Menstruation Flashcards
1
Q
Definition of primary amenorrhea
A
- absence of spontaneous menstruation by 16yo WITH secondary sex characteristics or 14yo WITHOUT secondary sex characteristics
- 4 main categories based on karyotype
- Turner syndrome (Gonadal agenesis) - 45 XO
- Hypothalamic-pituitary insufficiency - 46 XX
- Androgen insensitivity - 46 XY
- Imperforate hymen - 46 XX
2
Q
Definition of secondary amenorrhea
A
- woman who has previously menstruated
- absence of menses for 3 months if previous cycles nl
- absence of menses for 6 months if previous cycles irreg
- Cause
- THE MCC 2ary amenorrhea = PREGNANCY
- Drug use, stress, significant weight change, or excessive exercise
- PCOS, CNS tumor, hyperPRL, Sheehan syndrome (causes postpartum hypopit - pituitary gland is damaged, caused by excess blood loss (hemorrhage) or extremely low blood pressure during or after labor)
- previously normal menstrual cycles and normal E, think stress or outflow obstruction (Asherman syndrome - scar tissue forms in the uterus, rare but can be a complication of multiple D&Cs)
- If galactorrhea present, prolactinemia is MCC
3
Q
Amenorrhea
A
- Primary or secondary
- women with no menstruation in presence of E stimulation of endometrium have increased risk of endometrial cancer
4
Q
Turner Syndrome: karyotype, PE, Labs, management
A
- Karyotype: 45 XO
- PE: short webbed neck, no breast development
- Labs: High FSH
- Management: cyclic estrogen and progestins
5
Q
Hypothalamic-pituitary insufficiency: karyotype, PE, Labs, management
A
- Karyotype: 46 XX
- PE: no breast development
- Labs: Low FSH, Low LH
- Managment: Cyclic estrogen and progestins
6
Q
Androgen insensitivity: karyotype, PE, Labs, management
A
- karyotype: 46XY
- PE: Normal breast development
- Labs: High testosterone
- Management: Remove testes; start estrogen
7
Q
Diagnostic studies for amenorrhea
A
- First line: B-hCG, TSH, PRL
- Second line: FSH, E, LH, T
- If bleeding occurs after progesterone challenge, anovulatory cycles are the cause
8
Q
Characteristics of dysfuncitonal uterine bleeding (DUB or AUB)
A
- Presents as abnormal bleeding with a generally unremarkable PE
- Abnormal uterine bleeding in non-pregnant women
- different from normal cycle in terms of regularity, flow, duration, and volume
- normally occurs right after menarche or during perimenopause
- Causes = PALM-COIEN (polyp, adenomyosis, leiomyoma, malignancy - coag, ovulatory dysFN, endometrial, iatrogenic, not otherwise classified)
- Menorrhagia = heavy or prolonged bleeding
- Metrorrhagia = irregular bleeding between menses
- PE includes speculum, evaluate for bleeding from other sources
9
Q
Diagnostic studies for DUB
A
- B-hCG, CBC, iron, PT, PTT, documentation of ovulation, thyroid, serum P, LFTs, PRL, serum FSH
- Pap, US, hysterosalpingography, hysteroscopy, and/or D&C
- endometrial bx should be done on all women over 35yo w/ obesity, HTN, or DM and on all postmenopausal pts
10
Q
management of DUB (AUB)
A
- depends on severity of bleeding - may include observation, iron therapy, and volume replacement
- progestin trial - if bleeding stops, anovulatory cylces are confirmed
- OCPs:
- older women w/o risk factors
- OCPs should NOT be used in women over 35 who smoke, have HTN, DM, or hx of vascular dz, breast CA, liver dz, or focal HA
- D&C can be dx and curative
- refractory cases may require endometrial ablation or vaginal hysterectomy
11
Q
Dysmenorrhea general characteristics
A
- PRIMARY: painful menstruation caused by increased prostaglandin and leukotriene levels - painful uterine cramping, N/V/D
- Onset: usually w/in 2yrs menarche, peak incidence = late teens/early 20s
- THERE IS NO PATHOLOGIC ABNORMALITY
- SECONDARY: painful menstruation caused by identifiable condition (usually uterus or pelvis - endometriosis, adenomyosis, fibroids, PID, IUD)
- usually affects older women (>25yo)
12
Q
clinical features of dysmenorrhea
A
- Primary: sxs are central lower abdomen or pelvis radiating to back or thighs, beginning before or at onset of menses, lasting 1-3 days
- PE, labs, radiologic tests = nl
- Secondary: similar sxs as above but may also include bloating, heavy menstrual bleeding, and dyspareunia
- less related to first day of flow
13
Q
diagnostic studies for dysmenorrhea
A
- dx of primary dysmenorrhea based on hx, use of menstrual diary, PE
- specific tests for secondary dysmenorrhea - hysteroscopy, D&C, laparoscopy
- all allow both dx and tx
14
Q
management of dysmenorrhea
A
- Primary:
- start NSAIDs right before expected menses, continue 2-3 days
- OCPs, vit B (B1, thiamine; B6, pyridoxine), magnesium, acupuncture, heat, regular exercise
- Secondary:
- underlying conditions should be treated
- sx treatment may be sufficient
15
Q
general characteristics of menopause
A
- definition: menopause is the last menses, and perimenopause (usually lasting 3-5 yrs) is the time surrounding menopause.
- Dx made: 1 yr of no periods after age 40 with no pathologic cause
- FSH elevated (21-100), estradiol low (<20)
- progesterone levels nl
- mean age = 51.5 yrs
- smoking is associated with early menopause
- premautre menopause (spontanous premature ovarian failure) is cessation of menses before age 40 years
- ovaries continue to produce testosterone and androstenedione; estrone is the predominant postmenopausal circulating estrogen
