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EOR Women's Health > menstruation > Flashcards

menstruation Flashcards

1
Q

steady GnRH used for what?

A
  • suppress FSH, LH, estrogen
  • adjuvant for estrogen-receptive breast cancer
  • delay precocious puberty
  • Tx endometriosis & uterine fibroids
  • hormone suppression in transsexual females

USE IN ESTROGEN DEPENDENT DISEASES

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2
Q

pulsatile GnRH used for what?

A

hypogonadotropic hypogonadism

  • low GnRH
  • induce normal puberty, menses development, reproductive cycle
  • fertility Tx
  • preserve reproductive capacity in chemo

RESTORE NORMAL FUNCTION

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3
Q

things that decr GnRH

A
  • mild incr E
  • progesterone
  • endorphins, opioids (heavy exercise)
  • Corticotropin Releasing Hormone (stress, incr cortisol, Cushings)
  • prolactin
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4
Q

things that incr GnRH

A
  • rapidly incr E

- Kisspeptin (adipose tissue)

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5
Q

FSH

A

granulosa cells, androgens to estrogen, inhibin & activin

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6
Q

LH

A
  • theca cells, production of androgens
  • ovulation
  • convert residual follicle to corpeus luteum
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7
Q

dominant follicle maturation dependent on what?

A

FSH

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8
Q

what causes release of oocyte?

A

LH surge

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9
Q

as dominant cell prepares for ovulation, what level increases?

A

high estrogen

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10
Q

what hormone converts residual follicle to corpeus luteum?

A

LH

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11
Q

corpeus luteum produces what?

A

progesterone

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12
Q

progesterone roles

A
  • menses

- implantation

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13
Q

no fertilization…

A

corpus luteum–> corpus albicans–> gone

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14
Q

fertilization…

A

HCG from zygote

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15
Q

role of HCG initially

A

sustain corpus luteum, progesterone secretion for implantation

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16
Q

estrogen effect on lipids, cardiovascular?

A

decr LDL, incr HDL
vasodilation
lower CAD

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17
Q

estrogen and skin?

A

thick skin, elasticity, collagen incr, incr melanocytes

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18
Q

estrogen & bone?

A

inhibits osteoclasts

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19
Q

menopause estrogen

A

estrone

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20
Q

most potent estrogen

A

estradiol

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21
Q

pregnancy estrogen

A

estriol

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22
Q

reproductive years estrogen

A

estradiol

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23
Q

extra-ovarian production of estrogen

A

adrenal glands, adipose tissue

breasts, liver

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24
Q

menses E & P

A

LOW

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25
Q

in follicular phase, pituitary secretes FSH. what is the result?

A
  • ovaries up-regulate FSH receptors (granulosa cells)
  • produce E from androgens
  • rapid incr E stimulates GnRH
  • GnRH causes LH surge
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26
Q

mittelschmerz

A

feel ovulation pain

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27
Q

luteal phase follicle transformed into what?

A

corpus luteum

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28
Q

luteal phase progesterone causes what?

A

neg feedback on LH and FSH

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29
Q

endometrial lining conditioning by what?

A

PROGESTERONE and E

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30
Q

corpus luteum lifespan

A

9-11 days

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31
Q

E effects on endometrium

A

build up

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32
Q

P effects on endometrium

A

differentiation of components

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33
Q

E & P if no fertilization

A

major drop E & P, endometrium sloughs

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34
Q

normal menses blood loss, length

A

20-60 mL

3-7 days

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35
Q

in order for P to be produced in menses, what must occur?

A

ovulation

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36
Q

if no ovulation

A

E unchecked (no P), no secretory phase, abnorm bleeding (sloughing irregular)

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37
Q

breast tenderness when?

A

luteal phase

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38
Q

mucus with E & P

A

E: thin, P: thick

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39
Q

hypothalmic cause of irreg menses, anovulation. what to order next?

