Naz teaches Amenorrhea

Question 1

What defines amenorrhea

Answer 1

No period for 3 cycles.

OR 6 months

Question 2

Primary amenorrhea is ?

Answer 2

the absence of menarche by age 16 or 4 years after thelarche.

Question 3

_______ is the onset of female breast development.

Answer 3

Thelarche

Question 4

_________ is the onset of androgen-dependent body changes such as growth of axillary and pubic hair, body odor, and acne.

Answer 4

Adrenarche

Question 5

______ is the appearance of pubic hair.

Answer 5

Pubarche

Question 6

Etiologies of Primary Amenorrhea

Outflow tract abnormalities

Answer 6

Imperforate hymen
Transverse vaginal septum
Vaginal agenesis
Vaginal atresia
Testicular feminization
Uterine agenesis with vaginal dysgenesis
MRKH syndrome

Question 7

Etiologies of Primary Amenorrhea

End-organ disorders

Answer 7

• Ovarian agenesis
• Gonadal agenesis 46,XX
• Swyer syndrome/gonadal agenesis 46,XY
• Ovarian failure
• Enzymatic defects leading to decreased steroid biosynthesis
• Savage syndrome—ovary fails to respond to FSH and LH
• Turner syndrome

Question 8

Etiologies of Primary Amenorrhea

Central disorders

Answer 8

Trauma
Tuberculosis
Sarcoidosis
Irradiation
Kallmann syndrome—congenital absence of GnRH
Pituitary
Damage from surgery or radiation therapy
Hemosiderosis deposition of iron in pituitary
Hypothalamic
Local tumor

Question 9

Swyer syndrome/gonadal agenesis 46,XY is?

Answer 9

congenital absence of the testes in an XY, testes never develop, have normal internal and external female genitalia.
NO estrogen–> will not develop breasts.

phenotypical picture similar to that of ovarian agenesis.

Question 10

Mayer-Rokitansky-Küster-Hauser syndrome is?

Answer 10

it is Müllerian agenesis

They may have
complete vaginal agenesis and absence of a uterus or partial
vaginal agenesis with a rudimentary uterus and distal vagina.

Question 11

“female” without uterus and Amenorrhea

Answer 11

Karyotype:
testicular feminization,
Müllerian agenesis,
46,XY steroid enzyme defects,
pure gonadal dysgenesis, or anorchia

Question 12

androgen insensitivity vs mullerian agenesis

Answer 12

androgen insensitivity will have no pubic hair (they do have testes so go cut em out)

both have blind pouch vagina and breasts

Question 13

Vaginal atresia is?

Answer 13

where the Müllerian system is developed but the distal vagina is composed of fibrosed tissue.

Question 14

Describe progesterone challenge

Answer 14

progesterone or oral medroxyprogesterone acetate given.

If sufficient serum estradiol (greater than 50 pg/mL), withdrawal bleeding 2-7 days after the progestin is withdrawn, indicating that the patient’s amenorrhea is due to anovulation.

If no bleeding occurs after withdrawal, then the patient’s amenorrhea is likely to be due to either a) low serum estradiol, b) hypothalamic-pituitary axis dysfunction, c) a nonreactive endometrium or d) a problem with the uterine outflow tract, such as cervical stenosis or uterine synechiae

Question 15

If no bleeding occurs after progesterone challenge withdrawal, then the patient’s amenorrhea is likely to be due to either ?

Answer 15

a) low serum estradiol
b) hypothalamic-pituitary axis dysfunction
c) a nonreactive endometrium
d) a problem with the uterine outflow tract, such as cervical stenosis or uterine synechiae

Question 16

Patients with hyperprolactinemia require rx?

Answer 16

bromocriptine

Question 17

With progesterone challenge failure, the differential diagnosis becomes:

Answer 17

hypergonadotropic or hypogonadotropic hypogonadism

that can be differentiated by an FSH measurement.

