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Bloc I - Reproduction > Sept5 A2-Oligomenorrhea_Amenorrhea > Flashcards

Sept5 A2-Oligomenorrhea_Amenorrhea Flashcards

1
Q

primary amenorrhea def

A

no prior menses

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2
Q

secondary amenorrhea def

A

menses stopped

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3
Q

oligomenorrhea def

A

<9 menstrual cycles per year

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4
Q

causes of oligo, ameno

A
  • H
  • P
  • O not responding to HP
  • uterus not responding to P and E
  • distal problem (vagina). like imperforate hymen
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5
Q

some causes of primary amenorrhea

A
  • 45,X and variants (Turner)
  • Mullerian agenesis
  • Eating disorders, stress, excess exercise
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6
Q

some causes of secondary ameno

A
  • PCOS (chronic anovulation)
  • Sheehan syndrome
  • high prolactin level
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7
Q

top ddx causes of primary amenorrhea

A
  1. primary POF (hypergonadotropic hypogonadism)
  2. HH (hypogonadotropic hypogonadism)
  3. PCOS
  4. hyperPRLemia
  5. weight related
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8
Q

top ddx causes of secondary amenorrhea

A
  1. PCOS
  2. POF
  3. hyperPRLemia
  4. weight
  5. HH
  6. exercise induced
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9
Q

top ddx causes of anovulatory infertility

A
  1. PCOS

2. POF

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10
Q

POF sx

A
  • amenorrh, oligomeno
  • hot flushes
  • vaginal dryness
  • infertility
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11
Q

POF labs

A
  • high FSH (bc no estradiol and inhibin B)and LH
  • low AMH
  • low antral follicular count (AFC)
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12
Q

AFC in POF vs PCOS

A 
POF = low
PCOS = high
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13
Q

(imp) most common cause of POF caused by gonadal dysgenesis

A

Turner syndrome

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14
Q

(imp) Turner nuances

A
  • pure turner
  • some cells X, some XX
  • some cells X, some cells XY
  • all females*
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15
Q

(imp) most common PE featurs of Turner

A
  • webbed neck
  • low stature
  • brown spots nevi
  • folds of skin in the neck
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16
Q

how Turner dx

A

karyotype

17
Q

Turner problems long term

A

no P and E made so increased risk of CVD and osteoporosis

18
Q

turner tx

A

HRT

19
Q

mullerian agenesis (MRKH syndrome) def

A

uterus, cervix and upper part of vagina are absent

20
Q

PCOS def

A

increased AFC, lot of follicles, big swollen ovaries, follicles pockets
NO CYSTS

21
Q

clinical pres of PCOS

A
  • obesity
  • insulin resistance (diabetes and acanthosis nigricans)
  • hirsuitism
  • acne
  • oligo, amenor
  • lean PCOS (not all sx, still periods, normal weight)
22
Q

criteria of PCOS dx

A

2 of the following 3:

  • > 12 follicles on one ovary on US
  • ameno, oligorrhea
  • hyperandrogenism (clinical evidence lab evidence)
23
Q

main factor in PCOS to act on and why

A
  • reduce obesity
  • bc main pathophgy is obesity causing insulin resistance leading to anovulation via diff steps. this anovulation is also caused by high androgen activity
24
Q

consequences of PCOS

A
  • infertility
  • chronic anovulation (unopposed E on endometrium = endometrial hyperplasia, ca)
  • long term (metabolic syndrome, glucose intolerance, CVD, obesity, dyslipidemia, OSA, FLD)
25
Q

PCOS: decreases in weight corresponds with what

A

higher rate of return to ovulation

26
Q

PCOS tx if want conception

A
  • oral agents (clomiphene citrate and letrozole) = aromatase inhibitors. low estrogen = higher FSH
  • injected gonadotropin (FSH)
  • metformin
  • IVF
  • ovarian drilling, less theca cells, less androgen prod
27
Q

PCOS tx if don’t want conception

A
  • OCP
  • cyclic progesterone
  • LNG-IUS
  • anti-androgens
  • 3 first for endometrial protection*
28
Q

HH def

A

englobes diff congenital and acquired diseases of HPO axis leading to hyposecretion of FSH and LH

  • estrogen low bc no FSH
  • either hypothalamic or pituitary causes
29
Q

Kallman’s syndrome

A

non functional GnRH neurons. primary amenorrhea

30
Q

main causes of hypothalamic HH

A

-weight loss
-intense exercise
(Kallman’s)

31
Q

tx of hypothalamic HH

A
  • GnRH pump

- exogenous gonadotropins (FSH, LH) injections

32
Q

Sheehan’s syndrome (a cause of pituitary HH) def

A
  • pit apoplexy secondary to hypovolemic shock due to postpartum hemorrhage
  • pit enlarged in pregnancy so prone to infarction
  • get panhypopituitarism
33
Q

(imp) hyperPRLemia: what happens

A
  • PRL disrupts GnRH pulsatile secretion

- PRL inhibited by dopamine from hypothalamus

34
Q

hypothalamic hormone that STIMULATES PRL (dopamine inhibits it)

A

TRH

so hyperPRLemia is seen in hypothyroidism sometimes bc low TH = high TRH

35
Q

causes of hyperPRLemia

A
  • phgy (pregnancy, lactation, non-REM sleep, stress, nipple stim
  • pharmaco (dopamine Rs antag, dopamine depletors, cocaine, opiates, etc.)
  • pathological (stalk effect tumor compressing, stopping dopamine from reaching ant pit), prolactinomas, other pit tumors
36
Q

tx or hypePRLemia

A
  • dopamine agonists

- transsphenoidal (through the nose) hypohysectomy, pituitary radiotherapy

37
Q

(imp) long term complications of amenorrhea

A
  • endometrial hyperplasia, cancer (in PCOS)

- bone loss and vascular disease (POF)

Bloc I - Reproduction (57 decks)

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