Term
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Definition
|
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Term
| SECOND HALF OF CYCLE IS ALMOST ALWAYS 14 DAYS. SO COUNT FORWARD YOUR 32 DAYS IF YOUR CYCLE IS LONG, AND THEN COUNT BACKWARD 14 DAYS AND THAT’S WHEN THEY CAN GET PREGNANT. SO MIGHT HAVE TO TRACK YOUR CYCLE A FEW MONTHS TO SEE HOW LONG THE CYCLES ARE BEFORE YOU CAN COUNT BACK THE 14 DAYS. |
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Definition
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Term
| Day 0 is when bleeding begins. On Day 7, the dominant __ starts producing ___ which causes a __ feedback resulting in a surge of __ which causes ovulation around day __. |
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Definition
- follicle
- estradiol
- positive
- LH
- 14 |
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Term
| After ovulation, follicles become __ __ __ which pump __ to stabilize the endometrium and help maintain pregancy IF it occurs. |
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Definition
- corpus luteum cyst
- progesterone |
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Term
| After the LH surge, ___ begins pulsatile release again. Follicles are already being recruited for next cycle around day ___. |
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Definition
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Term
| The follicle of the follicular/proliferative phase secretes ___ has __ feedback on the anterior pituitary causing a __ of __. However, the corpus luteum cyst of the luteal/secretory phase secretes ___ and has ___ feedback on __ release from the anterior pituitary. |
|
Definition
- estradiol
- positive
- surge of LH
- progesterone
- negative
- LH release |
|
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Term
|
Definition
- No period by age 13 without secondary sex characteristics
- No period by age 16 with secondary sex characteristics |
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Term
| number one cause of secondary amenorrhea: |
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Definition
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Term
|
Definition
- menstrual cycle starts normally
- then 3 consecutive cycles missed or only 9 in one year |
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Term
| 4 places things can go wrong resulting in amenorrhea: |
|
Definition
- CNS
- Pituitary
- Ovaries
- Uterus |
|
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Term
|
Definition
- uterine adhesions scarred down, usu secondary to D&C
- may cause amenorrhea
- treat with curative scraping |
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Term
|
Definition
- post-partum hemorrhage damages hypothalamus> no more ovulation
- can be a cause of amenorrhea
- Tmt: hormones or IVF |
|
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Term
| Number one cause of post-partum hemorrhage: |
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Definition
| Uterine atony- floppy uterus that lost ability to contract down and constrict arteries> hemorrhage> likely Sheehan syndrome |
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Term
| Mullarian anomalies occur in the upper 1/3 of the vagina. Pts may lack vaginal tract or only have patches of the tract. May have only one uterine horn, or even only one kidney and ureter> can still have a baby. |
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Definition
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Term
| Vaginal septum (lower 1/3 of vagina) usu very painful. Tmt is: |
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Definition
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Term
| Vaginal agenesis occurs in the lower 1/3 of vagina. It is __ __. Most of these pts also lack a __. Many of these patients have ___ from the uterus back bleeding into the abdominal cavity. |
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Definition
- NOT curable
- lack a cervix
- endometriosis |
|
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Term
| 3rd MCC of primary amenorrhea: |
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Definition
|
|
Term
| Androgen Insensitivity aka Testicular Feminization: |
|
Definition
- genetically XY
- don't have proper androgen receptors
- testes make testosterone but not sensitive to it> no axillary hair or pubic hair
- Antimullarian hormone so no female parts either
- DHEA- converted to estrogen in periphary> breasts develop
TMT: TAKE OUT TESTES AROUND AGE 18 |
|
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Term
| Chromosomal abnormalities may cause streaked gonads and result in amenorrhea: |
|
Definition
- 50% 45X
- Mosaicism
- 46XX |
|
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Term
Turner Syndrome
45X 40%, may have some 46XX with other mosaic to make abnormal tissue
Short webneck, shield chest (nipples point outward), increased elbow carrying angle, <63” tall
No FSH or LH produced to stimulate ovaries
Work up for other anomally like bicuspid aortic valve, aortic dissection, horseshoe kidney
