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Repro > week four > Flashcards

week four Flashcards

1
Q

What is the dx criteria of PCOS

A

Rotterdam

Ovarian dysfunction (irregular or absent ovulation)

Clinical and/or biochemical evidence of androgen excess

Polycystic ovaries (TVUS)

Presence of 12+ follicles in at least one ovary measuring 2-9 mm in diameter and/or ovarian volume > 10 (not necessary for dx)

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2
Q

What is the pathophys behind insulin resistance in PCOS?

A

Dec SHBG > inc testosterone bioactivity > android or visceral fat

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3
Q

Pathophys of ovarian hyperandrogenism in PCOS

A

Intrinsic abnormality of theca cell steroidgenesis

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4
Q

Pathophys anovulation in PCOS

A

Persistent estrogen production arising primarily from peripheral conversion of androgens to estrone and inc androgens in the ovary

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5
Q

Pathophys increased LH in PCOS

A

Primary neuroendocrine defect and inc androgens > inhibits feedback effects of estrogens and progesterone on pulsatile LH release

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6
Q

Pathophys dec FSH in PCOS

A

Feedback effect of chronic unopposed estrogen secretion > dec aromatase activity

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7
Q

List the ways hyperandrogenism presents clinically from most to least common

A

PCO
Obesity
Oligomenorrhea
Hirsutism
Acne
Metabolic syndrome
Alopecia

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8
Q

What are mechanisms that underlie CVD in the PCOS patient?

A

Inc insulin > inc homocysteine

Impairment of cardiac structure + function (inc cardiac size, inc BP, dec EF)

Endothelial dysfunction and dec max O2 consumption due to IR

Elevated CRP

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9
Q

What are some of the MOA for development of endometrial hyperplasia and carcinoma in the PCOS patient?

A

Anovulation, presence of DMII (hyperinsulinemia), obesity, HTN

Insulin upregulates estrogen producing aromatase enzyme system in glands and stroma

Progesterone resistance due to dysregulation of endometrial gene expression

Hyperandrogenism

Hypersecretion LH which modulates endometrial growth

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10
Q

What is the initial lab work for PCOS dx? What imaging can be ordered after and why?

A

initial working is serum free testosterone and FSH/LH

TVUS can be ordered if necessary to meet 2 of 3 dx criteria

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11
Q

What are some of the goals of medical management in a PCOS patient?

A

Restoring ovulation
Normalize endometrium
Amelioration hyperandrogenism sx
Reduce IR
Manage underlying metabolic abnormalities
Reduce RF for DM2 and CVD
Contraception*

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12
Q

What are the main lifestyle treatments used in management of PCOS? What difference do they make?

A

Mindfulness stress management (dec cortisol, BP, blood sugar)

Weight loss (restore cycles, improve preg rates)

Exercise (dec IR, BP, improves lipids)

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13
Q

What are some effective nutraceuticals for PCOS pts?

A

Fish oil
Vit E succincinate
N acetyl cysteine
Chromium
Vit D3
Probiotics
DCI
MI

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14
Q

What are some herbs used in PCOS pts with glucose-insulin issues and dyslipidemia?

A

Berberine
Gymnema
Cinnamon
Flax
Nettle
Saw palmetto
Mentha spicata
Vitex
Cimifuga racemosa
Peonia lactiflora
Tribulus terrestris
Licorice
Maitake mushroom

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15
Q

When is metformin useful with PCOS?

A

Off label to treat or prevent oligomenorrhea, hirsutism, infertility, obesity, to prevent DM2

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16
Q

What are pharmaceutical options for PCOS pts?

A

Progesterones
Progestins
Mirena IUD
OCP
Metformin
Statins
Acarbose alpha glucosidase inhibitor
Spironolactone
Letrozole

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17
Q

What are the six sources of pelvic pain?

A

GI
Uro
Gyn
Psych
MSK
Neuro

18
Q

What are the most common psych causes of pelvic pain?

A

2nd chakra issues - fear of losing control, relationships, etc
Depression
Physical/sexual abuse
Somatisation

19
Q

What are the main GI causes of pelvic pain?

