Women's Health Flashcards
(182 cards)
1
Q
absence of menstrual period
A
amenorrhea
2
Q
light flow or spotting
A
cryptomenorrhea
3
Q
heavy or prolonged bleeding @ normal menstrual intervals
A
menorrhagia
4
Q
irregular bleeding between expected menstrual cycles
A
metrorrhagia
5
Q
irregular excessive bleeding between expected menstrual cycles
A
menometrorrhagia
6
Q
infrequent menstruation (prolonged cycle >35 days BUT less than 6 months)
A
oligomenorrhea
7
Q
frequent cycle interval (<21 days)
A
polymenorrhagia
8
Q
two types of dysfunctional uterine bleeding (DUB) and which one is more prevalent
A
1) chronic anovulation (90%)
2) ovulatory
9
Q
what age group is chronic anovulation seen in
A
extremes of ages (early teens or periomenopausal)
10
Q
what is chronic anovulation due to
A
disruption of the hypothalamus-pituitary axis
11
Q
s/sxs of chronic anovulation
A
*IRREGULAR, unpredictable shedding (due to the unopposed estrogen because there is no progesterone to ovulate)
12
Q
what is ovulatory DUB and what are the s/sxs
do you bleed?
do you ovulate?
what hormones play a part in the s/sxs?
A
- *regular CYCLICAL bleeding
- ovulation
- prolonged progesterone (due to decreased estrogen levels) –> increased blood loss from endometrial vessel dilation & prostaglandins –> MENORRHAGIA
13
Q
how do you dx DUB
A
dx of exclusion:
- must exclude organic causes (reproductive, systemic,
iatrogenic causes)
- if workup shows NO evidence of organic causes & -
pelvic exam –> DUB is dx
14
Q
what is the workup for DUB
A
-hormone levels
-transvaginal US
-endometrial bx if endometrial stripe >4mm on
transvaginal or in women >35 y/o
- to r/o endometrial hyperplasia or carcinoma
15
Q
tx for acute severe bleeding from dysfunctional uterine bleeding (DUB)
A
- high dose estrogens OR
- high dose OCPs
- reduce dose as bleeding improves
- dilation & curettage if IV estrogen fails
16
Q
1st line for anovulatory dysfunctional uterine bleeding (DUB)
- what do you use if estrogen is contraindicated
- what another drug class that you can use to temporarily cause amenorrhea
A
-OCPs
- regulates the cycle, thins the endometrial lining &
reduces menstrual flow
- Use Progesterone: if estrogen is contraindicated
- e.g. medroxyprogesterone
-can use a GnRH agonist: Leuprolide (if given
continuously)
17
Q
tx for ovulatory dysfunctional uterine bleeding (DUB)
A
- OCPs
-Progesterone (oral or IUD)–(e.g. Mirena reduces
bleeding in 79-94%)
-GnRH agonist: Leuprolide with add-back progesterone
(to reduce SE of Leurprolide)
18
Q
what is the last resort for dysfunctional uterine bleeding (DUB) is pharmacological medication does not work
A
Surgery:
- Hysterectomy: definitive management
-Endometrial ablation: endometrial destruction in pts
who dont want a hysterectomy
19
Q
what is dysmenorrhea
A
painful menstruation that affects normal activities
20
Q
primary vs secondary dysmenorrhea
A
primary:
- NOT due to pelvic pathology
- due to INCREASED PROSTAGLANDINS –> painful
uterine muscle wall activity
-Pain usually starts 1-2 yrs after menarche
secondary:
-due to PELVIC PATHOLOGY
- e.g. endometriosis, adenomyosis, leiomyomas,
adhesions, PID
- increased as women age (>25 y/o)
21
Q
clinical manifestations of dysmenorrhea
A
-**diffuse pelvic pain right BEFORE or with the ONSET of
menses
- cramps last 1-3 days
- may be associated w/ HA, N/V
- +/- lower abdomen, suprapubic, or pelvic pain that may
radiate to the lower back & legs
22
Q
what are PE findings of dysmenorrhea
A
- can be normal
-may have uterine tenderness but the findings are based
on the cause
23
Q
1st line tx for dysmenorrhea
MOA
other tx
procedure if medical tx fails
A
- NSAIDs = 1st line
-MOA: inhibits prostaglandin-mediated uterine activity
(best to start before s/sxs onset and given for 2-3
days)
-Others:
- Supportive: local heat, Vit E started 2 days prior to &
for 3 days into menstruation
-Ovulatory suppression: OCP*/ depo provera/vaginal
ring significantly reduces symptoms
- Laparoscopy: if medication fails (done to r/o
secondary causes e.g. endometriosis or PID
- Endometriosis if MC secondary cause in
younger pts!!!!
