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31 Cards in this Set

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What physical characteristics define primary amenorrhea?
No menses by age 16 or no menses

No secondary sex characteristics by age 14
What are some causes of primary amenorrhea?
1. imperforate hymen
2. drastic weight reduction/malnutrition
3. extreme obesity
4. diabetes type 1
5. thyroid alterations
6. Turner syndrome
Is pregnancy a primary or secondary amenorrhea?
Secondary
Describe what secondary amenorrhea is
When a woman who has been having normal menstrual cycles stops getting her periods for 6 + months
What are some causes of secondary amenorrhea?
1. Pregnancy
2. Depo-Provera
3. Premature ovarian failure
4. Menopause-- premature menopause
5. polycystic ovary syndrome
6. female athlete triad (low body fat, associated with eating disorders)
7. Side effect of Dilantin
why would you want to give daily calcium supplements + milk for women with athletic related amenorrhea?
Because secondary amenorrhea can lead to osteoporosis
What is primary dysmenorrhea?

What type of women do you see this commonly happen to?
1. Painful menstruation w/o pathology

2. Smoker & obese
What is an advice to give to a pt. w/ PMS who's experiencing breast tenderness?
Sleep bra or sports bra to support breasts
What are some advice to give to a pt w/ PMS symptoms?
1. decrease sugars, caffeine, eat small frequent meals
2. increase water intake
3. decrease sodium
4. calcium, mg, vitamin b^
What are the causes of secondary dysmenorrhea?
1. excess prostaglandins
2. endometriosis
3. tumor
4. PID
5. infection
6. fibroids
7. polyps, cancer
When a patient comes in with metorrhagia, what questions should you ask during history exam?
Birth control switch?

Depo Provera?
What is dysfunctional uterine bleeding and name 2 types of DUB?
Deviation from the usual menstrual pattern.

2 types: metorrhagia & menorrhagia.
Who is at risk for menorrhagia?
1. Obese (seems like they are in all kinds of bleeding problems)
2. Young women who have not established a regular ovulation cycle
3. Women approaching menopause (perimenopause)
What are some complications that could happen with endometrial ablation (a tx for heavy prolonged menstrual bleeding when bleeding has not yet responded to other tx & childbearing is completed)
1. Perforation of uterus
2. Burns
3. Pulmonary edema
4. Pulmonary embolism
5. Cervical laceration
T OR F

Fibroids are usually benign & do not require tx. Fibroids can cause pp hemorrhage.

We can give lupron to shrink fibroids instead of surgery
YES

YES

YES
what are the occasions that fibroids might need treatment?
1. large enough to cause pressure on other organs (i.e: bladder)
2. growing rapidly
3. causing abnormal bleeding
4. causing problems with fertility
Describe polycystic ovary syndrome
Ovaries contain many small follicles or cysts, visible on ultrasound.

Each contains an egg, but they don't grow normally and shrink before ovulation. Each month, new follicles develop and shrink into cysts.
What happen to the hormones in PCOS? especially androgen?
In PCOS, hormones get out of balance.

Normally the ovaries make tiny amt of androgen. PCOS -- start making slightly more androgens.
excessive androgens in PCOS cause what kind of sx?
cessation of ovulation
acne
grow extra facial & body hair
What happen to the blood sugar levels in PCOS?
body may have a problem w/ insulin resistance, causing increased bs levels. Overtime, this increases chance of developing type 2 diabetes
What are the sx of PCOS?
1. Menstrual irregularities, abnormal bleeding
2. Impaired fertility
3. Higher miscarriage rates
4. Increased hirsutism and acne
5. Abnormal insulin action (40 percent of women with PCOS from insulin resistance will develop gestational diabetes, and 50 percent will develop diabetes)
6. Higher risk of developing endometrial (uterine) abnormalities, including uterine cancer.
What meds are used for insulin resistance sx of PCOS?
Metformin. It can lower testosterone production

Avandia once daily to reverse the endocrine abnormalities seen w/ PCOS
What is this disease?

-Most common cause of pelvic pain
-____ tissue found outside of uterus, in other areas of body
-Caused by retrograde menstruation
-Develops into nodules, tumors, lesions, implants, growths
-Growths can cause pain, infertility, & other problems
Endometriosis
What is one very distinctive characteristic of endometriosis?
PAIN: debilitating, chronic pain (lower back & pelvic), dyspareunia, intestinal pain
What are the tx options for endometriosis?
1. NSAIDS
2. Hormone tx (combination of progestin & estrogen or progestin alone)
3. Danzol
What are some common sx of pelvic relaxation?
Urinary incontinence, constipation, pressure, sneeze & squirt
What are some interventions for pelvic relaxation?
1. Kegel exercises
2. Pessaries for mild sx
3. Hysterectomy
What are the CM for fistula?
1. Urinary or fecal incontinence through vagina
2. flatus through vagina
What kind of therapy is needed if ovaries are removed?
Transitional Hormone Replacement Therapy
What are some d.o that would warrant the tx of abdominal hysterectomy?
1. DUB
2. fibroids
3. prolapse of uterus, bladder, rectum
4. endometriosis
What are some physiologic changes associated with peri/menopause?
1. Flushes & flashes (d/t estrogen decline)
2. Night sweats (d/t estrogen decline)
3. Decreased bone density
4. Sleep problems
5. Dry genital --> dysparenunia
6. Decreased metabolism --> increased weight