Women's Health

Question 1

Layers of uterus

Answer 1

• Peritoneum
• Myometrium
• Endometrium

Question 2

Where does embryo implantation occur?

Answer 2

Endometrium

Question 3

Oocytes travel to the uterus via ________

Answer 3

Fallopian tubes

Question 4

Where does fertilization occur?

Answer 4

Distal end of Fallopian tubes (adjacent to ampulla)

Question 5

____-day cycle from primordial follicle to dominant/Graafian follicle

Answer 5

120

Question 6

Normal menarche occurs at age _____

Answer 6

8-15

Question 7

Normal cycle length is ___ days

Answer 7

21-35

Question 8

Polymenorrhea is….

Answer 8

<21 day cycle

Question 9

Oligomenorrhea is….

Answer 9

> 35-day cycle

Question 10

Metrorrhagia is…

Answer 10

Bleeding at irregular intervals

Question 11

Normal menses lasts ____ days.

Answer 11

1-8

Question 12

Menses is abnormal in length if it lasts…..

Answer 12

> 8 days

Question 13

Menorrhagia is….

Answer 13

Abnormally heavy bleeding at REGULAR intervals

Question 14

Menometrorrhagia is….

Answer 14

Abnormally heavy bleeding at IRREGULAR intervals

Question 15

Term for ovulation/mid-cycle pain

Answer 15

Mittelschmerz

Question 16

Give a brief overview of the menstrual cycle

Answer 16

Low estradiol (menstruation) → GnRH from hypothalamus → LH & FSH from ant. pituitary → follicular growth → elevated estradiol mid-cycle → LH surge → ovulation → corpus luteum forms and turns into corpus albicans and progesterone rises → estrogen & progesterone levels fall

Question 17

Ovarian cycle consists of what stages?

Answer 17

Follicular phase → Ovulation → Luteal Phase (always 14 days)

Question 18

Oocytes are surrounded by ______ cells and ______ cells

Answer 18

granulosa & theca

Question 19

What do theca cells do?

Answer 19

Contain LH receptors → produce androgens

Question 20

What do granulosa cells do?

Answer 20

Contain FSH receptors → produce estrogen & convert androgens to estrogens

Question 21

Corpus luteum produces _____

Answer 21

progesterone

Question 22

What are the phases of the uterine cycle?

Answer 22

Proliferative phase → Secretory phase → Menses

Question 23

Criteria for diagnosing primary amenorrhea

Answer 23

Never had period by age 15 but has normal secondary sex characteristics

Question 24

Criteria for diagnosing secondary amenorrhea

Answer 24

Pt has normally regular cycles but stops having menses for >3 cycles OR has normally irregular cycles but stops having menses for >6 cycles

Question 25

Most common cause of secondary amenorrhea is….

Answer 25

Pregnancy!

Question 26

Labs for diagnosing amenorrhea

Answer 26

HcG (r/o pregnancy first!)
FSH
TSH
PRL
\+/- testosterone (acne, hirsutism, PCOS)

Question 27

Treatment for amenorrhea

Answer 27

• Correct underlying pathology
• Help achieve fertility if needed
• Psychological counseling
  +/- Surgery

Question 28

Dysmenorrhea is….

Answer 28

Recurrent crampy lower abdominal pain during menstruation without pelvic pathology

Question 29

What causes dysmenorrhea?

Answer 29

Excess production of endometrial prostaglandin → incr. intrauterine contraction → ischemia, pain

Question 30

Tx for dysmenorrhea

Answer 30

• NSAIDs (take w/ food) - ibuprofen or naproxen preferred, mefenamic acid alt.
• Hormones (suppress ovulation)

Question 31

Criteria for diagnosing PMS

Answer 31

• Occur repetitively in 2nd half of menstrual cycle
• Resolve after menses starts
• Interferes with some aspects of life
• Must occur in at least 3 consecutive cycles

Question 32

What sx’s occur with PMS?

Answer 32

Physical, emotional, behavioral, cognitive sx’s

Physical sx’s incl. breast tenderness, bloating, constipation, H/A, fatigue, hot flashes

Question 33

Important to assess _____ in PMS pts

Answer 33

Impact on quality of life and suicide risk

Question 34

Tx for PMS

Answer 34

• Mild → exercise, stress reduction techniques
• Moderate-severe:
  SSRIs (preferred)
  OCPs +/- low-dose alprazolam
  GnRH agonist w/ low-dose estrogen-progestin replacement
  Surgery

Question 35

What is PMDD?

Answer 35

Premenstrual dysphoric disorder - severe form of PMS

Question 36

What is dysfunctional uterine bleeding? When does it usually occur?

Answer 36

• Abnormal bleeding unrelated to anatomical lesions, pelvic pathology, pregnancy, other dz
• Commonly occurs right after menarche and during perimenopause