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61 Cards in this Set
- Front
- Back
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What is Amenorrhea?
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Absence of menstruation
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What is DUB?
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Irregular menstruation w/out irregularity of the uterus.
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How are DUB and amenorrhea related?
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Sometimes the underlying pathophysiology is the same.
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What is primary amenorrhea?
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If a woman has NEVER menstruated BEFORE.
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What is 2ndry amenorrhea?
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If a woman HAS menstruated before, but not in the last 6 months.
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What is oligomenorrhea?
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Reduced FREQUENCY of menses - interval is >40 days but not as long as 6 months.
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So if a woman has 2 periods per YEAR, what is this?
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2ndry amenorrhea
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But if a woman has 3 periods per year this is:
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Oligomenorrhea
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What are 4 causes of amenorrhea?
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-Pregnancy
-Hypothal-pituitary dysfunction -Ovarian dysfunction -Outflow abnormality |
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Which is the most COMMON cause of amenorrhea?
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Pregnancy
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Why is it important to rule out pregnancy when evaluating amenorrhea?
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Some of the treatments for amenorrhea can be harmful in pregnancy.
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How is GnRH normally released?
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In PULSES
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What happens when pulses aren't released?
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FSH and LH fail to be secreted
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Results of loss of FSH and LH are:
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Failure to ovulate and menstruate.
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What are 3 functional causes of Hypothal-Pituitary amenorrhea?
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Weight loss
Excess exercise Obesity |
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What are 2 drugs that can cause Hypothal-Pituitary amenorrhea?
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Marijuana and Tranquilizers
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What are 3 neoplasms that can cause Hypothal-Pituitary amenorrhea?
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-Craniopharyngeoma
-Prolactinoma -Hypothalamic Hamartoma |
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What are 5 other random causes of Hypothal-Pituitary amenorrhea?
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Chronic anxiety
Pseudocyesis Anorexia Chronic medical illness Head injury |
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What are the 3 tests to run in looking for Hypothal-Pituitary amenorrhea etiology?
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FSH, LH, and Prolactin
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What is a common symptom that will differentiate Hypothal-Pituitary amenorrhea vs Ovarian failure?
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Hot flashes and sleeping problems
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What are 2 things that cause ovarian failure?
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-Exhaustion of ovaries
-Resistance to FSH/LH stimulation |
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What happens as the ovaries normally fail in a woman to blood FSH/LH?
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They increase
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What would you suspect in a woman with failing ovaries but LOW levels of FSH/LH?
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CAH of 21-hydroxylase defic type
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2 chromosomal causes of ovarian failure:
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-Turners syndrome
-Deletion of long arm of X |
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What is Savage syndrome?
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Gonadotropin resistant ovary syndrome
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Why is it important to rule out pregnancy when evaluating amenorrhea?
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Some of the treatments for amenorrhea can be harmful in pregnancy.
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How is GnRH normally released?
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In PULSES
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|
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What happens when pulses aren't released?
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FSH and LH fail to be secreted
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Results of loss of FSH and LH are:
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Failure to ovulate and menstruate.
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What are 3 functional causes of Hypothal-Pituitary amenorrhea?
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Weight loss
Excess exercise Obesity |
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What are 2 drugs that can cause Hypothal-Pituitary amenorrhea?
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Marijuana and Tranquilizers
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What are 3 neoplasms that can cause Hypothal-Pituitary amenorrhea?
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-Craniopharyngeoma
-Prolactinoma -Hypothalamic Hamartoma |
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What are 5 other random causes of Hypothal-Pituitary amenorrhea?
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Chronic anxiety
Pseudocyesis Anorexia Chronic medical illness Head injury |
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What are the 3 tests to run in looking for Hypothal-Pituitary amenorrhea etiology?
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FSH, LH, and Prolactin
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What is a common symptom that will differentiate Hypothal-Pituitary amenorrhea vs Ovarian failure?
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Hot flashes and sleeping problems
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What are 2 things that cause ovarian failure?
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-Exhaustion of ovaries
-Resistance to FSH/LH stimulation |
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What happens as the ovaries normally fail in a woman to blood FSH/LH?
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They increase
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What would you suspect in a woman with failing ovaries but LOW levels of FSH/LH?
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CAH of 21-hydroxylase defic type
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2 chromosomal causes of ovarian failure:
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-Turners syndrome
-Deletion of long arm of X |
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What is Savage syndrome?
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Gonadotropin resistant ovary syndrome
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What is Blizzard syndrome?
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Autoimmune ovarian failure
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What is an iatrogenic cause of ovarian failure?
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Alkylating chemotherapy
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What would prevent menstruation even if ovulation occurs?
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GENITAL TRACT OUTFLOW OBSTRUCTIONS
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What do most outflow obstructions result from?
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Abnormal development and canalization of the mullerian ducts.
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What is the most FREQUENT cause of secondary amenorrhea due to anatomic
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Asherman's syndrome
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How is Asherman's syndrome treated?
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-By surgical lysis of adhesions
-Estrogen therapy to stimulate endometrial regen. |
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How do you treat amenorrhea due to functional causes like weight loss, excess exercise, or obesity?
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Behavioral changes
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How do you treat amenorrhea due to a prolactinoma?
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Bromocriptine (parlodel)
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How do you treat amenorrhea due to mullerian agenesis?
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Vaginal dilators,
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How do you treat amenorrhea due to ovarian failure?
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Estrogen replacement
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Failure to ovulate can result in what two things:
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Amenorrhea
DUB |
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How often does ovulation occur in amenorrhea vs dub?
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Amenorrhea - not at all
DUB - infrequently |
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How do menses compare between Amenorrhea vs DUB?
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Amenorrhea - not at all
DUB - heavy/irreg bleeding |
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What is the deal that failure to Ovulate can lead to such opposite conditions?
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ESTROGEN STATUS!
Estrogen is hypo in amenorrh. Estrogen is "estrus' hyper in DUB |
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What is Chronic Estrus?
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Constant, noncyclic low blood levels of estrogen that stimulate endometrial growth
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What are the 3 conditions in which DUB is most likely to occur?
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-Polycystic ovarian syndrome
-Obesity -Adrenal hyperplasia |
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What is a cause of DUB in which ovulation can occur?
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Luteal phase defect - lack of progesterone so always stuck in the proliferative phase.
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What are the 3 main reasons we need to diagnose and treat DUB?
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-Incapacitating bloodloss
-Endometrial hyperplasia -Endometrial cancer |
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What is the primary goal in treating DUB?
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To convert the proliferative endometrium into secretory
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What is the most common treatment for DUB?
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PRovera - progesterone
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What is an alternative treatment method and how does it work?
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OCPs - suppress the endometrium and establish regular, predictable cycles.
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