PR3152 IC18 (el)

Question 1

define amenorrhea

Answer 1

no menses for more than 90 days

Question 2

what are the two types of amenorrhea?

Answer 2

primary/functional
- no menses by 15 years old in females who never menstruated

secondary
- no menses for more than 3 cycles in previously menstruating femalae
- caused by weight loss (decrease in pulsatile GnRH secretion causing less LH and FSH secretion) , intense exercise, <25yo with hx of menstrual irregularities

Question 3

what are the three etiology of amenorrhea?

Answer 3

1) anatomical causes
- pregnancy, uterine structure abnormalities

2) endocrine disturbances leading to chronic anovulation

3) ovarian insufficiency/failure

Question 4

non phx treatment for amenorrhea?

Answer 4

identify the underlying causes
- stress management, weight gain, reduce exercise intensity

Question 5

phx treatment options for amenorrhea?

Answer 5

copper IUD, progestin only, oestrogen only, COCs.

Question 6

definition of menorrhagia?

Answer 6

more than 80ml of bleeding per cycle
(arbitrary, may want to check the QOL)

OR

more than 7 days of menses per cycle

Question 7

what are the two pathophysiological factors to menorrhagia?

Answer 7

uterine-related
- uterine fibroids
- adenomyosis
- endometrial polyps
- gynaecological cancers
- alterations to HPO

coagulopathy
- VWD von willebrand disease
- Cirrhosis
- idiopathic thrombocytopenia purport

Question 8

what are the two phx measures for menorrhagia?

Answer 8

FOR MAINTENANCE

contraception based:
- progestin only tablet or injection, COCs, progestin IUD
- progestin helps to stabilise the endometrium and thin lining.

non-contraception based:
- NSAIDS for bleeding
- Tranexamic acid for bleeding (slows breakdwon of blood clots)
- cyclic progestins (14-21 days instead of every day)

Question 9

what are the non phx measures for menorrhagia?

Answer 9

hysterectomy
endometrial ablation

Question 10

definition of dysmenorrhea?

Answer 10

crampy pelvic pain with or just before menses

Question 11

causes of dysmenorrhea?

Answer 11

primary: prostaglandin and leukotrienes release = vasoconstriction

secondary: endometriosis

Question 12

non-phx tx for dysmenorrhea?

Answer 12

topical heat
acupuncture
exercise
low fat vegetarian diet

Question 13

phx tx for dysmenorrhea?

Answer 13

1st line: NSAIDS
- helps to inhibit prostaglandin release
2nd line: COC
3rd line: Progestin IUD or injection (may become amenorrheic)

Question 14

define premenstrual syndrome (PMS)

Answer 14

CYCLIC PATTERN OF symptoms 5 days prior to menses that resolves on menses onset

Question 15

symptoms (classification) of premenstrual syndrome (PMS)

Answer 15

1) somatic
- bloating, headache, dizzy/nausea, weight gain, appetite change, fatigue

2) affective
- anxiety, depression, angry outburst, social withdrawal, forgetfulness, tearful, restless

if SEVERE MOOD SYMPTOMS: premenstrual dysphoric disorder (PMDD) => psychiatric condition

Question 16

phx for pMS

Answer 16

SSRIs e.g. paroxetine

COC (?? somatic symptoms?))

Question 17

non- phx for pMS

Answer 17

increasing exercise, vitamins, reduce caffeine, refined sugar, sodium

Question 18

define PCOS

Answer 18

ovaries produce abnormal amt of androgen = growth of cysts in the ovaries

Question 19

clinical presentation of PCOS

Answer 19

1) menstrual irregularities e..g, menorrhagia…

2) androgenic:
(a) oily skin, acne, hirsutism
(b) metabolic disorder/insulin resistance : risk factor for CVS and DM.

Question 20

phx management of PCOS

Answer 20

COC (consider antiandrogenic progestin for the androgenic symptoms)

Metformin for the insulin resistance