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EOR - Women's Health > Menstruation: Amenorrhea, Dysfunctional uterine bleeding, Dysmenorrhea, Menopause > Flashcards

Menstruation: Amenorrhea, Dysfunctional uterine bleeding, Dysmenorrhea, Menopause Flashcards

1
Q

2 types of amenorrhea

A

primary
secondary

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2
Q

mc cause of secondary amenorrhea

A

intrauterine pregnancy

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3
Q

first step in work up for amenorrhea

A

pregnancy test

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4
Q

primary amenorrhea is the failure of menses to occur by __ yo

A

15 yo (according to AAPA Blueprint)
but apparently some sources say 16 yo

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5
Q

in order for primary amenorrhea dx, amenorrhea must occur in the presence of (2)

A

normal growth
secondary sexual characteristics

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6
Q

primary eval of amenorrhea should occur at age 13 if there is

A

complete absence of secondary sexual characteristics

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7
Q

6 causes of primary amenorrhea

A

turner’s syndrome
hypothalamic-pituitary insufficiency
androgen insensitivity
imperforate hymen
anorexia
mullerian agenesis

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8
Q

XO karyotype
webbed neck
broad chest
elevated FSH

A

turner’s syndrome

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9
Q

46 XX
elevated testosterone
breast development only

A

hypothalamic-pituitary insufficiency

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10
Q

46 xy
cyclic pelvic pain
diagnosis via speculum exam

A

imperforate hymen

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11
Q

46 xx
very low weight

A

anorexia

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12
Q

secondary sex characteristics present
no uterus

A

mullerian agenesis

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13
Q

secondary amenorrhea is absence of menses for _ months
in a woman w. previously normal menstruation
OR
_ months in a woman w. a hx of irregular cycles

A

3
6

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14
Q

4 causes of secondary amenorrhea

A

pregnancy
weight changes
hypothyroid
prolactinoma

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15
Q

lab work up for secondary amenorrhea

A

beta HCG
TSH
prolactin

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16
Q

work up for secondary amenorrhea should include what challenge test

A

progesterone challenge test

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17
Q

what is the progesterone challenge test

A

medroxyprogesterone/progestogen x 7-10 days - if bleeding occurs = anovulatory cycles

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18
Q

what do you think when you see a 35 yo woman w. heavy and irregular menstrual periods x 1 year - she is in a stable/monogamous relationship, no hx of abnormal paps, and no hx STI’s - elevated BMI, normal vitals and pelvic exam

A

dysfunctional uterine bleeding

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19
Q

excessive uterine bleeding and prolonged menses that is NOT caused by pregnancy or miscarriage

A

dysfunctional uterine bleeding/AUB

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20
Q

6 types of dysfunctional uterine/AUB

A

polymenorrhea
hemorrhagic/hypermenorrhea
menorrhagia
metorrhagia
menomethorrhagia
oligomenorrhea

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21
Q

menses that occur more frequently (< 21 days apart)

A

polymenorrhea

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22
Q

menses that involve more blood loss (> 7 days OR > 80 mL) w. irregular intervals

A

hemorrhagic/hypermenorrhea

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23
Q

prolonged/heavy bleeding (> 7 days OR > 80 mL) w. regular intervals

A

menorrhagia

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24
Q

uterine bleeding that occurs frequently AND irregularly btw regular intervals

A

metrorrhagia

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25
Q

more blood loss during menses AND frequent and irregular bleeding btw menses

A

menometrorrhagia

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26
Q

long intervals btw menses

A

oligomenorrhea

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27
Q

oligomenorrhea involves > _ days btw menses

A

35

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28
Q

AUB in the absence of an anatomic lesion caused by a problem w. the hypothalamic-pituitary-ovarian axis

A

polymenorrhea
menorrhagia
metrorrhagia

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29
Q

gs dx for abnormal uterine bleeding

A

uterine dilation and curettage

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30
Q

work up for AUB

A

r/o pregnancy
labs
progestin trial
ovulation journal
pap smear/pelvic exam
endometrial bx
HSG (hysterosalpingography)

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31
Q

tx for AUB

A

OCP
NSAIDs

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32
Q

dull, throbbing cramping/lower abdominal pain during menses w. n/v - normal length and bleeding amount

A

dysmenorrhea

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33
Q

dysmenorrhea pain peaks _ days after the onset of menses and subsides after _ days

A

peaks: 24 hr
subsides: 2-3 days

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34
Q

t/f: dysmenorrhea can be primary or secondary

A

t!

