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32 Cards in this Set

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What is the definition of amenorrhea?
1. No period by age 14, absence of growth or development of 2nd sexual characteristics
2. No period by age 16 regardless of the presence of normal growth & development or appearance of 2nd sexual characteristics
3. No period for at least 3 cycles or no periods for 6 months
What is the 4-compartment classification of amenorrhea?
- Outflow tract
- Ovary
- Anterior pituitary
- Hypothalamus
What is oligomenorrhea?
Menstrual interval >35 days
What is polymenorrhea?
Menstrual interval <25 days
What is Menorrhagis?
Normal menstrual intervals with extra flow & duration
What is Metrorrhagia?
Irregular menstrual intervals with extra flow & duration
What are the WHO classification of amenorrhea?
Group 1: Low FSH, LH, Estradiol
Group 2: Normal FSH, LH, Estradiol
Group 3: High FSH, LH; Low Estradiol
What are the cause of hypogonadal hypergonadotropic amenorrhea? (7)
- Srugery
- Chemotherapy
- Radiotherapy
- Autoimmune
- Idiopathic
- FMR1 premutation
- Resistant ovary syndrome
What is Swyer syndrome?
Non-functioning SRY gene
What are the cause of hypogonadal hypogonadotropic amenorrhea with abnormal MRI? (4)
- Prolactinoma
- Craniopharyngioma
- CNS lesions
- Sheehan's syndrome
What are the cause of hypogonadal hypogonadotropic amenorrhea with normal MRI? (9)
- Anorexia
- Stress
- Strenuous exercise
- Primary hypothyroidism
- Hyperprolactinemia
- Physiological delay
- Kallmann syndrome
- Idiophic (IHH)
- FSH β mutation
What causes eugonadal chronic anovulatory amenorrhea?
PCOS
What causes eugonadal out flow tract abnormality amenorrhea?
1. Congenital
- Imperforated hymen
- Transverse vaginal septum
- Mullerian agenesis
2. Genetic
- Androgen resistance
3. Acquired
- Asherman's syndrome
What is the definition of natural menopause
- Permanent loss of ovarian follicular activity
- 12 consecutive months of amenorrhea
What is induced menopause?
Cessation of menstruation due to surgical removal of the ovaries OR therapeutic ablation
What is the prevalence of vasomotor symptoms in menopause?
- 75-80% of women
- 6 months to 2 years
What is the management of vasomotor symptoms?
- Lifestyle (Cool rooms, regular exercise, stop smoking)
- Non-Rx (Vitamin E)
- Rx (SSRI, Gabapentin, Clonidine)
What are the urogenital concerns for menopause?
- Urinary incontinence
- Urinary tract infection
- Vaginal atrophy
- Pelvic prolapse
Why do women in menopause get more urinary tract infections? (4)
- Mucosa is thinner
- Glycogen production declines
- Decreasing levels of lactobacilli
- Reduced lactic acid production
Why do women in menopause get urinary incontinence? (2)
- Reduction in mean urethral closure pressure
- Thinning of bladder mucosa and increased irritation
Why are women during menopause are more at risk to depression?
Estrogen has positive effect on serotonin activity
- Up-regulation of 5HT1 receptors
- Decreased MOA activity
Why do you have increased cardiovascular risk with menopause? (3)
- Less favorable lipid profiles
- Increased insulin resistance
- Increased likelihood of thrombosis
What is hormone replacement therapy approved for?
- Moderate to severe vasomotor symptoms associated with menopause
- Moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause
- Prevention of postmenopausal osteoprosis
What are the 4 types of bleeding?
- Estrogen withdraw bleeding (Mid cycle estrogen drop)
- Estrogen breakthrough bleeding (Too much estrogen and lining falls off)
- Progesterone withdraw bleeding (Bleeding after stopping progesterone)
- Progesteron breakthrough bleeding (Bleeding due to thin lining)
What is the differential for anovulatory bleeding? (6)
= DUB
= Structural
- Pregnancy
- Uterine cancer
- Polyps/Fibroids
- Cervical Polyps
- Adenomyosis
What causes dysfunctional uterine bleeding? (4)
- PCOS
- Hypothalamic Hypogonadism
- Perimenopausal patients
- Adolescents
When do you not biopsy?
- When uterine lining is <5mm
Generally what are the menopause symptoms? (11)
- Vasomotor symptoms
- Urogenital Concerns
- Mood
- Sexual Concerns
- Cardiovascular Risk
- Bones
- Weight gain
- Skin changes
- Eye changes
- Aches & Pains
- Sleep Disturbances
What are the abortion techniques in early pregnancy?
- Surgical: Suction Aspiration
- Medication
What are the abortion techniques in late pregnancy?
- Surgical: Dilation and Evacuation
- Medication
What are the pre-abortion care?
1. Offer to explore supports & decision
2. Establish gestational age
3. Review next steps
4. Discuss/prove contraception
What are the pro-abortion care?
1. Listen
2. Pelvic exam
3. Contraception
4. Arrange follow up