A

LH

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40
Q

menorrhagia

A

prolonged bleeding > 7 days

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41
Q

metrorrhagia

A

bleeding b/t menstrual periods

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42
Q

secondary amenorrhea

A

no menses 3-6 mo in previously menstruating female

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43
Q

primary amenorrhea

A
  • 13 y/o no menstruation, no secondary sexual characteristics
  • 15 y/o no menstruation, yes secondary sexual characteristics
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44
Q

MCC amenorrhea

A

pregnancy

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45
Q

2 cause amenorrhea

A

anovulation

46
Q

female athlete triad

A
  • anorexia
  • amenorrhea (b/c decr adipose tissue, excessive exercise)
  • osteoporosis (stress Fx)
47
Q

hypothalmic amenorrhea

A

anorexia (kisspeptin), excessive exercise (endorphins), stress (cortisol), opioids

48
Q

MCC pituitary amenorrhea

A

hyperprolactinemia (decr GnRH)

49
Q

hypothyroidism causes what?

A

incr TRH = incr TSH, prolactin

50
Q

ovary amenorrhea

A

PCOS, premature ovarian failure

51
Q

asherman syndrome

A

uterus scarring, no proliferation, no shedding

= amenorrhea (cause: procedures)

52
Q

MCC hirsutism

A

PCOS

53
Q

DHEA produced where

A

adrenals

54
Q

androstenedione produced where

A

adrenals, ovaries

55
Q

testosterone produced where

A

adrenals, ovaries, adipose tissue

56
Q

DHT produced where

A

hair, genitals

57
Q

most potent androgen

A

DHT

58
Q

adipose only CONVERTS androstenedione to what?

A

T and estrone

59
Q

ovary androgen prod

A

androstenedione, T, estradiol

60
Q

adrenals androgen prod

A

cortisol, androgens

61
Q

adipose androgen prod

A

converts to T, estrone

62
Q

Stein-Leventhal syndr

A

PCOS

63
Q

Sx PCOS

A

-anovulation
-hyperandrogenism (hirsutism, T)
-polycystic ovaries (string of pearls)
(obesity, infertility, miscarriage, metab syndr)

64
Q

labs PCOS

A

high LH, low FSH (>2.5-3 LH:FSH)
high free T
high androstenedione

65
Q

metabolic syndr

A
  • central obesity
  • incr TG
  • incr BP
  • decr HDL
  • hyperglycemia (> 100 fasting)
66
Q

HAIR-AN syndr, assoc with what?

A

HyperAndrogenism, Insulin Resistance, Acanthosis Nigricans

-PCOS

67
Q

PCOS pt- no hyperglycemia with blood glucose test. next step?

A

GTT

68
Q

impaired GTT (fasting glucose, 2hr GTT, HbA1C)

A
  • fasting glucose: 126
  • 2hr GTT: 200
  • HbA1C: 6.5
69
Q

Tx PCOS

A

wt loss
provera (progesterone)
OCP (desogen, modicon, ortho-cyclen)

Tx infertility: clomid
Tx hyperandrogenism: spironolactone, Vaniqa (topical hair removal)
Tx insulin resistance: metformin

70
Q

Tx hyperandrogenism (in PCOS)

A

spironolactone, Vaniqa (topical hair removal)

71
Q

specific tests to evaluate amenorrhea

A

P challenge, E-P challenge, FSH levels

72
Q

provera given, withdrawn. pt bleeds. what does this mean?

A

PCOS
anovulation
-enough E for endometrium build up, just anovulation

73
Q

provera given, withdrawn. pt doesn’t bleed. what does this mean? what to do next?

A

E deficient

E-P challenge next.

74
Q

premarin given, then provera, withrawn. pt bleeds. what to do next?

A

FSH in 2 wks

75
Q

premarin given, then provera, withrawn. pt doesn’t bleed. what does this mean?

A

anatomic problem

  • Asherman (scarred uterus)- can’t build up
  • cervical stenosis- can’t expel
76
Q

E-P challenge. pt bleeds. FSH high. what does this mean?

A

menopause

-ovaries not responding to FSH

77
Q

E-P challenge. pt bleeds. FSH low. what does this mean?