Don’t be afraid to get karyotype if suspect chromosomal abnormalities |
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Definition
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Term
| Premature Ovarian Failure occurs in women less than __ y/o. Can come out of it or recur. Possibly autoimmune related, but no one is really sure. |
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Definition
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Term
| Why would a prolactinoma present with amenorrhea? |
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Definition
| prolactin inhibits GnRH, FSH/LH secretion> amenorrhea |
|
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Term
| Prolactin-secreting adenoma symptoms: |
|
Definition
- visual field problems
- breast d/c
- check thyroid |
|
|
Term
| Tmt for prolactin secreting adenoma: |
|
Definition
- Dopamine agonist
- Surgery |
|
|
Term
|
Definition
- genetic
- pts have amenorrhea and are unable to smell |
|
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Term
| Hypothalamic amenorrhea may be caused by __ or ___. |
|
Definition
- stress
- weight loss/amenorrhea |
|
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Term
| Hyper/hypothyroidism may cause amenorrhea? |
|
Definition
|
|
Term
| What is the first test you do when investigating amenorrhea? |
|
Definition
- Progesterone challenge: Provera (progesterone) 5-10 mg qd x 10 days
- if bleed at the end, their uterus is okay and they are able to mentsruate> move on up and check TSH and Prolactin |
|
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Term
| After a progesterone challenge, pt did have bleeding. What is the next thing you should look at to investigate their amenorrhea? |
|
Definition
- prolactin
- TSH
- FSH
- LH |
|
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Term
| If pt bleeds with progesterone challenge and all other labs are normal, what is the cause of their amenorrhea and why? |
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Definition
| Anovulation b/c if they had been ovulating, progesterone would have been made by corpus luteum cysts> period |
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Term
| If pt does not bleed after progesterone challenge, what test should you do next? |
|
Definition
| estrogen and progesterone challenge |
|
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Term
| Pt does not bleed after progesterone challenge or after estrogen progesterone challenge. what is the problem? |
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Definition
| Structural Problem- Asherman's or HPO axis dysfunction |
|
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Term
| Elevated FSH suggests what? |
|
Definition
| Menopause b/c no negative feedback from ovaries so just keeps increasing |
|
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Term
| MCC of ovulatory dysfunction: |
|
Definition
| Polycystic Ovarian Syndrome |
|
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Term
|
Definition
Oligo- or anovulation
Clinical and/or biochemical signs of hyperandrogenism
Polycystic ovaries
Exclusion of ther etiologies
http://www.ovarian-cysts-pcos.com/images/Polycystic%20Ovary.jpg |
|
|
Term
Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, by either one or a combination of the following (almost certainly combined with genetic susceptibility[28]):
the release of excessive luteinizing hormone (LH) by the anterior pituitary gland[citation needed]
through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus[9]
Alternatively or as well, reduced levels of sex-hormone binding globulin can result in increased free androgens. |
|
Definition
|
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Term
|
Definition
| Obesity>Hyperinsulinemia and insulin resistance> decreased sex hormone binding globulin> stimulates ovarian insulin and IGF-1> increased androgens |
|
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Term
| How is the LH:FSH ratio related to PCOS? |
|
Definition
| You can look at the LH: FSH ratio as a test to help dx PCOS. If LH is 2-3x greater than FSH, a dx of PCOS is suggested. |
|
|
Term
| Standard u/s description of PCOS: |
|
Definition
| string of pearls appearance |
|
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Term
| Tmt of PCOS if desiring pregnancy: |
|
Definition
- Metformin
- Weight loss
- Clomid |
|
|
Term
| Tmt of PCOS if not desiring pregnancy: |
|
Definition
- Metformin
- Weight loss
- OCPs- help stimulate menstruation (dont want endometrial lining just builing and building> increased risk of endometrial cancer) |
|
|
Term
| Long term PCOS associated problems: |
|
Definition
Menstrual Disorders
Skin Disorders
Alopecia
Acne
Hirsutism
In pregnancy
Multiples
GDM
PIH
Infertility
Chronic anovulation
Obesity
Metabolic syndrome
Sleep Apnea
T2DM
CVD
Endometrial CA |
|
|
Term
| Tmt of hyperprolactinemia: |
|
Definition
- Dopamine AGONIST
- Thyroid replacement
- Clomid
- OCPs
- Progesterone monthly |
|
|
Term
| Meds that may cause galactorrhea: |
|
Definition
- SSRIs
- Benzos
- Beta blockers
- Anti-psychotics
- H2 blockers
- OCPs |
|
|
Term