- *Adenomyosis with increasing age
24
Q
how is premenstrual syndrome characterized
A
cluster of physical, behavioral, & mood changes with CYCLICAL occurence during the LUTEAL phase
25
definition of PMDD
severe PMS with functional impairment
26
clinical manifestations of PMS
physical
emotional
behavioral
Physical:
- bloating, breast swelling/pain, HA, bowel habit
changes, fatigue, muscle/joint paint
Emotional:
- depression, hostility, irritability, libido changes,
aggressiveness
Behavioral:
- food cravings, poor concentration, noise sensitivity, loss of motor sense
27
dx of PMS
-Symptoms INITIATE during the LUTEAL phase (1-2 wks before menses) and is RELIEVED within 2-3 days of the ONSET OF MENSES + at least 7 symptoms free days during the follicular phase
28
management for PMS:
lifestyle modifications
medications
Lifestyle modifications:
-stress reduction, exercise, caffeine & Na restriction,
NSAIDs, Vit B6 & E
Mediations:
-SSRIs*: for emotional symptoms
-OCPs*: induces anovulation.
*PMDD: Drosperinone-containing OCPs
-GnRH: continuous dosing w/estrogen add back if no
response to SSRI or OCP
-Bloating: Spironolactone (androgen inhibitor taken
during the luteal phase to relieve breast
tenderness and bloating)
-Refractory Breast Pain that does not resolve w/
above:
-Danazol, Bromocriptine
29
what is the workup for amenorrhea
```
HCG
serum prolactin
FSH
LH
TSH
```
30
primary vs secondary amenorrhea
Primary:
- failure of menarche onset by age 15 (in the presence
of 2ndary sex characteristics OR
- 13 in the absence of 2dary sex characteristics
Secondary:
-absence of menses for >3 months in a pt w/
previously normal menstruation OR >6 mos in a pt
who was previously oligomenorrheic
31
etiologies of primary amenorrhea:
with the uterus present (breast present/breast absent)
Breast Present:
-outflow obstruction: transvaginal septum, imperforate
hymen
Breast Absent:
- ELEVATED FSH & LH = ovarian causes
- E.g. Premature ovarian failure (46XX)
- Gonadal Dysgenesis (Turner's 45 XO)
- Normal/Low FSH & LH
- Hypothalamus-Pituitary Failure
- Puberty Delay (ex. athletes, illness, anorexia)
32
etiologies of primary amenorrhea:
withOUT the uterus present (breast present/breast absent)
Breast Present:
- Mullerian agenesis (46 XX)
- Androgen Insensitivity (46 XY)
Breast Absent (RARE)
-Usually caused by a defect in testosterone
synthesis.
