Test 1 Flashcards
Amenorrhea
Absence or abnormal cessation of the menses for more than 3 months
Oligomenorrhea
Scanty menstruation; menstrual periods occur at intervals of greater than 35 days, with only 4-9 periods in a year.
Polymenorrhea
Occurrence of menstrual cycles of greater than usual frequency.
Menorrhagia
Excessively prolonged or profuse menses
Metrorrhagia
Any irregular, acyclic bleeding from the uterus between periods
Menometrorrhagia:
Irregular or excessive bleeding during menstruation and between menstrual periods
Dysmenorrhea
Painful menses
Mittelschmerz
One sided lower abdominal pain that occurs in women at or around the time of ovulation
Tool for: Magnification and viewing of cervix, vulva, vagina, and perianal
Colposcopy
Indication for Endometrial Biopsy (EMB)=
Abnormal vaginal bleeding
Postmenopausal bleeding
Fertility Issues
Waht does a Hysteroscopy view?
Direct Intrauterine viewing (camera through cervix)
What are indications for Hysteroscopy?
Abnormal bleeding
Intrauterine Mass (fibroid/CA)
Pelvic Pain
What is a hysterosalpingogram?
Radiopaque dye outlines interior of uterus and fallopian tubes.
Indications for Laparoscopy?
Pelvic masses-uterus, ovaries, tibes
Pelvic pain PID, endometriosis, fibroids
Fertility issues
What is a Laparotomy?
When is it used?
Open abdominal surgery
Hysterectomy, Pelvic cancers, Pelvic masses, C-section.
When is are of menarche?
12-13
% of women with infertility=
20%
What does normal menses require?
Normal hypothalamic pituitary ovarian (HPO axis)
Responsive Endometrium
Unobstructed outflow tract
Effects of Estrogen
Endometrial proliferation Myometrial cell growth Vaginal cornification Reduced vaginal pH Increased cervical mucus
Estrogen in excess Sx
Dysmenorrhea Nausea Edema Enlarged uterus Fibroids Fibrocystic Breasts Menorrhagia
Estrogen Deficiency Sx
Scant menses
Mid cycle spotting
Progesterone effects
Endometrial secretory changes Decrease pH of cervical mucus Help maintain pregnancy Breast, uterine, tubal mm activity Thermogenic effects
Progesterone in excess Sxs
Edema Bloating Headache Depression Weight gain Fatigue Hypertension Vericose Veins (Sxs of pregnancy)
Progesterone Deficiency Sxs
Prolonged menses
Heavy menses
Severe cramps
Luteal spotting
Normal cycle length=
Flow=
Amount=
Cycle=21-45 days
Flow= 7 days (3-5 ave)
Amount= 80ml (16tsp)
Estradiol is highest in what phase?
Progesterone is highest in what phase?
Estrogen= Follicular
Progesterone= Luteal
Causes of primary amenorrhea (0.3% prevalence)
-CNS hypothalamic pituitary disorder
-Membranous blockage of vagina (hyman)
-Drastic weight loss/malnutrition
-Hypoglycemia
-Extreme obesity
-Thyroid disease
-Anemia
Congenital
Causes of Secondary Amenorrhea
- Pregnancy
- Weight reduction/gain
- Stress/depression
- Hypothyroidism
- PCOS
- Obesity
- Increased prolactin (inhibit GnRH)
- Early menopause
- Drugs
Medications that may cause Amenorrhea
Hormonal contraception Antipsychotics Antidepressants Cardiovascular meds Marijuana
Risks of long term amenorrhea:
If Hypoestrogenic Amenorrhea=
If Hyperestrogenic Amenorrhea=
Hypo=
- Bone mineral density loss
Hyper=
- Abnormal lipid levels
- DM
- Obesity
- Breast Cancer
Initial labs to check diagnose reason for amenorrhea=
B-hCG (Pregnancy)
TSH (Thyroid)
PRL (Inhibits GnRH)
Estrogen/ Progesterone challenge test
HPO axis and Amenorrhea:
If FSH >30 or LH>40=
If >45y=
If <40yo=
Low FSH/LH=
If FSH >30 or LH>40= ovarian failure
If >45y= menopause
If <40yo= premature ovarian failure
Low FSH/LH= pituitary or hypothalamic dysfunction
Exercise induced Amenorrhea can be cause by:
Body fat <15-18%
BMI <18
Nutritional deficient state: energy output exceeds input. Exercise alone does not lead to amenorrhea
Causes of Premature Ovarian Failure (early menopause <40)
Autoimune Chemo/radiation Family Hx Surgical removal/damage Chromosomal (fragile X/Turners)
Management of Premature Ovarian Failure (estrogen deficiency symptoms)
1) Hormone Replacement
2) SSRIs
3) Botanicals (black cohosh, red clover)
4) Diet, Exercise, Stress Mgmt
What diseases do you need to watch out for with Premature Ovarian Failure Management?
Osteoporosis
- DEXA, Cal/mag/D, Exercise, Meds
CAD
- Monitor BP, Lipids
Estrogen Deficiency
- Vaginal Atrophy, Libido, Insomnia, mood swings
What diseases do you need to watch out for with Premature Ovarian Failure Management?
Osteoporosis
- DEXA, Cal/mag/D, Exercise, Meds
CAD
- Monitor BP, Lipids
Estrogen Deficiency
- Vaginal Atrophy, Libido, Insomnia, mood swings
3 criteria for PCOS
1) Oligo-menorrhea
2) Hyperandrogenism
3) Exclusion of other disorder
* Polycystic varies are NOT required for diagnosis*
What % of women have full blown clinical picture of PCOS?
What is full blow?
1/3
Amenorrhea (50%)
Hirsutism (50%)
Obesity (40%)
Infertility (20%)
What do woment with PCOS usually seek medical care for?
Menstrual cycle Irregularities & infertility Metabolic issues: - Hypoglycemia - Insulin resistance - Hyperlipidemia -Hypertension
PCOS increases your risk for what 4 diseases?
Infertility
DM
CVD
Endometrial cancer
Making the diagnosis of PCOS.
Symptoms=
Tests=
Symptoms= hirsutism, anovulation, irregular menses
Tests= Free testosterone/DHEA, & Fasting glucose/insulin
Pelvic ultrasound NOT NECESSARY
How do you manage PCOS?
Treat disease and symptoms associated with it.
- Insulin resistance
- Androgen excess
- Fertility
- Diabetes, cancer, CVD, obesity.
Treating PCOS
Meds=
Supplements=
Lifestyle=
Meds=
- Progesterone for E:P
- Spironolocatone for androgens
- Metformin for BS
Supplements=
-SHBH (soy, flax, nettles, green tea)
-Decrease androgens: Saw palmetto, green tea
- Improve Insulin Resistance: Vit C, Chromium
Increase Ovulation: Vitex, Rhodiola
Lifestyle=
- High protein, low carm, low bad fats.
- EXERCISE