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35
Q

in order for dysmenorrhea dx, pain must (2)

A

prevent normal activity
require medication (OTC vs rx)

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36
Q

t/f: dysmenorrhea pain can occur w. menses OR 2-3 days before onset

A

t!

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37
Q

work up for dysmenorrhea (2)

A

pregnancy test
US

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38
Q

cause of primary dysmenorrhea

A

excessive PG’s (not pinot grigio, which actually helps)

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39
Q

what PG is associated with dysmenorrhea

A

any from Sonoma County
… jk

real talk: F2a

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40
Q

dysmenorrhea mc affects what age group

A

teens - early 20’s

declines w. age

41
Q

rf for dysmenorrhea (5)

A

menarche before 12 yo
nulliparity
smoking
fam hx
obesity

42
Q

how might primary dysmenorrhea pain be described

A

“labor-like” on days 1-3

43
Q

dysmenorrhea may be associated by what symptoms (3)

A

n/v
diarrhea
HA

44
Q

causes of secondary dysmenorrhea (lots!)

A

pathologic/clinically identifiable cause:
endometriosis
adenomyosis
polyps
fibroids
PID
IUD
tumors
adhesions
cervical stenosis
cervical lesions
psych

45
Q

how might secondary dysmenorrhea pain be described

A

begins mid-cycle
increases in severity until the end

46
Q

secondary dysmenorrhea is mc in what age group

A

20s-40s

47
Q

dx of menopause is based on _ or more months of amenorrhea

A

12

48
Q

mean age of menopause

A

51
(44-55 yo)

49
Q

on average, women spend _ years in the postmenopausal state

A

30+

50
Q

regular menstrual fxn that marks the transition btw reproductive capability and menopause

A

perimenopause

51
Q

perimenopause lasts _ years

A

3-5

52
Q

symptoms of menopause (6)

A

menstrual irregularity
vasomotor sx
sleep distrubances
irritability
mood disturbances
vaginal dryness

53
Q

what are vasomotor symptoms (2)

A

hot flashes
night sweats

54
Q

4 sx associated w. vaginal dryness

A

dyspareunia
vaginal atrophy
loss of urogenital integrity
loss of skin elasticity

55
Q

menopause onset before 40 yo

A

premature ovarian failure

56
Q

hallmark labs for menopause

A

FSH > 30
decreased estradiol

57
Q

tx for vasomotor sx

A

HRT - estrogen

58
Q

HRT for women with a uterus

A

estrogen + progesterone

59
Q

HRT for women with no uterus

A

ERT (estrogen replacement therapy)

60
Q

unopposed estrogen HRT in women w. a uterus increases the risk of

A

endometrial ca

61
Q

progestin HRT increases the risk of (2)

A

hot flashes
breast ca

62
Q

when should HRT be used for menopause

A

severe sx:
hot flashes
night sweats
vaginal dryness

63
Q

how should you dose HRT for menopause

A

smallest dose for shortest possible time
annual review of decision to use HRT

64
Q

t/f: HRT should be used to prevent CVD

A

f!
dt increased risk of breast ca, CVD, DVT

65
Q

effect of HRT on lipid profile

A

increases: HDL and TG
decreases: LDL

66
Q

contraindications for HRT (6)

A

elevated TG
undiagnosed vaginal bleeding
endometrial ca
hx breast ca OR estrogen sensitive ca
CVD hx
DVT/PE

67
Q

non hormonal tx for vasomotor sx of menopause (3)