-Presents like a phenotypic immature girl with
primary amenorrhea (**will often have
intrabdominal testes)
33
Etiologies of secondary amenorrhea
Hypothalamus dysfunction
Pituitary dysfunction
Ovarian Disorders
Uterine disorder
34
Etiologies of secondary amenorrhea: MC etiology and 2nd MC
Ovarian (40%)
Hypothalamus dysfunction (35%)
35
Etiologies of secondary amenorrhea:
explain hypothalamic dysfunction: MOA
- MOA: Disruption of normal pulsatile hypothalamic secretion of GnRH that directly lead to subsequent decrease in FSH and/or LH
36
Etiologies of secondary amenorrhea:
explain hypothalamic dysfunction: etiologies
Hypothalamic disorders
anorexia (or wt loss >10 ideal body weight), exercise, stress/nutritional deficiencies
systemic disease (e.g Celiac)
37
Etiologies of secondary amenorrhea:
explain hypothalamic dysfunction: Dx (labs)
Normal/decreased FSH & LH
LOW estradiol
*NORMAL PROLACTIN
38
Etiologies of secondary amenorrhea:
explain hypothalamic dysfunction: Tx
Stimulate gonadotropin secretion:
Clomiphene
Menotropin (Pergonal)
39
Etiologies of secondary amenorrhea:
Explain Pituitary Dysfunction: examples
Prolactin secreting pituitary adenoma
40
Etiologies of secondary amenorrhea:
Explain Pituitary Dysfunction: Dx labs
DECREASED FSH/LH
***INCREASED prolactin (**galactorrhea)
41
what diagnostic study should you do if you suspect pituitary dysfunction (as an etiology of 2ndary emnorrhea)
MRI of pituitary sella turcica
42
Etiologies of secondary amenorrhea:
Explain Pituitary Dysfunction: tx
surgery for tumor removal
43
how does prolactin affect GnRH
prolactin INHIBITS GnRH
44
Etiologies of secondary amenorrhea:
Explain ovarian disorders: examples
PCOS
Premature ovarian Failure: follicular failure or follicular resistance to LH/FSH
Turner's Syndrome
45
Etiologies of secondary amenorrhea:
Explain ovarian disorders: clinical manifestations
- symptoms of estrogen deficiency: "like menopause"
- hot flashes, sleep & mood disturbances,
dyspareunia, dry/thin skin, vaginal dryness/atrophy
46
Etiologies of secondary amenorrhea:
Explain ovarian disorders: Dx (labs)
INCREASED FSH/LH
| DECREASED estradiol --> ovarian abnormalities
47
Etiologies of secondary amenorrhea:
Explain ovarian disorders: what test should you order to see if it an ovarian etiology or hypoestrogenic or uterine etiology
Progesterone Challenge Test:
+ withdrawal bleeding = ovarain etiology
- withdrawal bleeding = hypoestrogenic or uterine etiology
48
Etiologies of secondary amenorrhea:
Explain Uterine disorder: what is it
scarring of the uterine cavity
49
what is Asherman's Syndrome
acquired endometrial scarring 2dry to postpartum hemorrhage
50
Etiologies of secondary amenorrhea:
Explain Uterine disorder: Dx
Pelvic US (absence of normal uterine stripe)
Hysteroscopy to dx & treat
51
Etiologies of secondary amenorrhea:
Explain Uterine disorder: management
Estrogen treatment to stimulate endometrial regeneration of the denuded area
52
definition of menopause
cessation of menses >1 yr due to LOSS OF OVARIAN function
53
average age of menopause in the US
51.5
54
what is premature menopause
menopause before age 40
55
who is at higher risk for premature menopause
DM
Smokers
Vegetarians
Malnourished patients
56
clinical manifestations of menopause
Estrogen Deficiency Changes:
- menstrual cycle alterations
- vasomotor instability (including HOT FLASHES)
- mood changes
- skin/nail/hair changes
- increased cardiovascular events
- hyperlipidemia
- osteoporosis
- dyspareunia
- urinary incontinence