A

anorexia, exercise, opioids, stress, pituitary adenoma

-inappropriate release of FSH, LH (hypothalamus, pituitary problems)

78
Q

follicles become resistant to FSH (no follicle stimulation). what is this?

A

menopause

79
Q

menopausal FSH levels

A

> 30

80
Q

premature menopause

A

before 30 y/o

81
Q

menopause definition

A

menses cessation x 1 yr

82
Q

factors that have no effect on menopause

A

lactation, menarche age, # of pregnancies, OCP, race

83
Q

hormones of menopause

A

testosterone, estrone

84
Q

Sx of menopause

A

sleep disturbance, genital atrophy (cystocele, uterine prolapse, vaginitis, mood changes, osteoporosis, incr LDL, decr HDL, thin skin, hirsutism, hot flashes, nightsweats

85
Q

DEXA -1.0 to -2.5

A

osteopenia

86
Q

DEXA < -2.5

A

osteoporosis

87
Q

when to start routine bone density scanning

A

65 y/o

88
Q

osteoporosis RF

A

white, incr age, Fx, smoking, dementia, low body wt, estrogen def, alcoholism, chronic corticosteroids, sedentary

89
Q

osteoporosis Tx

A
  • calcium
  • vit D
  • bisphosphonates
  • SERM: raloxifene
  • estrogen replacement
  • calcitonin
  • progesterone
90
Q

calcium requirement in menopause

A

1200-1500 mg/day

91
Q

vitamin D supplementation in menopause

A

800-2000 Units/day

92
Q

active form Vit D

A

vit D3

93
Q

how to measure vit D

A

25-OH Vit D

94
Q

ADR bisphosphonates

A

osteonecrosis of jaw, esophageal erosions

-holiday after 5 yrs of use

95
Q

main management of Sx related to menopause

A

estrogen replacement

Premarin

96
Q

estrogen ADR

A

melasma, gallstones, endometrial CA, incr CAD/stroke/DVT/breast CA/dementia

menstrual Sx

97
Q

progesterone

A

Provera, levonorgestrel, norethindron, drospirendone

98
Q

combined menopause Tx

A

cyclic: E days 1-25, medroxyprogesterone acetate days 16-25
continuous: together

99
Q

absolute contraindications to hormonal therapy

A

unDx vaginal bleeding, thrombophlebitis, cerebral vascular disease, pregnancy, CAD, smoker >35 y/o, impaired liver, breast CA, hyperlipidemia

100
Q

incr risk of what diseases in hormonal therapy?

A

MI, thromboembolism, stroke, breast CA

not colorectal CA

101
Q

monophasic, biphasic, triphasic OCP

A
  • mono: same doses, both, all month
  • bi: same E dose, incr progestin dose second 1/2
  • tri: varying dose both
102
Q

progestin only/mini pill 2 indications (take at SAME TIME every day)

A

> 40 y/o

lactating

103
Q

break through bleeding with progestin

A

resolves in 3 mo

104
Q

depo medroxyprogesterone acetate (Depo-Provera) affects what?

A 
suppress LH (ovulation), no effect on FSH
thicken mucus
105
Q

Depo shot ADR

A

osteoporosis

106
Q

PMS, PMDD- what phase ONLY?

A

luteal phase

P makes women mean!

107
Q

PMDD

A

core Sx: depressed, anxiety/tension, sad/tearul/sensitive, irritable/angry

anhedonia, lethargy, insomnia

108
Q

main contraceptive effect of pill attributed to?

A

E

109
Q

spotting on pill, what should you do?

A

wait 3 months, will go away

110
Q

PMS

A

5 days before menses! in 3 menstrual cycles! gone in 4 days of LMP! no drugs!

depression, angry, irritable, confusion, social withdrawal, breast tender, bloating, HA

111
Q

Tx PMS

A
  • less carbs, caffeine, fat, EtOH
  • exercise
  • NSAIDs
  • SSRI: fluoxetine, sertraline
  • calcium, Mg

(danazol)

112
Q

Tx PMDD

A

SSRI (GOLD STANDARD)
fluoxetine, sertraline, paroxetine

-14 days before menses

EOR Women's Health (4 decks)

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