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R2F > Puberty and Menstrual Disorders 2 > Flashcards

Puberty and Menstrual Disorders 2 Flashcards

1
Q

secondary amenorrhea- definition

A

-absence of menstruation for 6 months

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2
Q

causes of menstrual irregularity

A
  • pregnancy
  • endocrine causes
  • acquired conditions
  • tumors
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3
Q

Secondary amenorrhea- labs

A
  • urine HCG
  • TSH
  • PRL
  • FSH
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4
Q

Secondary amenorrhea- check what?

A
  • TSH and PRL
  • abnormal TSH- thyroid dz
  • if normal- progesterone challenge test
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5
Q

Secondary amenorrhea- normal PRL, abnormal TSH

A

mild hypothyroidism

  • assoc with oligomenorrhea
  • tx should restore menses
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6
Q

Secondary amenorrhea- abnormal PRL

A
  • hyperprolactinemia- most common sx is galactorrhea
  • PRL > 100- prolactinoma (head MRI- pit adenoma, empty sella syndrome)
  • PRL < 100- other causes- ectopic production
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7
Q

Secondary amenorrhea- PRL > 100

A
  • microadenoma (<10 mm)- MRI- dopamine agonist

- macroadenoma (>10 mm)- dopamine agonist

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8
Q

Secondary amenorrhea- normal PRL and TSH- do what?

A

progesterone challenge test

  • blood- normogonadotropic hypogonadism
  • no blood:
  • do estrogen/progesterone challenge test:
  • blood- inc FSH and LH (hypogonadotropic hypogonadism); dec FSH and LH (hypogonadotropic hypogonadism)
  • no blood- outflow obstruction
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9
Q

Secondary amenorrhea- progesterone challenge test

A
    • blood- normogonadotropic hypogonadism- PCOS
  • neg blood- estrogen/progesterone challenge test:
  • if neg- outflow obstruction
  • if positive- inc FSH and LH (hypogonadotropic hypogonadism); dec FSH and LH (hypogonadotropic hypogonadism)
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10
Q

Anatomic causes of secondary amenorrhea

A
  • asherman syndrome

- cervical stenosis

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11
Q

Secondary amenorrhea- TSH and PRL normal- blood on progesterone challenge test

A

Normogonadotropic hypogonadism

  • adrenal disorders- CAH, cushing’s, adrenal androgen secreting tumor
  • ovarian- PCOS, sertoli-leydig cell tumor
  • exogenous androgens
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12
Q

PCOS

A
  • 10% of women of reprod age
  • leading cause of female anovulatory infertility
  • insulin sensitivity
  • inc in T!!
  • dx- 2 of 3: oligomenorrhea or amenorrhea; hyperandrogenism (LH to FSH 2:1); mult small cysts on US
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13
Q

PCOS- mech

A
  • inc estrogen
  • inc LH, dec FSH
  • dec follicular maturation- chronic anovulation
  • stim of stroma and theca- inc ovarian androgen- androgen excess
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14
Q

PCOS- sx’s, signs

A
  • anovulation
  • hyperandrogenism
  • LH hypersecretion
  • elevated T
  • hirsutism, acne, menstrual dysfxn
  • acanthosis nigricans
  • chronic anovulation- inc risk of endometrial cancer!!
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15
Q

PCOS- tx

A
  • weight loss
  • oral contraceptives- suppress FSH and LH
  • clomiphene citrate- induce ovulation
  • spironolactone- competes for T binding sites
  • insulin-sensitizing agents
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16
Q

Secondary amenorrhea- PCT neg- estrogen (PCT) positive- check what??

A

FSH and LH levels

  • inc FSH and LH- hypogonadotropic hypogonadism- postmenopausal ovarian failure, premature ovarian failure
  • dec FSH and LH- hypogonadotropic hypogonadism- check MRI (pit tumor)- anorexia, chronic illness, radiation, excessive exercise, malnutrition)
17
Q

evaluation of pts with hyperandrogenism

A
  • PCOS and late onset CAH- progress slowly
  • neoplastic disorders- rapid virilization
  • inc 17-hydroxyprogesterone- CAH
  • cortisol- cushing syndrome
  • prolactin and TSH- hyperprolactinemia and thyroid dysfxn
  • glucose, lipid levels
  • T and DHEA-S
18
Q

primary amenorrhea

A

-no menstruation by 13 W/O secondary characteristics
OR
-age 15 WITH secondary characteristics

19
Q

secondary amenorrhea

A

absence of menses for > 6 months

20
Q

polymenorrhea

A

freq menses < 21 days

21
Q

menorrhagia

A

excessive and/or prolonged bleeding (>80 mL and > 7 days) occurring at normal intervals

22
Q

metrorrhagia

A

-irregular episodes of uterine bleeding

23
Q

menometrorrhagia

A

heavy and irregular uterine bleeding

24
Q

intermenstrual bleeding

A

scant bleeding at ovulation for 1-2 days

25
Q

oligomenorrhea

A

-menstrual cycles occurring > 35 days, but less than 6 months

26
Q

DUB (dysfxnal uterine bleeding)- structural causes?

A

PALM

  • polyp
  • adenomyosis
  • leiomyoma
  • malignancy and hyperplasia
27
Q

DUB (dysfxnal uterine bleeding)- nonstructural causes?

A

COEIN

  • coagulopathy
  • ovulatory dysfxn
  • endometrial
  • iatrogenic
  • not yet classified
28
Q

DUB- dx evaluation

A
  • office endometrial bx

- hysteroscopy directed endometrial sampling

R2F (18 decks)

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