Question 18

Anatomic abnormalities including Asherman syndrome and cervical stenosis may lead to secondary amenorrhea. These patients
_________ to estrogen and progesterone withdrawal.

Answer 18

fail to respond to estrogen and progesterone withdrawal.

Question 19

In the absence of breasts and presence of a uterus, FSH will differentiate between

Answer 19

hypergonadotropic and hypogonadotropic

hypogonadism. Karyotype may be necessary to rule out gonadal agenesis in a 46,XY.

Question 20

The causes of hypothalamic-pituitary amenorrhea are:

Answer 20

• functional (weight loss, obesity, excessive exercise)
• drugs (marijuana and tranquilizers)
• neoplasia (pituitary adenomas)
• psychogenic (chronic anxiety and anorexia nervosa)

Question 21

PCOS cancer risks

Answer 21

unopposed estrogen exposure that accompanies women with PCOS, these individuals carry a higher risk of developing endometrial hyperplasia and cancer.

PCOS is considered to increase the risk of ovarian cancer.

Question 22

PCOS labs

Answer 22

Testosterone levels will be helpful to confirm the diagnosis

An increased LH/FSH ratio is observed to be elevated in PCOS

progesterone levels are helpful during medical treatment to check if the woman is ovulating.

Question 23

____________ are the first-line of treatment for ovulatory dysfunction in PCOS patients.

Answer 23

Metformin and ovulation induction agents

Question 24

what is imipramine.

Answer 24

TCA

s/e= hyperprolactinemia

Question 25

exercise-induced hypothalamic amenorrhea, which is characterized by ____ (labs)

Answer 25

normal FSH and low estrogen levels

Question 26

A clomiphene challenge test, which consists of ?0,

Answer 26

giving clomiphene citrate days five to nine of the menstrual cycle and checking FSH levels on day three and day 10

Question 27

When do you have sex if you want a baby

Answer 27

The day you ovulate
egg is good for 24 hours
sperm are good for 3 days

Women are most fertile during the middle of their cycle when they are ovulating. Assuming normal cycles every 28 days, a woman is most likely to ovulate on day 14.

Question 28

Women are most fertile during the middle of their cycle when they are ovulating. Assuming normal cycles every 28 days, a woman is most likely to ovulate on day ____?

Answer 28

14 of her cycle

Question 29

Women aged 21-29 years should have a Pap test every ?

Answer 29

three years.

Question 30

Women aged 30-65 years should have a Pap test and an HPV test (co-testing) every ___________

Answer 30

every five years (preferred). It is acceptable to have a Pap test alone every three years.

Question 31

Women should stop having cervical cancer screening when?

Answer 31

-after age 65 years
-if no hx of dysplasia/ cancer
-three negative Pap test results in a row or…
-two negative co-test results in a row within the past 10 years,
need to meet all criteria

Question 32

The major symptom associated with myomas is ?

Answer 32

menorrhagia,

1) ↑ uterine cavity size that leads to greater surface area for endometrial sloughing;
2) an obstructive effect on uterine vasculature that leads to endometrial venule ectasia and proximal congestion in the myometrium/endometrium resulting in hypermenorrhea.

*Most uterine fibroids are asymptomatic and do not require any treatment.

Question 33

___________ myomas are most likely to cause lower pregnancy and implantation rates.

Answer 33

Submucosal or intracavitary

Question 34

Growth of uterine fibroids is stimulated by _________

Answer 34

estrogen

Question 35

________________ inhibit endogenous estrogen production by suppressing the hypothalamic-pituitary-ovarian axis. They can result in a 40-60% reduction in uterine size.

Answer 35

Gonadotropin-releasing hormone agonists

Hot flashes are experienced by >75% of patients

Question 36

abnormally heavy bleeding at menstruation

Answer 36

Menorrhagia

Question 37

Gonadotropin-releasing hormone agonists s/e

Answer 37

Hot flashes are experienced by >75% of patients

Question 38

_________ is the surgical removal of fibroids from the uterus

Answer 38

Myomectomy