57
characteristics of atrophic vaginitis
thin, yellow discharge
pruritus
vaginal pH >5.5
58
PE for menopause
- decreased bone sensitivity
- skin: think/dry/decreased elasticity
- vaginal: atrophy thin mucosa
59
Dx of menopause (labs)
FSH assay = most sensitive initial test (increased FSH
>30 IU/mL)
INCREASED serum FSH, LH
DECREASED estrogen (due to depletion of ovarian follicles)
(androstenedione levels do NOT change)
predominant estrogen - estrone after menopause
60
what is the most sensitive initial test for menopause
FSH assay = most sensitive initial test (increased FSH
| >30 IU/mL)
61
complications of menopause
Loss of estrogen:
- increased osteoporosis
- increased lipids
- increased cardiovascular risk
62
Menopause: vasomotor insufficiency tx
```
estrogen*
progesterone*
Clonidine
SSRIs
Gabapentin
```
63
Menopause: vaginal atrophy tx
estrogen (transdermal, intravgainal)
64
Menopause: osteoperosis prevention tx
Ca+ Vit D, weight bearing exercises
**bisphosphanates
calcitonin
**SERM (Raloxifen, Tamoxifen)
estrogen (w/w/o progesterone)
65
Menopause:
| Risks/Benefits of ESTROGEN only HRT
Benefits:
- *MOST effective for symptomatic tx
- NO increased risk of breast cancer
Risk:
- INCREASED risk of endometrial cancer (due to
unopposed estrogen)
- often only used in pts with NO uterus
-Increased thromboembolism
-Increased liver disease
66
Menopause:
Risk/Benefits of estrogen + progesterone
Benefits:
- symptomatic relief
- decreased heart & stroke risk
- decreased osteoporosis & dementia
- ****PROTECTIVE against endometrial cancer
- usually used with a women w/ intact uterus
Risk:
- venous thromboembolism
- controversial : higher risk of breast cancer
67
Leiomyoma aka...
uterine fibroid
68
MC benign gynecological lesion
uterine fibroid (Leiomyoma)
69
what type of tumor is a Leiomyoma (uterine fibroid)
benign uterus SM tumor
70
what hormone is a Leiomyoma's growth associated with
estrogen
therefore it regresses after menopause***
71
Leiomyoma (uterine fibroid) are MC in (age group)
30s
72
Leiomyoma (uterine fibroid) are MC in (ethnicity)
AA
73
types of Leiomyoma (uterine fibroid)
intramural
submucosal
subserosal
parasitic
74
MC clinical manifestations of Leiomyoma (uterine fibroid)
and others
bleeding = MC (menorrhagia)
- most are asymptomatic, dysmenorrhea
- abdominal pressure/pain related to size & location
- bladder: frequency & urgency
75
what would you see on PE during an abdominal or pelvic US during bimanual of a Leiomyoma (uterine fibroid)
- Abdominal or pelvic US during bimanual:
| - **large, irregular, hard palpable mass
76
dx for Leiomyoma (uterine fibroid)
pelvic US
77
management of Leiomyoma (uterine fibroid) for the majority
majority do not need tx
78
most effective* management of Leiomyoma (uterine fibroid): medical tx
others
Goal: inhibition of estrogen (to decrease endometrial
growth)
Most effective: GnRH Agonist: Leuprolide (shrinks the
uterus)
Others:
-Progestins: causes endometrial atrophy
79
3 types of management for Leiomyoma (uterine fibroid)
1) observation
2) medical
3) surgical
80
definitive tx for Leiomyoma (uterine fibroid)
hysterectomy
81
MC cause of hysterectomy
fibroids
82
surgery for Leiomyoma (uterine fibroid) if fertility is desired
myomectomy
83
what is adenomyosis
islands of endometrial tissue within the myometrium
84
clinical manifestations of adenomyosis
**mennorhagia (progressively worsens)
**dysmenorrhea
+/- infertility
85
PE findings for adenomyosis
**SYMMETRICALLY TENDER
**enlarged boggy uterus
86
