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Nurp 501 > Week 1- The Menstrual Cycle > Flashcards

Week 1- The Menstrual Cycle Flashcards

1
Q

What does the HPA axis stand for?

A

Hypothalamus pituitary ovarian loop

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2
Q

The function of the HPA axis is important for:

A

Ovulation and menstrual cycle regulation

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3
Q

The HPA axis system is regulated by what kind of system?

A

Positive and negative feed-back loops

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4
Q

Hormones that are produced to regulate the menstrual cycle start at the ____ which releases what?

A

Hypothalamus

GnRH

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5
Q

When GnRH is released from the hypothalamus what happens next?

A

It tells the anterior pituitary to secrete FSH and LH

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6
Q

When the anterior pituitary secretes FSH and LH, this tells what to secret what?

A

Ovaries

Estrogen and progesterone

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7
Q

FSH stimulates the ovaries to release:

A

Estrogen

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8
Q

When a woman ovulates, what is stimulated to be produced?

A

LH

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9
Q

The LH allows the follicle/egg to ___ which in turn allows for ___.

A

Rupture

Ovulation

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10
Q

If pregnancy/ conception does not occur, and the egg does not become fertilized, what happens? What hormone is secreted as a result?

A

Produces the corpus luteum

Progesterone

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11
Q

What happens when the corpus let run degenerates completely?

A

Progesterone is withdrawn and there is a withdrawal bleed

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12
Q

What starts the menstrual cycle?

A

Progesterone withdrawal

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13
Q

In a woman with AUB, what are the minor causes?

A

Stress

Nutritional deficiencies

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14
Q

Too frequent cycles are called what and these cycles are closer than every ___ days.

A

Hypermenorrhea or polymenorrhea

24

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15
Q

Periods that are infrequent are called what and are how far apart?

A

Oligomenorrhea

38 days

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16
Q

How many days are considered a normal cycle?

A

24-38

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17
Q

Normal menstrual flow last how long?

A

4-8 days

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18
Q

Normal menstrual flow volume is:

A

5-80ml

Average= 30-35ml

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19
Q

Menorrhagia is flow greater than:

A

80ml

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20
Q

What is the term for heavy or prolonged periods?

A

Menorrhagia

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21
Q

What is the term for periods that irregular?

A

Metorrhagia- t stands for trouble regulating periods

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22
Q

What is a condition that presents as endometrial overgrowth glandular tissue that you may see protruding from outside of the cervix or higher up in the uterus seen on an ultrasound?

A

Polyp

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23
Q

What is the difference between primary and secondary dysmenorrhea?

A

Primary- starts within the first couple years of menarche and happens most of their life (starts in younger women)

Secondary is a pathologic condition like endometriosis, adenomyosis, fibroids, and is a sudden onset after not having painful periods.

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24
Q

Are we more concerned with primary or secondary dysmenorrhea?

A

Secondary

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25
Q

If a woman complains of dysmenorrhea, what is important in the subjective history?

A 
Gynecologic history 
Menstrual history 
Contraceptive history 
Social-abuse-somatic symptoms 
Diet
Stress
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26
Q

Why is getting the contraceptive history important in a woman with dysmenorrhea?

A

IUD or progestin only method?

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27
Q

What is the first line treatment for dysmenorrhea?

A

NSAIDS- decrease prostaglandin secretion that causes pain

COC

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28
Q

How does COC help with dysmenorrhea?

A

Suppresses ovulation- decreases pain due to decrease in hormone influence on the ovaries

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29
Q

Patient is sexually active with heavy menstrual bleeding, primary dysmenorrhea, work-up for heavy bleeding. What are you concerned about with a 19-year-old?

A

1st r/o pregnancy
STD- speculum or urine- gonorrhea and chlamydia
Look for cervicitis
R/o anemia

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30
Q

What if a patient comes in for a work-up for heavy bleeding and it’s day 10 of heavy bleeding. What can we do in the office that day to help with acute heavy bleeding?

