Paulson Menstral disorders Flashcards
In the US average age of puberty is between _________
8-13
_________ increase in androgens befoe the onset of puberty
adrenarch
____________ is breast development and requires (2 hormones)
thelarche, estrogen and progesterone
Menarche requires 5 hormones and ______ (anatomy)
GnRh, FSH, LH, progesterone, estrogen, normal outflow tract
pubertal development before 8 age in girls and 9 in boys is called
precocious puberty
average age to start menstrating is 12-13, _____ years after breast bud development
2.5
Normal cycle is ___________
28 days +/- 7 days
primary amenorrheas the abscens of spontaneous mentrastion by age________ with no secondary sex characteristic or ________ with prescesn of secondary sex characteristics
13, 15
4 main categories of primary amennorhea
ovarian dysfunction, pituitary dysfunction, hypothalamic dysfunction, outflow obstruction
example of ovarian dysfunction
turners syndrome. congenital development disorder of the repro system (sex chromosome abnormality)
example of hypothalamic dysfunction
GnRH pulse is messed up: Kallmanns (idopathic hypogonadotropic hypogonadism) + anosmia
Anoexia, excercise
Pituitary dysfunction examples
Sheehans syndrom (infartion of pitutatry d/t hemmorhage)
Outflow tract obstruction due to _________
imperforate hymen
How to work up primary amennohea. 1) sex characteristics Y/N
yes-outflow problem
No- check fhs/lh karyotype
Secondary amenorrhea defined:
cessation of previsouly present and regular menses for 3 months or irrecular menses for 6 months
M/C reasons for secondary amennhorehea (6)
pregnancy, PCOS, OCPS/meds, dibetes, hyper/hypothyroidsm, surgery
workup for secondary amenorrhea
1)preg test
2)check tsh/prolactin
3) progesterone challenge test
4) check FSH/LH
Imaging: CT or MR of hypothalamus, pit or pelvis
Progesterone challenge test is done by giving progesterone medication to a woman who doesn’t get periods to try to induce a period .
Med/dose and expected result
Provera 5mg BID x 5-7 days
+ withdraw bleed within 2-7 days
A + progesterone challenge test means that there is ________ present but is not __________. If no withdrawal bleeding occurs the patient either has very low ____________ or there is a problem with ___________
estrogen, ovulating
estrogen, outflow tract (adhesions)
Mullerian agensis is when the _________- doesnt develop properly
uterus
PCOS…consider screenign for ________-
metabolic syndrome, losely related to insulin resistance
Rotterdam criteria is used to dx ___________. Include criteria
PCOS. 2/3 hyperandrogenism, ovulatory dysfunction, polycycstic ovaries
Rotterdam criteria:
2/3: hyperandrogensim, polycycstic ovaries, issues ovulating
Polycycsti ovary is defines as and ovary with _______ or more follicles measuring _____-______ mm , or ______+ml
12, 2-9mm
10
s/sx of PCOS
acne, male hair loss patterns, thick/heavy facial and body hair growth, obestiy, irregular menses, skin tags, acanthosis nigracans
Tx for PCOS
OCA, metformin (used in cases of hyperglycemia), weight loss,
screen for _____ (4)in PCOS
lipids, BP, sleep apnea, dpression, DM
MEds that cause amenohrrea (4anties on oncol)
anti: phycs, depressants, histamines, hypertensives,
opiates
female athlete triad
amenorrhea, low bone density, eating disorder
female athlete triad
amenorhhea, osteopenia, eating disorder
_______________ are the most frequent pituitary tumor and inhibit GnRH resulting in low __________ and _______ levels
prolactinoma, estrogen and gonadotropin
primary dysmennhohera is caused by excessive __________ secretion in menstrual fluid with a usual onset within 3-6 months of menarch. peaks late teens, early 20s’
E2 prostaglandin
Secondary dysmen has a _________ cause
pathologic
in primary dysmennohreah you may have gneneralized pelvic tenderness, N/V/D, typically _________ (when does it happen)
first day of menses
In secondary dsymenorrhea pain lasts _____________
longer than a menstraul period
Secondary is usuallly (age)___________ and timeline
older (25+) than primary,
starts prior to menses, worsens and persists
causes for secondary dysmen
endometriosis, adenomyosis, IUD, cervical stenosis, fibroids, PID
__________ is a big risk factor for dysmennorhhea
heavy menses
TX for dysmennohhea
NSAIDS (most effective), tyelnol, heat, OCPs, excercise, TENS
NSAIDS for dysmenor
IBUPROPHEN (very effective in reducing prostaglandins)
Most common cause for AUB
PALM COIEN
Polyp
Adenomyosis
Leiomas
Malignancy/hyperplasia
Coag issues
Ovulatory issues
Endometrial
Iatrogenic
Not otherwise classed
PALM COIEN
Polyps
Adenomyosis
Lieomyoma
Malignancy/hyperplasia
Coag
Ovulation probs
Endometrial
Iatrogenic
Not otherwise speci
if a patien is 45+ with AUB, what must you do
endometrial biopsy
if thre is a palpable mass on PE with somewith AUB, what imagining would you perform
transvaginal US
TX for AUB
IUD (levono-mirena), COC’s, continueous POP’s, TXA (safe when trying to get preggers), hysterectomy and endometrial ablation when done having kids
Heavy mentral bleeding in adolescent may be 1st sign of bleeding disorder. In the acute phase you can treat with __________, maintanenc therapy includes ________
estrogen, injectibale progestin (depo), levo IUDS (mirena)
Acute AUB in repro age people Tx
IV estrogen, OCPs (monophasic of ethinl estradiol TIDx 7days)
DEPO +COC
TXA
REFER TO GYN
Iv estrogen is contraindicated in
breast cancer hx, DVT, liver dz
PMS sx occur in which phase
luteal
PMS can be dxed if they repor sx during the ____ days prior to menses and ends within ______ after onset of menses
4, 5
PMDD diagnosis
5/11 listed sx
how to treat PMDD
SSRIS
Prozac
Zoloft
Lexapro
Celexa
