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10 Cards in this Set
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No menarche by 16 y/o:
breast development (thelarche) requires: pubarche requires: menarche requires: |
primary amenorrhea
estrogen androgens pulsatile GnRH, FSH/LH, estrogen/progesterone |
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Explain androgen insensitivity:
Dx based on: Most common cause of hypogonadotropic hypogonadism (low FSH, LH): What syndrome can cause it? |
breast development, but no hair; female phenotype, genetic male, undescended testes
lab tests, karyotype analysis constitutional delay of puberty, growth - family hx Kallmann's |
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Explain hypergonadotropic hypogonadism (high FSH, LH):
What is secondary amenorrhea? Major diff dx of secondary amenorrhea: What other S/S should you ask about? |
gonadal dysgenesis - most common female form is Turner's (45XO)
absence of menses for 3 months in women with previously normal menses PREGNANCY galactorrhea, HA, visual changes |
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Mild hypothyroidism usually has what effect on menstruation?
Eval for prolactinoma: What drugs can cause hyperprolactinemia? |
hypermenorrhea, oligomenorrhea instead of amenorrhea
normal TSH, MRI for prolactinoma, if negative then check other causes (metabolic, pharm, hypothyroid, stimulation) contraceptives, anti-psych, anti-depressants, anti-HTN, H2 blockers, opiates, THC |
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What should you do if a patient has normal TSH and prolactin?
Most common cause of outflow obstruction in secondary amenorrhea: |
Progesterone challenge test
if +, then HPA abnormality, ovarian problem if -, then outflow tract abnormality, inadequate estrogenization Asherman's syndrome - intrauterine scarring from curettage/infection |
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Most common cause of hyperandrogenic chronic anovulation:
lab features: Principal underlying disorder in PCOS: |
PCOS
elevated testosterone, DHEA-S; elevated LH/FSH ratio, check 17-OHP (maybe CAH) insulin resistance - hyperinsulinemia --> excess ovarian androgen production |
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Primary tx for PCOS:
Other options: Major cause of hypergonadotropic hypogonadism: Increased risk of: |
weight loss - can lower androgen levels, improve hirsutism, normalize menses, decreases insulin resistance
oral contraceptives, insulin sensitizing agents, Clomid to stimulate ovulation premature ovarian failure - <40 y/o OP, heart disease, autoimmune diseases |
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"Athlete's triad":
Dysmenorrhea is thought to be caused by: Tx of dysmenorrhea: |
eating disorder, amenorrhea, OP - excessive weight loss, exercise, stress
release of PG's in menstrual fluid - uterine contractions also vasopressin - increases uterine contractility anti-PG, NSAID's, oral contraceptives, Depo-Provera, Mirena (IUD) |
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Supplements that may help with dysmenorrhea:
Other pain tx: Primary somatic dysfunctions in dysmenorrhea, and benefits of tx: |
Vit E, Omega-3's, Mg, maybe NTG
TENS, topical heated patch, surgery upper thoracic, cervical - especially with increased sympathetic tone thoracic/pelvic diaphragm - increase ROM, reduces venous/lymphatic stasis |
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4 compartments of amenorrhea:
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I - outflow problems, uterus - Mullerian anomalies, Asherman's
II - ovary (Turner's, premature failure) III - anterior pituitary (prolactinoma, empty sella) IV - hypothal (abnormal GnRH, eating disorders) |
