain with intercourse, or abdominal pain outside of menses. Pain tends to peak 24 h after the onset of menses and subsides after 2 to 3 days. A pelvic exam is normal.
What is the diagnosis?
Dysmenorrhea
what is the treament of dysmenorrhea
NSAIDs and oral contraceptive pills
what are common etiologies of secondary dysmenorrhea
endometriosis, adenomyosis, polyps, fibroids, PID, IUD, Tumors, adhesions, cervical stensosis/lesions, psych
how is menopause described
12 or more months of amenorrhea occuring at a mean age of 51 years old
(average age 51.5 (44-55years))
what is perimenopause
transition between reproductive capability and menopause
hallmark is irregular menstrual function, lasting 3-5 years
how long does the perimenopausal period usually last
3-5 years
what are treatment options for menopause
Estrogen for hot flashes
- if uterus: HRT (estrogen + progesterone), if no uterus (ERT)
- Woman with an intact uterus should not use estrogen alone
what are contraindications for HRT
Elevated triglycerides
Undiagnosed Vaginal bleeding
endometrial cancer
history of breast CA or estrogen-sensitive cancers
CVD hisotry
DVT or PE history
what are some non-hormonaal therapies for menopause
cool temperatures
avoid hot, spicy foods/beverages
avoid ETOH, exercise and soy
can use SSRIs, SNRIs, clonidine, gabapentin for vasomotor symptoms
at what period of the menstrual cycle is the chance of fertilization is highest?
between day 11 and day 15 of an average 28 day cycle
what is the follicular phase
aka proliferative phase - day 0-14 days
first, GnRH (from hypothalamus) stimulates FSH and LH releast
follicule grows - secreting estrogen
what releases GnRH
hypothalamus
what releases FHS and LH
anterior pituitary
what part of the mensturation is there a LH spike - causing ovulation
follicular phase
what is the luteal phase
aka secretory phase
- day 15-28 day
- after ovulation - follicle becomes corpus luteum, which secretes progesterone and provides negative feedback to FHS and LH
- decrease in hormones lead to endometrial sloughing or menses
- GnRH is secreted to begin a new follicular phase
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 the diagnosis?
premenstrual dysphoric disorder
what is the treatment of PMDD
SSRI - fluoxetine and sertaline
SNRI - venlafaxine
birth control - low dose estrogens
diuretics
what is premenstrual syndrome
group of symptoms that occur in woman typically between ovulation and period (a week or two before their period)
caused by an imablance of estrogen and progesterone along with excess prostaglandin production
what symptoms occur duing the luteal phase
bloating, irritatbility - 1-2 weeks before menses
what are somatic symptoms of menstruation
breast tenderness
abdominal bloating
headache
edema
what are affective symptoms of menstruation
irritability
depression
angry outbursts
anxiety
social withdrawal
confusion
what is the treatment of premenstrual syndrome
exercise and stress reduction
SSRI = first line option
combo estrogegn-progestin OCP as first line if contraception is high proiority
