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33 Cards in this Set
- Front
- Back
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1 amenorrhea
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lack of bleeding by age 14 in absence of growth/2 sex characteristics OR no period by age 16 regardless of 2 charac
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2 amenorrhea
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absence of menses longer than 6 mo in pt w hx of normal menses; absence of menses for total of 3 prev cycles
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mcc of physiologic amenorrhea
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pregnancy (b-HCG)
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central amenorrhea causes
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hypothalamic/pit dysfunction
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ovarian causes of amenorrhea
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anovulation
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antipsychotics
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cause amenorrhea (no dopamine -> inc prolactin)
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signs of hypoestronism
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atrophic changes in vagina; hot flashes (menopause)
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progesterone challenge test
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10 mg prog for 5-10 days; see if patient bleeds (if so = positive)
it means that serum estrogen > 40 ph/mL = enough to prime the endometrium; the progesterone given leads to bleeding to imitate the menstrual cycle also assumes ant pit is producing LH/FSH and menstrual outflaw tracts are functioning if test is neg = no bleeding or spotting after giving progesterone |
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differnetial for progesterone
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Asherman's syndrome; cervical stenosis; uterine agenesis; imperforate hymen; vaginal septum; or may just be hypoestrogenic
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Mullerian agenesis
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norla hair distribution, mature nipples
absent uterus/upper vagina normal ovaries, normal serum testosterone, karyotype 46XX blind ending vagina |
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blind ending vagina
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Mullerian aganesis
send pt for US, no uterus in midline but w normal ovaries |
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associations w mullerian agenesis
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renal anomalies;; do IV pyelography or renal ultrasound
*serum test normal in pts w mullerian agenesis |
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Asherman syndrome
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hx of intrauterine instrumenttal procedure usually following pregnancy; uterine surgery such as metroplasty and myomectomy
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myomectomy
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remove uterine leiyomas; also known as fibroids
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imperforate hymen
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hymenal opening nonexistent; all menstrual blood is trapped in the vagina causing mucometria and hematometria
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initial tests on pt w amenorrhea and positive progesterone challenge test
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thyroid and prolactin level
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hypothalamic causes of amenorrhea
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GnRH deficiency (kallmans syndrome = anosmia, midline craniofacial defects) and isolated gonadotropin deficiency
CNS neoplasm/infiltratino dz like TB or sarcoid stress anorexia/bulimia |
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metabolic derangement of anorexia
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low levels of T3 due to impaired peripheral conversion = slow metabolism
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initial tx of anorexia
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estrogen and progesterone in the form of combined controceptives to give minimal dose of estrogen to prevent osteoporosis (chronic hypoestrogenic state)
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athletic amenorrhea
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beta endorphins dec release of GnRH = FSH and LH -> hypoestrogenic w significant loss of bone density
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pituitary amenorrhea causes
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Sheehan's syndrome - no FSH/LH secreting cells
hyperprolactinemia |
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endocrine causes of amenorrhea
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thyroid, cushing syndrome, acromegaly
check thyroid hormone/growth monr, prolactin and cortisol levels |
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androgen insensitivity (testicular feminization)
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blind vagina (androgen induction of the wolffian duct system does not occur despite normal male levels of testosterone); MIH is still present; mullerian system does not devellop
male karyotype often have to remove tumors |
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premature ovarian failure (no follicles, cant produce oocytes)
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amenorrhea due to ovarian failure before age of 40 years; pts w symptoms of hypoestrogenism and increased FSH
ovarian biopsy: only primordial follicles and with no progression past the antrum stage Karyotyping |
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whens hould you perform karyotyping
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gonadal failure, androgen insensitivity
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FSH level in turner syndrome
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high, bc trying to stimuale androgens
hypogonadotropic hyogonadism |
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17-alpha hydroxylase deficiency
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inc production of mineralcorticoids; decreased synthesis of sex steroids
tx w cortisol |
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obese vs lean PCOS pts
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bilateral cysts
mc presenenting symptoms = infertility>hirsuitism>amenorrhea>obesity>dysfunctional bleeding |
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amenorrhea initial workup
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b-HCG > prog challenge test
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abnormal lab values in pts w PCOS
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LH:FSH = 3:1 ratio = PCOS
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initial mgmt of PCOS in fam med setting
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lose weight; dec aromatase -> dec estrogen
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1 dysmenorrhea
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dysmenorrhea not ass w any pathology; inc production of prostaglandin F2 -> vasoconstriction
tx w NSAIDs (dec PG production) OCP (atrophy of endometrium -> primary site of PG production0 |
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2 dysmenorrhea
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uterine myomas, adenomyosis, endometriosis, pelvic infection
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