A

SSRI’s/SNRI’s
clonidine
gabapentin

68
Q

what SSRI is used for vasomotor sx of menopause

A

paroxetine

69
Q

2 phases of the 28 day menstrual cycle

A

follicular (proliferative)
luteal (secretory)

70
Q

normal menstrual cycle can vary in duration from _ to _ days

A

20-35

71
Q

each menstrual cycle begins on

A

the first day of ovulation

72
Q

ovulation occurs _ days before teh first day of menstruation

A

14

73
Q

chance of fertilization is highest btw days _ and _ of the menstrual cycle

A

11-15

74
Q

days 0-14 of menstrual cycle

A

follicular (proliferative) phase

75
Q

during the luteal phase, _ from the hypothalamus stimulates _ and _ to be released from the anterior pituitary

A

hypothalamus: GnRH
anterior pituitary: FSH, LH

76
Q

FSH and LH stimulate _ growth,
which secretes _

A

follicle
estrogen

77
Q

increasing estrogen levels during the follicular phase cause _ feedback, which causes a surge in _ (2)

A

positive
FSH, LH

78
Q

what causes ovulation

A

LH spike (caused by increasing estrogen release from the follicle)

79
Q

days 15-28 of the menstrual cycle

A

luteal (secretory) phase

80
Q

after ovulation, the follicle become the _
which secretes _

A

corpus luteum
progesterone

81
Q

increased progesterone in the luteal/secretoy phase causes _ feedback and a decrease in _ (2)

A

negative
LH/FSH

82
Q

in the absence of fertilization during the luteal phase, the corpus luteum becomes the _

A

corpus albicans

83
Q

the corpus luteum does not produce estrogen or progesterone, which leads to _

A

endometrial sloughing -> menses

84
Q

after menses, _ secretion marks the beginning of a new follicular phase

A

GnRH

85
Q

26 yo f c/o dpn and anxiety x 1 year just prior to menses - this interferes w. her relationships and work productivity - also c/o poor sleep, feeling overwhelmed, easily fatigued - PE and labs are normal

A

premenstrual dysphoric d.o

86
Q

repeated episodes of significant dpn and related sx during the first week before menstruation

A

premenstrual dysphoric d.o (pmdd)

87
Q

difference btw pmdd and pms

A

pmdd is a severe disabling extension of pms -> causes marked disruption in functioning

88
Q

dsm 5 for pmdd

A

at least 5 sx in the final week before onset of menses, which improve/become absent a few days after onset of menses:
affective lability/mood swings
interpersonal conflict
dpn
anxiety
decreased interest in activities
difficulty concentrating
lethargy
change in appetite
hypersomnia OR insomnia
sense of being overwhelmed
physical sx: ex breast tenderness, bloating, joint pain

89
Q

tx for pmdd (3)

A

SSRIs: fluoxetine, sertraline
SNRIs: venlafaxine
OCP + diuretics

90
Q

tx for severe/refractory pmdd (4)

A

GnRH
TCAs
benzos
ovariectomy

91
Q

25 yo c/o abd bloading, HA, irritability, dpn, poor sleep, breast tenderness 5 days before menses - sx greatly improve w.in 4 days of menses onset

A

premenstrual syndrome

92
Q

when do sx of pms typically occur

A

btw ovulation and menses

93
Q

what causes pms sx

A

-imbalance of estrogen and progresterone
-excess PG’s

94
Q

what pms sx typically occur during the luteal phase (3)

A

bloating
irritability
pmdd

95
Q

what criteria is used to for pms dx

A

ACOG:
one of the following sx is present during the 5 days before menses and abates w.in 4 days of menses:
-somatic: breast tenderness, abd bloating, HA, edema
-affective: irritability, dpn, angry outbursts, anxiety, social w/d, confusion

96
Q

tx for pms

A

exercise
stress reduction
SSRIs
combined OCP

97
Q

t/f: for pms, SSRI’s can be dosed cyclically

A

t!

98
Q

tx for resistant/severe PMS

A

GnRH
oophrectomy

EOR - Women's Health (15 decks)

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