how is adenomyosis dx
dx of exclusion
87
management of adenomyosis
ONLY effective therapy:
hysterectomy
88
leiomyoma vs adenomyosis
Leiomyoma:
-asymmetric pain, firm, nontender
Adenomyosis:
-symmetric, soft, tender
89
what is endometritis
infection of the uterine endometrium
90
what is chorioamnionitis
fetal membrane infection
91
T/F: endometritis is usually polymicrobial
True
92
RF for endometritis
* *postpartum or postabortal infection
* *C-SECTION = biggest RF!**
- prolong ROM >24 hrs
- vaginal delivery
- dilation/curettage
93
what is the biggest RF for endometritis
c-section
94
S/sxs & PE findings of endometritis
* fever
* tachycardia
* abdominal pain & uterine tenderness after c-section/postabortal
- may have fould smelling lochia/bleeding/vaginal discharge
95
tx for endometritis post c-section
Clindamycin + Gentamicin
may add ampicillin for additional group B step coverage
Bactrim is an alternative
96
tx for endometritis post vaginal delivery or chorioamnionitis
Ampicillin + Gentamicin
97
prophylaxis during C section to reduce endometritis
1st gen cephalosporin x 1 dose
98
what is endometriosis
presence of endometrial tissue (stroma & gland) outside the endometrial cavity
*the ectopic endometrial tissue responds to *cyclical hormonal changes
99
MC site for endometriosis
ovaries
100
sites of endometriosis
```
*ovaries
posterior cul de sac
broad & uterosacral ligaments
rectosigmoid colon
bladder
```
101
RF for endometriosis
* nulliparity
- FH
- early menarche
102
when is the usual onset of endometriosis
usually <35 y/o
103
classic triad of endometriosis
1) cyclic premenstrual pelvic pain
2) dysmenorrhea
3) dyspareunia
also dyschezia
104
does endometriosis cause infertility
Yes, >25% of all causes of female infertility
105
PE of endometriosis
usually normal, +/- fixed adenexal masses
106
definitive dx of endometriosis and what will you see
laparoscopy with bx
raised, patches of thickened, discolored scarred or "powder burn" appearing implants of tissue
107
what is an endometrioma and what is it associated with
it is endometriosis involving the ovaries large enough to be considered a tumor, usually fill with old blood appearing "chocolate colored"
***chocolate cyst
108
medical management of endometriosis
-for premenstrual pain: *OCPs & NSAIDs
-progesterone: suppresses GnRH --> causes endometrial
tissue atrophy
-Lueprolide: GnRH analog causes pituitary FSH/LH
suppression
-Danazol: testosterone (supresses FHS/LH surge)
109
surgical tx for endometriosis
- conservative laparoscopy with ablation (if fertility is desired)
- total abdominal hysterectomy with salpingo-oophorectomy (TAH-BSO)
110
what is endometrial hyperplasia
endometrial gland proliferation
111
what is endometrial hyperplasia a precursor to
endometrial carcinoma
112
why does endometrial hyperplasia occur
due to continuous unopposed estrogen* by progesterone
113
causes of endometrial hyperplasia
*chronic anovulation
| PCOS, perimenopuase, obesity
114
how does obesity cause endometrial hperplasia
conversion of androgen --> estrogen in adipose tissue
115
what population is endometrial hyperplasia most common in
postmenopausal women
116
clinical manifestations of endometrial hyperplasia
***bleeding: menorrhagia, metrorrhagia, postmenopausal bleeding, +/- discharge
117
how to dx endometrial hyperplasia (and what will you see)
1) Transvaginal US (stripe >4mm)
| 2) Endometrial Bx (definitive dx)
118
definitive dx for endometrial hyperplasia
endometrial bx
119
tx for endometrial hyperplasia: withOUT atypia