A

High dose of COC-monophasic- double up 1 pill BID until bleeding slows down or progestin

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31
Q

What do you give for estrogen therapy for acute bleeding i.e. long heavy menstrual flow?

A

Conjugated equine estrogen (CEE) 2.5 mg PO QID for 2-3 days and then add medroxyprogesterone acetate (MPA) provera 10mg for 10-14 days while continuing CEE.

COCs 2-3 times a day and then taper

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32
Q

What do you give for progestin therapy for acute bleeding i.e. long heavy menstrual flow?

A

All of the following for 3 weeks then once a day for 7-10days

  1. Medroxyprogesterone acetate 10-20mg BID
  2. Megestrol 20-40 mg BID
  3. Norethindrone 5 mg BID
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33
Q

If sexually active with heavy bleeding what’s the first thing you r/o?

A
  1. Pregnancy
  2. Cervicitis
  3. STIs
  4. Coagulation problems- Von Wildebrands
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34
Q

What age does secondary dysmenorrhea start?

A

30 and older

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35
Q

Which dysmenorrhea do you look at PALM COIEN for?

A

Secondary

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36
Q

What do you look at besides the waist down if someone is having irregular bleeding?

A

Thyroid gland- hypothyroidism can cause heavy or irregular bleeding
Pituitary gland
Bruising- coagulation disorder

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37
Q

Woman on 3rd day of menses and has fever and rash. What is going on?

A

TSS

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38
Q

If a woman has malaise, fever, rash on period, what would you suspect?

A

TSS

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39
Q

Main organism what causes TSS?

A

Staph aureus

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40
Q

What items can cause TSS?

A

High absorbency tampons

Diaphragm- not changing like should

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41
Q

What do you do if a patient comes in with TSS?

A

Send to ED- need IV antibiotics and hydration

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42
Q

What’s the difference between PMS and PMDD?

A

PMS is more mild and ends with end of menstruation

PMDD severely impairs daily function

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43
Q

What part of the cycle does PMS and PMDD occur?

A

PMS- ovulatory to Luteal phase second half

PMDD- ovulatory to luteal phase second half

44
Q

If a woman has PMS symptoms and it does not end with the luteal phase, what is it?

A

Depression

45
Q

How do you treat PMDD?

A

COC suppress ovulation- NOT progestin only
Zaz
SSRI begin day 14 (luteal phase)
Paxil, Prozac, Zoloft
Acupuncture, vitamin b6 and calcium, stress reduction

46
Q

What is PALM COIEN?

A 
Polys
Adenomyosis
Lyemyoma
Malignancy 
Coagulopathy
Ovulatory dysfunction 
Iatrogenic
Endometrial abnormalities 
Not yet classified
47
Q

A 40 year old female presents with irregular vaginal bleeding after a history of regular menses, besides palm coien what would you look at?

A

Thyroid- TSH, FSH
Could be premenopausal
CBC
R/o cancer

48
Q

What do you want to r/o in thin women with no menses?

A

Eating disorders, dehydration, signs of vomiting

49
Q

What do you look for in a breast exam with a woman not having periods?

A

Tenders- r/o pregnancy

Gylacteria-discharge

50
Q

What test do you order if a women is having gylacteria?

A

Prolactin level- could be a tumor

51
Q

If a woman has gylacteria with a HA, they could have what?

A

Pituitary tumor- adenoma

52
Q

What do you order if the prolactin level is up?

A

MRI of the head or CT to look at the pituitary gland for tumor- can happen with secondary amenorrhea

53
Q

What other labs might you order for a 30 year old female with a BMI of 17 who reports no menses in 5 months?

A

FSH, LH, r/o premature menopause

54
Q

In PCOS, what would the FSH and LH look like?

A

Elevated

55
Q

What are some causes of amenorrhea?

A 
PCOS
Malnutrition 
Hyperprolactinemia 
Cushing syndrome 
Congenital adrenal hyperplasia
56
Q

Are you more concerned with primary or secondary amenorrhea?

