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Endocrine Module > Women's Health Issues During Reproductive Years > Flashcards

Women's Health Issues During Reproductive Years Flashcards

1
Q

Amenorrhea Definition

A

No Menstrual Bleeding in a 90 day period

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2
Q

Primary Amenorrhea

A

Absence of menses by age 15 years in females who have never menstruated

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3
Q

Secondary Amenorrhea

A

Absence of menses for 3 cycles or for 6 months in a previously menstruating individual

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4
Q

What are 3 categories of etiology for amenorrhea?

A

Anatomical Causes
Endocrine Disturbances
Ovarian Insufficiency/Failure

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5
Q

What is the normal sequence of hormones that does not occur without ovulation?

A
  1. Estrogen production
  2. Progesterone production
  3. Estrogen/Progesterone Withdrawal
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6
Q

What are the signs of Amenorrhea?

A
  1. Cessation of menses >6 months for those with established menstruation
  2. Absence of menses by age 16 in normal secondary sexual develop
  3. Absence of menses by age 14 in the absence of normal secondary sexual development
  4. Recent significant weight loss or gain
  5. Presence of acne, hirsutism, hair loss, or acanthuses nigricans
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7
Q

What are the symptoms of Amenorrhea?

A
  1. Cessation of menses
  2. Infertility, vaginal dryness, or decreased libido
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8
Q

What are the treatment goals for Amenorrhea?

A
  1. Bone density preservation
  2. Bone loss prevention
  3. Restoration of ovulation to improve fertility
  4. Correct of premature ovarian failure
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9
Q

What is the definition of heavy menstrual bleeding (menorrhagia)?

A

Heavy menstrual blood loss (>80 mL per cycle) or prolonged menstrual bleeding >7 days

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10
Q

What are the treatment options for menorrhagia?

A

NSAIDs, Hormal Contraception, Medroxyprogesterone, and Tranexamic Acid

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11
Q

What is the place of therapy for NSAIDs in menorrhagia?

A

20-50% reduction in blood loss, 1st LINE

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12
Q

What is the place of therapy for Hormonal Contraception in menorrhagia?

A

30-60% for oral
79-97% fr IUD
1st LINE

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13
Q

What is the place of therapy for Medroxyprogesterone in menorrhagia?

A

32-50% reduction
AVOID

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14
Q

What is the place of therapy for Tranexamic Acid in menorrhagia?

A

34-56% reduction
Antifibrinolytic effect, Not as effective

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15
Q

What is Premenstrual Syndrome PMS?

A

Results from the interaction of cyclic changes in ovarian steroids and central neurotransmitters

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16
Q

What is diagnostic criteria for Premenstrual Dysphoric Disorder PMDD?

A

At least 5 symptoms are present for most of the time during the late luteal phase, with at least 1 system that is severe

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17
Q

What are the severe symptoms?

A

Affective lability, irritability, tension/anxiety, and depressed mood

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18
Q

What is diagnostic criteria for PMS?

A

Must have at least 1 physical and 1 behavioral symptom that is self-reported to have occurred in each of 3 prior menstrual cycles

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19
Q

What are the nonpharmacologic therapies for mild/moderate PMS?

A

Dietary modifications and regular exercise

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20
Q

Antidepressants for PMS/PMDD

A

Fluoxetine
Paroxetine
Sertaline

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21
Q

What is the efficacy of antidepressants?

A

60-90%

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22
Q

When do antidepressants become effective and what is its place in therapy for PMS/PMDD?

A

Within first treatment cycle
FIRST LINE

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23
Q

What antidepressants are considered Second Line (when SSRIs are not tolerated or CI)?

A

SNRIs: Clompiramine, Duloxetine, Nefazodone, and Venlafaxine

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24
Q

Benzodiazepines for PMS/PMDD

A

Alprazolam

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25
Q

When is alprazolam utilized for PMS/PMDD?

A

Most useful for treatment of acute anxiety and intermittent insomnia, short term use only

26
Q

5HT1A Agonist for PMS/PMDD

A

Buspirone

27
Q

What is the place of therapy for 5HT1A?

A

May be tried in patients with anxiety if drug dependence is a concern, to avoid benzos

28
Q

What are nonprescription therapies for PMS/PMDD?

A

Calcium
NSAIDs
Pamprin

29
Q

When should calcium be recommended for PMS/PMDD?

A

Should be recommended for all women with symptoms of PMS because of potential benefits if it is well-tolerated, benefits for osteoporosis prevention

30
Q

What Ovulation Suppression is commonly prescribed for PMS and PMDD symptoms?

A

CHC: combination hormone
Those containing drospirenone Yah or Tasmin more beneficial

31
Q

What are 2 different therapies for PMDD that should not be used in PMS?

A

GnRH Agonist and Surgery

32
Q

What is the GnRH Agonist utilized in PMDD?

