Reproductive System Flashcards
What is the definition of secondary amenorrhea in a woman who has previously menstruated?
It is defined as the absence of menses for 3 months if previous cycles were normal
What is the definition of secondary amenorrhea in a woman with irregular menses?
Absence of menses for 6 months
In a woman with normal estrogen, what is the most likely cause(s) of secondary amenorrhea?
It is likely to be Asherman syndrome (intrauterine synechiae) or PCOS
In a hypoestrogenic woman, what are some causes of secondary amenorrhea?
CNS tumor, stress, hyperprolactinemia, hypophysitis, Sheehan syndrome, and premature ovarian syndrome
First-line test for amenorrhea
Beta-human chorionic gonadotropin (B-hCG) for pregnancy, TSH, and prolactin
What type of test will determine the presence or absence of sufficient estrogen?
Progesterone challenge test
Gonadal dysgenesis (Turner syndrome; primary amenorrhea cause) karyotyping, physical exam, labs, and management
Karyotyping: 45, X0
Physical exam: Short webbed neck, no breast development
Labs: High FSH
Management: Cyclic estrogen and progestins
Hypothalamic-pituitary insufficiency (primary amenorrhea cause) karyotyping, physical exam, labs, and management
Karyotyping: 46, XX
Physical exam: No breast development
Labs: Low FSH, low LH
Management: Cyclic estrogen and progestins
Androgen insensitivity (primary amenorrhea cause) karyotyping, physical exam, labs, and management
Karyotyping: 46, XY
Physical exam: Normal breast development
Labs: High testosterone
Management: Remove testes; start estrogen
Imperforate hymen (primary amenorrhea cause) karyotyping, physical exam, labs, and management
Karyotyping: 46, XX
Physical exam: Normal breast development
Labs: Dx on PE
Management: Surgically open
What is the predominant postmenopausal circulating estrogen?
Estrone
With menopause, the ovaries continue to produce what?
Testosterone and androstenedione
Menopause diagnostic studies
FSH of greater than 30 mIU/mL is diagnostic of menopause
Combined hormone replacement therapy his effective in reducing menopausal symptoms but appears to increase the risks of what?
Cardiovascular disease, breast CA, and cognitive changes. Other possible risks include migraine and gallbladder disease
Contraindications to hormone replacement therapy
Undiagnosed vaginal bleeding, acute vascular thrombosis, liver disease, and history of endometrial or breast CA
What is dysfunctional uterine bleeding (DUB)?
It is abnormal uterine bleeding in the absence of an anatomic lesion, usually caused by a problem with the hypothalamic-pituitary-ovarian hormonal axis
DUB clinical features
Abnormal bleeding with an unremarkable physical exam in a very young or perimenopausal woman
DUB diagnostic studies
- Urinary Beta-hCG should be done first to r/o pregnancy
- CBC, possibly iron studies, PT and PTT, documentation of ovulation, thyroid function tests, serum progesterone level, liver function tests, and prolactin and serum FSH levels are needed
- Pap smear, endometrial biopsy, pelvic U/S, hysterosalpingography, hysteroscopy, and/or D&C may be indicated based on history and physical exam
What are the types of fibroids that are classified by their location?
Subserous (deforming external series), intramural (within uterine wall), and sub mucous (deforming uterine cavity). Sub mucous is the type that causes uterine bleeding
Diagnostic procedures that may be done in fibroids
U/S, D&C, saline hysteroscopy, hysterosalpingography, and laparoscopy
In most cases of leiomyomata, what is the recommended treatment?
Observation
For symptomatic patients with leiomyomata, what type of treatment may they undergo?
Myomectomy, hysterectomy, or D&C
What type of medications may be given to reduce the tumor size of leiomyomata?
GnRH agonists and mifepristone; in women with small leiomyomata, GnRH agonists may restore fertility. Treatment is limited to 6 months
What treatment may be done in patients with leiomyomata who have no desire of future fertility?
Use of uterine arterial embolization or endometrial ablation