A

Primary

57
Q

What is considered primary amenorrhea?

A

No period by 16 regardless of sex characteristics

No menses by 14 and absence of sex characteristics

58
Q

What is considered secondary amenorrhea?

A

Had period before then stopped for 3 cycles or 6 months

59
Q

What do we work up in someone with primary amenorrhea?

A

Thyroid- TSH
Pituitary- FSH, LH
Outflow problems- obstruction for blood to come out
Asherman syndrome-scarring

60
Q

If a women has amenorrhea, what is a good test to perform to see if it’s and outflow tract problem?

A

Progesterone challenge

61
Q

How do you perform a progesterone challenge?

A

10 mg of progesterone- provera for 10 days

62
Q

What is a positive progesterone test? What does it indicate?

A

Bleeding

No outflow problem

63
Q

What do you do if they don’t bleed?

A

Send to endo

64
Q

22 year old overweight female presents with irregular menses and excessive facial hair, what does she have?

A

PCOS

65
Q

PCOS causes menstrual irregularities due to the:

A

Hyperandrogens that affect the lining of the uterus and puts the woman into estrogen excess

66
Q

What tests do you conduct to diagnose PCOS?

A

Diagnosis of exclusion

67
Q

What do you r/o to conclude diagnosis of PCOS?

A

Cushing syndrome
Congenital adrenal hyperplasia
Adrenal secreting tumors
Hyperprolactemia

68
Q

You can diagnose PCOS if you r/o what with what symptoms?

A

Androgen secreting syndrome
Irregular periods
Androgen excess symptoms like excessive hair growth or acne or hirutism

69
Q

Women with PCOS can be at increased risk for what kinds of conditions?

A

DM2
CV dx- lipid panel
Ovulatory dysfunction- infertility- order HCG
Hyperplasia, uterine CA, they make excessive testosterone and estrogen

70
Q

If you are worried about PCOS patient being at risk for DM2, what labs do you order?

A

One of 2 hour fasting glucose

71
Q

What labs would you want to order if you suspect PCOS?

A 
1-2 hour glucose tolerance test
Lipid panel
TSH
Thyroid level
HCG
72
Q

What is the term for heavy, prolonged menstrual flow?

A

Menorrhagia

73
Q

What are the terms for light menstrual flow?

A

Oligomenorrhea

Hypomenorrhea

74
Q

What are the terms for frequent menstrual bleeding?

A

Polymenorrhea

Hypermenorrhea

75
Q

What is the term for irregular menstrual bleeding?

A

Metorrhagia

76
Q

What is the term for irregular, heavy menstrual bleeding?

A

Metomenorrhagia

77
Q

Any post-menopausal woman with uterine/vaginal bleeding should be considered as having:

A

Endometrial hyperplasia or endometrial cancer until proven otherwise.

78
Q

Is a common condition that typically affects women who are multiparous and older than 40 (4-5th decade). It is characterized by a small area of endometrial tissue within the myometrium (burrows deep into the uterine muscle in the uterine wall and is a variant of endometriosis).

A

Adenomyosis

79
Q

Commonly occurring benign growths on the cervix that are easily visualized with a speculum, appearing smooth, deep to bright red growths that are fragile and bleed easily.

A

Endocervical polyp

80
Q

Are usually benign growths on the endometrium consisting of connective, glandular, or muscular tissue; usually asymptomatic and found of transvaginal US.

A

Endometrial polyps

81
Q

What can be given to shrink large endometrial polyps prior to hysteroscopic resection?

A

GnRH agonists

82
Q

What may prevent endometrial polyps in high-risk women?

A

Levonogestrel IUD

83
Q

These are commonly known as fibroids, and are fibromuscular benign tumors in the myometrium. Most common benign pelvic tumors in women and the leading indication for hysterectomy.

A

Leiomyomas

84
Q

What are the most common symptoms of endometrial cancer are:

A

AUB

Postmenopausal women

85
Q

What tests should coagulopathy be ruled out with?