A

Leuprolide (Lupron Depot) IM

33
Q

What is the action of Leuprolide?

A

A medical oophorectomy, reserved for those with severe PMDD who do not respond to more conservative measured due to adverse effects

34
Q

What entails a surgical therapy for PMD??

A

Surgical ablation of the ovaries

35
Q

What is the dosing of Ibuprofen for Dysmenorrhea?

A

400 mg Q4-6 hrs for 3 days each month, max dose 3200 mg/day

36
Q

What is the dosing of Naproxen Sodium (anaprox) for Dysmenorrhea?

A

275 mg PO Q6-8hrs or 550mg Q12 hrs for 3 days each month

37
Q

What is the dosing of Fluoxetine/Sarafem for PMS/PMDD?

A

10-20mg QD or days 14-28 of the cycle

38
Q

What is the dosing of Paroxetine/Paxil CR for PMS/PMDD?

A

12.5-25 mg QD or 14-28 of the cycle

39
Q

What is the dosing for Sertraline/Zoloft for PMS/PMDD?

A

50-150mg QD or 14-28 of the cycle

40
Q

What is the dosing for Calcium for PMS/PMDD?

A

600 mg BID (plus adequate vitamin D intake)

41
Q

What is Dysmenorrhea?

A

Crampy pelvic pain occurring with just prior to menses

42
Q

What is primary dysmenorrhea?

A

Cause by factors INTRINSIC to the uterus

43
Q

What is secondary dysmenorrhea?

A

Caused by UNDERLYING PELVIC PATHOLOGY such as pelvic inflammatory disease, endometriosis, complications associated with IUDs, and ovarian cysts

44
Q

What are the steps of the ovulation?

A

Ovulation –> Increased Serum Progesterone –> Increased arachidonic acid -converted to-> prostaglandins and leukotrienes –> pain, inflammation, and uterine contractions

45
Q

What are the risk factors of Dysmenorrhea?

A

Young age, nulliparity, period before age 12, heavy menstrual flow, tobacco use, BMI <20 or >30, stress, anxiety, and depression

46
Q

What are the nonpharmacologic treatment for Dysmenorrhea?

A

Regular exercise, low-fat, vegetarian diet, smoking cessation, and local application of heat

47
Q

What are the pharmacologic treatment for Dysmenorrhea?

A
  1. Analgesics: NSAIDs and COX-2 Inhibitors
  2. Contraceptives: CHC
  3. Dietary Supplements: omega-3 fatty acid and vitamin D
48
Q

What is the MOA of NSAIDs?

A

Inhibits prostaglandin synthesis and provides analgesia

49
Q

What is the dosing of Diclofenac Potassium (Cataflam) for Dysmenorrhea?

A

50 mg Q8hrs RX

50
Q

When should NSAIDs be used in Dysmenorrhea?

A

Initiate 1-2 days prior to onset of menses and duration usually up to 3 days, FIRST LINE

51
Q

What should the frequency be for NSAIDs for Dysmenorrhea?

A

Scheduled

52
Q

What are the contraindications for Dysmenorrhea?

A
  1. Hypersensitivity to NSAID or ASA
  2. Renal Disease
  3. History of GI bleeding or ulceration
53
Q

What is the MOA of COX-2 Selective Inhibitors?

A

Inhibits prostaglandin synthesis and provides analgesia

54
Q

What is the dosing for Celecoxib (Celebrex) for Dysmenorrhea?

A

200 mg PO Q12 hrs

55
Q

What is the place of therapy for Celecoxib?

A

Similar to NSAIDs, but should be limited in patients with significant risk for GI ulceration

56
Q

Is Acetaminophen recommended for Dysmenorrhea?

A

NO

57
Q

What is the MOA of Contraceptives CHC?

A

Suppresses ovulation, decreases menstrual fluid volume, and thereby decreases prostaglandin production and uterine cramping

58
Q

What is the place of therapy for CHC for Dysmenorrhea?

A

FIRST LINE if Contraception is also desired

59
Q

How long should a drug therapy be given before switching therapy?

A

At least a 3 month trial

60
Q

If pain does not respond to drug therapy, it may be necessary to what?

A

Perform laparoscopy to determine cause

61
Q

What are the exclusions for Self Treatment of Dysmenorrhea?

A
  1. Severe dysmenorrhea and/or menorrhagia
  2. Symptoms inconsistent with primary dysmenorrhea
  3. History of pelvic inflammatory disease PID, infertility, irregular menstrual cycles, endometriosis, ovarian cysts
  4. IUD
  5. Allergy to aspirin or NSAIDs
  6. Warfarin, Heparin, or Lithium
  7. Active GI disease (PUD, GERD, Ulcerative Colitis)
  8. Bleeding disorders

Endocrine Module (16 decks)

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