* *Progestin (PO or IUD-Mirena)
| - repeat endometrial bx within 3-6 mos
120
tx of endometrial hyperplasia: with atypia
**Hysterectomy
-progestin if fertility if wishes or if they are not a surgical candidate
121
what is the MC gynecological malignancy in the US
endometrial cancer
122
what age group is most at risk for endometrial cancer
postmenopausal (50-60 y/o peak)
123
what type of hormone is endometrial cancer dependent
estrogen
124
what is a major risk factor for endometrial cancer
endometrial hyperplasia
125
RF of endometrial cancer (increased estrogen)
- nulliparity
- chronic anovulation
- PCOS
- obestiy
- *estrogen replacement therapy
- late menopause
- htn
- Tamoxifen
- DM
126
T/F: combination pills are protective against both ovarian & endometrial cancers
TRUE
127
clinical manifestations of endometrial cancer
*****ABNORMAL UTERINE BLEEDING (postmenopausal bleeding)
128
Diagnosis of endometrial cancer
1) Endometrial biopsy (MC = adenocarcinoma**)
| 2) US - usually endometrial stripe > 4mm***
129
MC type of endometrial cancer on bx
adenocarcinoma (>80%)
130
management of endometrial cancer
stage 1
stage 2,3
stage 4
Stage 1
- hysterectomy +/- post op radiation
Stage 2/3
-TAH-BSO + lymph node excision +/-post op radiation
Stage 4
-systemic chemotherapy
131
1st thing to think of in a postmenopausal woman with abnormal bleeding
endometrial cancer (10% of abnormal bleeding cause)
132
T/F: MOST postmenopausal bleeding is benign
True!
133
Any postmenopausal bleeding in a woman NOT on HRT should raise suspicion for...
endometrial cancer
hyperplasia
leiomyoma
134
what dx study can you use for postmenopausal bleeding and what is an indication for bx
Transvaginal US
stripe >4mm --> bx
stripe <4mm, repeat US in 4 months
135
what diagnostic test do you use if you see focal thickening of endometrium in a postmenopausal woman
hysteroscopy
136
after what does pelvic prolapse MC occur
childbirth
137
RF for pelvic prolapse
multiple vaginal births
obesity
repeated heavy lifting
childbirth
138
posterior bladder herniating int the anterior vagina
cystocele
139
pouch of Douglas (small bowel) into the upper vagina
enterocele
140
distal sigmoid colon herniates into the posterior distal vagina
rectocele
141
clinical manifestations of pelvic organ prolapse
- pelvic or vaginal fullness/heaviness "falling out" sensation
- lower back pain (esp. w/ prolonged standing)
- vaginal bleeding, purulent discharge
- urinary frequency, urgency, stress incontinence
142
PE of pelvic organ prolapse
bulging mass esp. w/ intrabdominal pressure
143
tx for pelvic oran prolapse
-kegels
-pessaries
-surgical (hysterectomy, uterosacral or sacrospinous
ligament fixation)
144
what are functional ovarian cysts (3 types)
Follicular
Corpus luteal
Theca Lutein
Follicular cysts: occur when follicles fail to rupture & continue to grow
Corpus luteal: cysts fail to degenerate after ovulation
Theca Lutein: excess BhCG causes hyperplasia of theca interna cells
145
Clinical manifestations of functional ovarian cysts
MOST are asymptomatic!!!
Unilateral RLQ or LLQ pain if the cyst ruptures, undergo torsion, or become hemorrhagic
146
PE for functional ovarian cysts
- unilateral pelvic pain/tenderness
| - may have a mobile palpable cystic adnexal mass
147
Dx of funtional ovarian cyst
-Pelvic US
-Follicular: smooth, think walled uniocular
-Luteal: complex, thicker walled w/ peripheral
vascularity
-Order beta HCG to r/o pregnancy
148
Management of functional ovarian cysts
- supportive!!