A

IBS
IBD

20
Q

What are the main urological causes of pelvic pain?

A

IC

21
Q

What are the main MSK/neurological causes of pelvic pain

A

Abdominal wall myofascial pain (trigger points)
Pelvic floor myalgia/elevator ani spasm

22
Q

What are the main gynecological causes of pelvic pain?

A

Adhesions
Adendomyosis
Endometriosis

23
Q

Red flag sx in pelvic pain

A

Unexplained wt loss
Hematochezia
Perimenopausal irregular bleeding
Post menopausal vaginal bleeding
Post coital bleeding

24
Q

What is an important consideration when prescribing anti-inflammatory pain meds for dysmenorrhea?

A

Clothing/DRESS syndrome ?

25
Q

What are the three most common conventional therapies for dysmenorrhea?

A

NSAIDs
Hormonal contraceptives
Mirena IUD

26
Q

How does estrogen dominance increase pain in endometriosis?

A

Inc estrogen > inc BDNF > inc hyperplasia

27
Q

What three body system disorders does endometriosis act like?

A

Autoimmune - immune defects unable to clear tissue when implanted, higher immune cells
Cancer - mesothelium invaginates and undergoes metaplasia into endometrial tissue
Endocrine - endometriosis glandular elements secrete paracrine substance that causes inflamatory response in surrounding tissue

28
Q

What are the most common sites for endometriosis to implant?

A

Cul de sac
Left broad ligament
Left utero-sacral ligament

29
Q

What are the most common sx of endometriosis?

A

Dysmenorrhea
Non menstrual pelvic pain
Deep dyspareunia/dyschezia
Lateral pelvic pain
Bladder pain, frequency, dysuria
Irregular vaginal bleeding
IBS
Infertility

30
Q

How is endometriosis definitively diagnosed?

A

Histologically on laparoscopy or laparotomy finding extrauterine endometrial cells

31
Q

What are the goals in managing endometriosis?

A

Relieve sx
Prevent complications of annexation masses
Exclude malignancy
Improve subfertility
Preserve ovarian function

32
Q

What are the standard conventional treatments for endometriosis?

A

Combined contraceptives
Progestins
Mirena IUD
GnRH analogs, agonists, antagonists
Androgen agents
Aromatase inhibitors
NSAIDs
Surgery

33
Q

What are the ways progestins treat endometriosis?

A

Anti-angiogenic
Immunomodulatory
Anti-inflammatory
Inhibits implantation and growth of refluxed menstrual endometrium
Suppresses menses, dec pain

34
Q

What is an example of an endocrine disruptor that contributes to endometriosis? How so? How would a woman be exposed?

A

PCBs - mimic estrogens, interfere with hormone processes

Found in meat, fish, eggs, milk

35
Q

What are the main symptoms related to adenomyosis?

A

Dysmenorrhea
Menorrhagia
Large clots

36
Q

Describe the classic presentation for pelvic congestion syndrome

A

Multiparous woman with chronic dull pelvic pain, typically with postcoital ache that may last for days

Fullness in legs, bladder irritability

Sx better lying, worse inc intraabdominal pressure

37
Q

What is thought to be the most likely underlying etiology for PMS/PMDD?

A

CNS NTs interacting with sex hormones, causing abnormal response to normal hormonal changes

38
Q

What is the only proven RF for PMS/PMDD? What are others?

A

Ovulatory cycles

Age
Stress
Genetics (ESR1)
Obesity
Smoking
Overall health
Depression and anxiety

39
Q

PMS dx criterai

A

1+ sx that causes interference; occurs 5 days before onset, remit within 4 days of menses onset, don’t recur til day 13. present 3 consecutive cycles

Still present in absence of rx, hormones, drugs, alcohol

1-4 sx of any nature
5+ sx behavioral

40
Q

PMDD dx criteria

A

5+ sx; occurs 5 days before onset, remit within 4 days of menses onset, don’t recur til day 13. present 3 consecutive cycles

Still present in absence of rx, hormones, drugs, alcohol

Have to have at least one affective/psych sx

Repro (7 decks)

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