| Nml for a mom to leak breast milk for up to one year after weaning. |
|
Definition
|
|
Term
|
Definition
- PCOS
- Sertoli-Leydig cell ovarian tumors
- Pregnancy related d/o
- Congenital Adrenal Hyperplasia
- Adrenal tumors
- Cushing's syndrome
- Hyperprolactinemia
- Idiopathic |
|
|
Term
| Tests that can be ordered to investigate hirsutism: |
|
Definition
- Testosterone
- DHEAs
- 17a-hydroxyprogesterone
- LH:FSH to look at ratio
- Glucose:Insulin ratio
- Prolactin
- TSH
- ACTH stimulation test
- Testing for Cushing's disease |
|
|
Term
| probably need to re-study information about Cushing's disease and how to test for it. |
|
Definition
|
|
Term
|
Definition
- OCPs (inhibit LH)
- GnRH agonists
- Spironolactone- androgen receptor antagonist
- Glucocorticoids
- Acne therapy
- Weight loss
- Treat diabetes and insulin resistance |
|
|
Term
| How does spiranolactone work as a treatment for hirsutism? |
|
Definition
| androgen receptor antagonist |
|
|
Term
| Highest incidence of PMS is in what age group? |
|
Definition
20-30s
75% of women get PMS |
|
|
Term
| when does PMS occur in the cycle? |
|
Definition
| one-two weeks before bleeding, should stop when bleeding starts |
|
|
Term
|
Definition
- headache
- breast tenderness
- pelvic pain
- bloating
- tension
- irritability |
|
|
Term
| Premenstrual Dysphoric D/O: |
|
Definition
- similar to PMS but more severe causing DISRUPTION IN DAILY FUNCTION
- irritable
- dyshporia
- mood lability |
|
|
Term
|
Definition
| - estrogen and progesterone influence serotonin levels |
|
|
Term
| Suspect PMS/PMDD, how do you further evaulate this? |
|
Definition
- r/o thyroid dysfunction
- chart for 2 cycles |
|
|
Term
|
Definition
| Sx must occur during the luteal phase w/ a Sx-free period of at least 7 days in the first half of the cycle for 2 consecutive cycles |
|
|
Term
|
Definition
- limit caffeine
- limit etoh
- limit tobacco
- limit chocolate
- limit sodium
- exercise
- NSAIDs
- SSRIs
- GnRH agonists
- BCPs |
|
|
Term
| Primary dysmenorrhea is painful menstruation preventing normal activity. It occurs __ __ __ NOT at the onset of menarche. Related to prostaglandins. Sx include N/V/HA. |
|
Definition
|
|
Term
| Primary Dysmenorrhea tmt: |
|
Definition
NSAIDS starting 1-2 days prior to menstruation (Ibuprofen, Naproxen)
NSAIDs are first line
OCPS can help b/c increasing estrogen usu decreases pain, great in conjunction with NSAIDs
surgery
heat
exercise
low fat, low meat diet |
|
|
Term
| Secondary dysmenorrhea, like with endometriosis, usu starts: |
|
Definition
|
|
Term
| Liver disease may cause abnormal uterine bleeding b/c interferes with estrogen metabolism. |
|
Definition
|
|
Term
| Required tests for abnormal uterine bleeding: |
|
Definition
- CBC
- Quantitative beta-hcg
- TSH
may also want:
- u/s
- EMB
- hysteroscope
- D&C |
|
|
Term
| Abnormal utering bleeding, alway always get a : |
|
Definition
|
|
Term
| NUMBER ONE CAUSE OF DYSFUNCTIONAL UTERINE BLEEDING: |
|
Definition
| ANOVULATION- usu from HPO axis dysfunction, usu associated with extremes of reproductive ages |
|
|
Term
| Dx for menarche to age 16 abnormal uterine bleeding: |
|
Definition
Soaking >25 pads or >30 tampons during menstrual period is considered abnormal
Absence of PMSx may mean anovulatory cycles
Fever and leukocytosis…PID
How long until abnormal cycles after Menarche are considered abnormal?
Testing:
CBC
UPT
STD’s
PT, PTT, INR
TSH
Your book mentions U/S |
|
|
Term
| Treatment for abnormal uterine bleeding menarche to age 16 (likely anovulatory cycles): |
|
Definition
REASSURANCE!!!
Treat the problem (thyroid, etc.) or…
NSAID’s
Fe supplementation
May need blood transfusion and pressors
Your book mentions OCP’s and DepoProvera |
|
|
Term
| Dx abnormal uterine bleeding ages 16-40s: |
|
Definition
MCC: pregnancy and contraceptive complications
Adenomyosis, endometriosis, fibroids
CBC
Pap-ages 21 and up
UPT
STD’s
Thyroid function
PT, PTT, INR
U/S if mass present
EMB!!! (best if done on 1st day of MP so as to not risk pregnancy complications, typically >30yo) |
|
|
Term
| greater than 30, with AUB, make sure and get a: |
|
Definition
|
|
Term
| Treatment AUB ages 16-40s: |
|
Definition
Treat the problem (thyroid, etc.) or…
OCP’s – i PO TID x 7d; no pills for 7 more days will result in heavy flow; open new OCP package and take i PO QD thereafter.
Provera 10mg i PO QD days 16-25 to reduce menstrual blood loss
Fe supplementation
IUD
Surgery if childbearing is completed |
|
|
Term
| AUB in pts >40 is ___ until proven otherwise. |
|
Definition
|
|
Term
| Post-menopausal bleeding is 12 months of amenorrhea preceding abnormal uterine bleeding. Suggests __ __. |
|
Definition
endometrial cancer
(usu anovulatory bleeding, but still must think this is CANCER until proven otherwise) |
|
|
Term
|
Definition
CBC
Pap
UPT
STD’s
Thyroid function
PT, PTT, INR
U/S if mass present
EMB!!! (best if done on 1st day of MP so as to not risk pregnancy complications, typically >30yo)
Take a good history!!! (pt may be on HRT or use estrogen-containing creams which can be a cause of the bleeding)
PE:
Vulvar/Vaginal atrophy can cause dry, cracked mucosa |
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