A

PT/PTT/platelet count

86
Q

This includes amenorrhea as well as light or heavy menses that can be frequent, infrequent, or occurring in regular patterns and is a diagnosis of exclusion.

A

Ovulatory dysfunction

87
Q

This usually occurs in predictive and cyclical manner and includes heavy menstrual bleeding. May also present with intermenstrual or prolonged bleeding patterns.

A

Endometrial AUB

88
Q

Medications that can cause iatrogenic AUB:

A 
Anticoagulants
Digitalis
Dilantin 
Progestin-containing contraceptives 
Antidepressants
89
Q

Primary amenorrhea is typically:

A

Hormonal in nature.

90
Q

Secondary amenorrhea is typically:

A

Due to lifestyle

91
Q

Asherman syndrome causes?

A

Mechanical obstruction of the endometrium, vagina, or cervix that results in amenorrhea

92
Q

This occurs after conization of the cervix, LEEP, cryotherapy, and D& C. Scar tissue causes a plug that doesn’t allow bleeding to drain (amenorrhea)

A

Cervical stenosis

93
Q

Causes of amenorrhea:

A
  1. Disorders of the genital outflow tract
  2. Disorders of the ovary (PCOS)
  3. Disorders of the anterior pituitary (hyperprolactemia caused by a prolactin-secreting tumor or hypothyroidism)
  4. Disorders of the hypothalamus or CNS (due to excessive exercise, grieving, anorexia)
94
Q

Hypothalamic lesions, tuberculosis, sarcoid, and encephalitis can result in ___ secretion of GnRH and ___ levels of FSH and estrogen causing amenorrhea.

A

Decreased

Reduced

95
Q

What medications affect prolactin levels?

A

Antihypertensives
Psychotropic drugs
H2 blockers
Oral contraceptives

96
Q

With amenorrhea if the FSH/LH is high it is:

A

An ovarian problem

97
Q

In amenorrhea If FSH/LH is low it is:

A

Pituitary or CNS problem

98
Q

Normal FSH level:

A

5-30 IU/L

99
Q

Normal LH level:

A

5-20 IU/L

100
Q

Occurs when ovary becomes resistant to FSH or LH stimulation or lacks sufficient eggs to ovulate?

A

Ovarian amenorrhea

101
Q

Related to deficiency of FSH and LH combined hypothalamic and pituitary amenorrhea (central amenorrhea).

A

Pituitary amenorrhea

102
Q

A single episode of heavy menstrual bleeding is likely caused by:

A

Pregnancy

Infection

103
Q

Chronic, cyclic heavy menstrual bleeding can be managed with:

A

IUD- levonorgestrel IUD can be used to treat heavy menstrual bleeding

Monophasic OCPs- Low dose OCPs will help stabilize the endometrium and help with heavy bleeding.

Patch or ring

104
Q

Heavy menstrual bleeding treatment medications include:

A
  1. Progestin- Limits endometrial growth and regulates flow- depo May do same
  2. GnRH agonist- creates a state similar to menopause- May result in bone loss
  3. NSAIDs- blocks synthesis of prostaglandins
  4. Danozol- synthetic steroid used to treat endometriosis
105
Q

For PCOS you must rule out these other causes of hyperandrogenism:

A
  1. Androgen-secreting tumors- May cause elevated levels of testosterone
  2. Adrenal gland tumor- dheas level
  3. Adult onset non-classical congenital adrenal hyperplasia- accompanied by amenorrhea
  4. Cushing syndrome- 24 hour urine cortisol
106
Q

PCOS management:

A

COCs- suppress enlarged ovaries and inhibit LH secretion and androgen production

Progesterone- LNG-IUD, mini pill, subdermal implant, progestin therapy only

107
Q

Treating the hirsutism of PCOS:

A

Antiandrogens in combo with COCs
Spironolactone- inhibits testosterone
Finasteride-reduces DHT and blocks conversion of testosterone

Nurp 501 (8 decks)

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