REI Flashcards
Normal sequence of sexual maturation
Breast budding, then adrenarche (hair growth), a growth spurt and then menarche (around 12).
Critical elements for development of secondary sex characteristics
Adequate body weight (85-106 lbs), sleep and optic exposure to sunlight
Noonan’s syndrome
Short stature, webbed neck, heart defects, abnormal faces, delayed puberty and a normal karyotype.
Turner’s syndrome
45X. Failure to establish secondary sexual characteristics, short stature, pterygium colli, shield chest and cubitus valgus.
Rokitansky-Kuster-Hauser Syndrome
Vaginal and uterine agenesis
Treatment for Kallman syndrome
Pulsatile GnRH agonist. This is because in Kallman syndrome there is olfactory tract hypoplasia and the arcuate nucleus does not secrete GnRH.
True precocious puberty treatment
Due to increased pulsatile GnRH secretion at a young age, treat with continuous GnRH agonist if onset occurs well before avg puberty onset. If close to avg age observation is appropriate.
CNS abnormalities that can cause precocious puberty
Tumors (astrocytomas, gliomas, germ cell tumors secreting hCG; hypothalamic hamartomas; acquired CNS injury caused by inflammation, surgery, trauma, radiation therapy, or abscess; or congenital anomalies (hydrocephalus, arachnoid cysts, suprasellar cysts).
McCune Albright Syndrome
Premature menses before breast and pubic hair development, polyostotic fibrous dysplasia and cafe au lait spots. This is a result of continuous activation of Gs subunit that causes autonomous activation of hormone synthesis.
Treatment for a child with precocious adrenarche due to CAH
Steroid replacement. This will allow for less ACTH secretion by the hypothalamus and less production of androgens.
Normal age of menarche
9-17
Anomalies that commonly occur in patients with Mullerian agenesis
Renal
Transverse vaginal septum
Normal vaginal opening with a short blind vagina and pelvic mass
Imperforate hymen presentation
Bluish vaginal mass with menstrual cycle pelvic pain due to blood accumulation behind the hymen.
Causes of hypothalamic-pituitary amenorrhea
FUNCTIONAL: weight loss, obesity, excessive exercise. DRUGS: marijuana and tranquilizers. CANCER :pituitary adenomas. PSYCH: chronic anxiety and anorexia, and other chronic medical conditions.
Most common cause of amenorrhea
Pregnancy
Why does Asherman’s syndrome cause amenorrhea?
D&C or endometritis causes intrauterine synechiae or adhesions due to trauma to the basal layer of the endometrium, which causes amenorrhea.
Normal labs to assess ovarian function
Day 3 FSH, AMH, prolactin, day 21 progesterone, TSH and estrogen levels.
Risk for “post pill” amenorrhea
Hx of oligomenorrhea prior to starting the pill
r/o adrenal tumor as cause of hirsutism
DHEA-S and testosterone levels
r/o pituitary cause of hirsutism
Prolactin and TSH
r/o CAH as cause of hirsutism
17-OH-progesterone
Why use OCPs to help women with PCOS?
They establish regular menses, lower ovarian androgen production and cause an increase in SHBG which allows more testosterone to be bound and unavailable at the hair follicle…reducing hirsutism
Cause of postpartum hair loss
Estrogen increases “synchrony” of hair growth, causing hair to grow and be shed at the same time.
Presentation of Sertoli-Leydig cell tumors in women
Rapid onset of hirsutism and virilizing signs (acne, amenorrhea, clitoral hypertrophy, deepening of the voice), suppression of FSH and LH, elevation of testosterone and presence of an ovarian mass.
Hyperthecosis
More severe form of PCOS with diabetes, hair thinning, deepening of the voice and temporal balding.
Management options for endometrial polyps
Observation (if
How can you reach a diagnosis of PCOS in a woman with irregular menstrual bleeding and a hairy face?
Testosterone levels at the upper limits of normal (free testosterone is elevated because SHBG is decreased due to elevated androgens). LH is increased and FSH is decreased. Pts often have insulin resistance and chronic anovulation.
Contraindications to OCPs
Age > 35, smokes, hx of cardiovascular disease
When is laparoscopic myomectomy contraindicated?
If the fibroid is submucosal, you must take it out hysteroscopically.
How do OCPs improve dysmenorrhea?
Progesterone causes endometrial atrophy, which is where the pro-inflammatory prostaglandins are produced that cause menstrual pains
USPSTF recommendation for gonorrhea and chlamydia screening
All sexually active females age 25 and younger
USPSTF recommendation for HPV screening
Paps at 21, antibody at 30, unless Paps show ASCUS.
How does adenomyosis cause dysmenorrhea?
The gland tissue grows during the menstrual cycle and, at menses, tries to slough, but cannot escape the uterine muscle. This trapping of blood and tissue causes uterine pain in the form of monthly menstrual cramps.