- most cysts <8cm are functional & usually resolve spontaneously
- Repeat US in 6 wks
- If cysts >8cm or persistent/found postmenopausal --> +/-laparoscopy or laparotomy
149
what is the 2nd MC gynecological cancer
ovarian cancer
150
what gynecological cancer has the highest mortality of all
ovarian cancer
151
RF for ovarian cancer
***FH
***increased # of ovulatory cycles (infertility, nulliparity,
>50, late menopause)
***BRCA1/2
- Peutz Jehgers
-Turner's syndrome
152
protective factors of ovarian cancer
OCPs**
high parity
TAH
153
clinical manifestations of ovarian cancer
**rarely symptomatic until late disease course
- abdominal fullness/distension
- Back/abdominal pain, early satiety, urinary frequency
- Irregular menses, menorrhagia, postmenopausal bleeding, constipation, intestinal compression
154
what decades does ovarian cancer usually present in
40-60 y/o
155
PE for ovarian cancer
- Palpable abdominal or ovarian mass (*solid, fixed, irregular)
- ***SIster Mary Joseph's nodes: mets to umbilical LN
- possibly ascites
156
dx for ovarian cancer
what will you see on bx
90%= EPITHELIAL (esp. in postmenopausal)
Germ cell <30 y/o
157
management of ovarian cancer
Early
Surgery
Chemo
Early:
-TAH-BSO + selective lympahdenectomy
Surgery:
- tumor debunking
-***serum CA125 levels used to monitor treatment
progress
Chemotherapy:
-Paclitaxel (Taxol) + Cisplatin or Carboplatin
158
how do you monitor tx for ovarian cancer (surgery)
serum CA125 levels
159
what is the MC benign ovarian neoplasm
dermoid cyst teratomas
160
management of benign ovarian neoplasm
removal (due to increased risk of potential torsion or malignant transformation)
161
in reproductive years, ___% of ovarian neoplasms are benign. Risk of malignancy ___ with age
90%
increases
162
triad of PCOS
1) amenorrhea
2) Obesity
3) Hirsutism
163
PCOS is due to...
insulin resistance
164
___% of the population has PCOS
10%
165
clinical manifestations of PCOS
1) menstrual irregularity (2ry amenorrhea/oligomenorrhea)
2) Increased androgen (hirsutism)
3) Insulin resistance (Type II DM, *OBESTIY-80%, Htn)
166
what is the pathology os PCOS?
increased insulin & LH--> ?
increased ovarian androgen production
167
PE for PCOS
- *bilateral enlarged, smooth, mobile ovaries
| - *acanthosis nigrans
168
dx of PCOS
- labs
- imaging
-exclude other disorders
-Labs:
-increased testosterone****
-LH:FSH ratio >3:1*******
-GnRH agonist stimulation test: rise is serum
hydroxyprogesterone
-Pelvis US
**** "string of pearls" appearance
- bilateral enlarged ovaries with peripheral cysts
169
mainstay of PCOS tx
combination OCPs
170
what type of OCP do you want to avoid in PCOS
androgenic progesterone (norgestrel or levonorgestrel)
171
antiandrogen agents for hirsutism for PCOS
**spironolactone
172
T/F: Spironolactone is teratogenic
TRUE! must be used w/ OCPs
173
tx for inferitliy for PCOS
clomiphene
| selective estrogen receptor modulator
174
complications of PCOS (due to chronic anovulation)
- increased risk of infertility
-**increased risk of endometrial hyperplasia & carcinoma
(due to unopposed estrogen)
- insulin resistance --> increased risk of atherosclerosis &
htn
175
____ decreases amplitude of GnRH
Estradiol
176
___ decreases frequency of GnRH
progesterone
177
what level does progesterone have to be to ovulate
>3
178
neuropeptides that stimulate GnRH
NE
galanin
NYP
179
neuropeptides that inhibit GnRH
GABA
dopamine
B-endorphins
corticotrophin releasing hormone
180
what induces the FSH surge
low levels of progesterone
181
FSH targets ____cells
granulosa cells
182
LH targets ___ cells
thecal & stromal cells