Tx for adenomyosis in women who wish to preserve fertility
Hysteroscopic endometrial ablation and levonorgestrel IUD
When should all women get an endometrial biopsy when they present with irregular bleeding
> 40 years old
What distinguishes a leiomyoma from a leiomyosarcoma?
More than 20 mitotic figures per high power field
Premature ovarian failure age cutoff
35
Optimal daily calcium intake for postmenopausal women
1200 mg of elemental calcium per day. Ca absorption decreases with age because there is a decrease in biologically active vitamin D
Interval between DEXA scans for women with osteoporosis taking bisphosphonates
Every 2 years
Risks of HRT
Breast cancer, myocardial infarction, cerebrovascular accident, and thromoboembolic events
Most effective treatment for severe menopausal symptoms that include hot flashes, night sweats and vaginal dryness.
HRT with annual reviews regarding the decision to continue taking hormones
Most common reason why women stop taking HRT
Bleeding and spotting usually happens in the first 6 months and causes women to stop therapy.
Alternatives to estrogen that may be as effective in treating hot flashes
SSRIs, some anti-seizure medications and soy products
HRT is not currently recommended for treatment of cardiovascular disease; however, how can HRT help someone with CVD
Estrogen increases triglycerides and increases LDL catabolism and lipoprotein receptor numbers/activity. This decreases LDL levels. Hormones inhibit hepatic lipase activity, which prevents conversion of HDL2 to HDL3, thus increasing HDL levels.
WHO vs. ACOG definition of osteopenia
WHO: -1 to -2.5. ACOG: for scores of -1.5 to -2, T scores should be interpreted in combination with the patient’s risk factors (prior fracture, family history, race, dementia, history of falls, poor nutrition, smoking, low BMI, estrogen deficiency, alcoholism, and insufficient physical activity).
Natural way to lessen menopause symptoms
Aromatize more androgens (androstenedione and testosterone) to estrogen by increasing fat stores.
When would you think about ordering a semen analysis, ovarian function labs and HSG in a woman who is completely normal as far as fertility symptoms go?
After trying to conceive for > 12 months
How common is infertility in patients who have one episode of salpingitis?
15.00%
Lab that will help confirm the diagnosis of PCOS. Labs that help guide treatment of PCOS.
Confirm dx with elevated testosterone levels. Guide treatment by assessing progesterone, FSH and LH levels.
How will patients with irregular menses due to hypothyroidism respond to OCPs?
They won’t respond. This helps differentiate PCOS from hypothyroidism.
Management of infertility in patients with PCOS
1) Lose weight #2) Metformin + Ovulation induction agents (letrozole or clomiphene citrate)
Drugs that can cause infertility via hyperprolactinemia
1) Dopamine antagonists (antipsychotics) 2) SSRIs 3) TCAs 4) Methyldopa 5) Metachlopromide
Cause of exercise-induced hypothalamic amenorrhea? How do you treat?
Normal FSH and low estrogen levels due to insufficient caloric intake. Treat with supplemental FSH and LH if estrogen levels do not rise after increasing caloric intake. Clomiphene doesn’t work because of low estrogen levels.
What test can you do to determine ovarian reserve in a woman struggling with infertility
Clomiphene challenge: give clomiphene on days 5-9 of menstrual cycle and checking FSH levels on days 3 and 10. (Clomiphene is a SERM than inhibits the negative feedback of estrogen on the hypothalamus, thus FSH should be elevated on day 10 if the ovaries have diminished reserve and FSH should be at baseline if ovarian reserve is normal and ovaries produced sufficient amount of estrogen to inhibit increased FSH levels)
What does basal body temperature monitoring tell you about a patient’s menstrual cycle
Retrospective data on when they ovulated. If you want predictive data you need to use ovulatory urine kits that measure LH levels in the urine.
How long is an ovulated egg viable for? How long are sperm viable for in the fallopian tubes?
Egg - 24 hours. Sperm - 3 days.
Percentage of infertility cases due to male factor
35.00%
Criteria necessary to diagnose someone with premenstrual dysphoric disorder (PMDD)?
5 out of 11 clearly defined symptoms, functional impairment and prospective charting of symptoms
Deficiencies in which vitamins may exaccerbate or even cause PMS?
A, E, B6
What is the difference between PMS and PMDD?
Adverse physical, psychological and behavioral symptoms occur during the luteal phase of the menstrual cycle in both. PMS is characterized by mild to moderate symptoms, while PMDD is associated with severe symptoms that seriously impair usual daily functioning and personal relationships.
Pharmacologic treatment for clinically significant PMS
OCPs suppress the HPO axis and relieve symptoms
1st step in managing a patient who has mood symptoms associated with menstrual periods
Menstrual calendar/diary for around 2 months to document symptoms to see if they really are from PMS or PMDD
Medical management of patients with PMDD
SSRIs daily or just during the 1st 10 days of the luteal phase
What are risk factors for development of PMS?
Family history of PMS, Vitamin B6, calcium, or magnesium deficiency. Increasingly common as women age through their 30s.
