Y2B3 Cs- Amenorrhea And Anovulation

Front 1

What is the biggest concern w/ amenorrhea?

Back 1

endometrial cancer d/t endometrial hyperplasia.

Front 2

what is primary amenorrhea? secondary?

Back 2

primary: young woman w/ secondary sexual characteristics that has not menstruated by age 16
secondary: has had previous menstrual periods and has not had a menses for six months.

Front 3

define oligomenorrhea.

Back 3

greater than 35 consistent days between cycles

Front 4

define hypermenorrhea.

Back 4

less than 21 days between cycles

Front 5

define: menometrorrhagia

Back 5

dysfunctional uterine bleeding w/ anovulatory cycles

Front 6

what are the 5 things that need to be addressed when a pt comes in w/ a menstrual problem?

Back 6

1) hx- age, onset, medicatiosn, etc (HcG diet for weight loss often disrupts menstrual cycle)
2) PE – uterine abnormalities (fibroids, ovarian cyst)
3) Blood tests – rule out conditions (hypothyroidism, anemia, polycystic ovarian condition)
4) Sonography/Radiology studies – confirm index of suspicion (fibroids)
5) Pathology – endometrial sampling to rule out malignancy (especially in older patients)

Front 7

what surge induces ovulation? when does this occur?

Back 7

LH surge- day 11-13

Front 8

what does FSH induce?

Back 8

granulosa cells- stimulates ovarian estradiol production (the most potent form of estrogen)

Front 9

what is secreted by the corpus luteum post ovulation? what is the purpose?

Back 9

progesterone- prepares endometrium for implantation. The corpus luteum regulates progesterone production during the remainder of the cycle or the subsequent development of pregnancy.

Front 10

If patient has irregular intervals with their menstuation, which half of the cycle is usually the culprit?

Back 10

1st half, the proliferative phase; because there is a fixed lifespan to the luteal phase that has to do with the ovulation event and the formation of the corpus luteum.

Front 11

what affect does the progesterone shift have on basal body temperature?

Back 11

upward by 0.6 to 1.0 degrees.

Front 12

what are 4 the causes of primary amenorrhea?

Back 12

Delayed puberty
imperforate hymen
gonadal failure (turner's sydnrome and karotyping studies)
Gonadal agenesis

Front 13

what are the 3 causes of secondary amenorrhea?

Back 13

pregnancy- MC always run a pregnancy test (very accurate if pregnancy is over 8 days)
Hypothalamic-pituitary dysfunction leading to ovarian dysfunction- anovulatory cycles
anatomical alterations like adhesions, fibroids/ polyps

Front 14

T/F

Women can still get a period while breast feeding.

Back 14

FALSE

They will not see a menses while breast feeding

Front 15

T/F

Women can still get pregnancy while breast feeding

Back 15

True

Breast feeding confers birth control, but it is not fool proof.

Front 16

levels of what five hormones need to be tested when a pt presents w/ amenorrhea?

Back 16

FSH
LH
TSH
Prolactin
DHEA-S

Front 17

why should you not order estrogen levels? which other hormone is helpful?

Back 17

Estrogen levels vary w/ time of day and are therefore useless. Progesterone levels are helpful.

Front 18

As far as the hypothalamic pituitary causes of amenorrhea ar concerned, what functional cause will impact menstruation? medication induce? neoplastic? psychogenic?

Back 18

function: excessive weight loss- can impact menstruation
medication induced: chemotherapy agents- can be thrown into premature menopause
neoplastic- pituitary adenomas; prolactin secreting tumor results in amenorrhea
psychogenic- anorexia nervosa

Front 19

how can obesity result in amenorrhea? why do long distance runners not menstruate?

Back 19

obesity- peripheral estrogen stores in body fat--> leading to amenorrhea
runners: often don't menstruate d/t low body fat

Front 20

At what age can you get premature ovarian failure? how do you diagnose?

Back 20

(also called premature menopause)- can occur as early as 40 yo and average age is 50. Diagnose using FSH levels: extremely elevated FSH level is indicative of menopause. (draw FSH not estrogen level).

Front 21

How do you tx anovulatory cycles?

Back 21

by transitioning into secretory endometrium by giving luteal phase progestin.

Front 22

What is Asherman's syndrome? what causes it?

Back 22

scarring of the uterine cavity (thick fibrous bands), formation of intrauterine adhesions.
Cause: over vigorous dilatation and curettage procedure--> infection and retained products of conception.

Front 23

what is the most frequent anatomical cause of secondary amenorrhea?

Back 23

Asherman's syndrome

Front 24

T/F

Pts w/ asherman's syndrome get the cramps, the bloating, but never get the bleeding.

Back 24

true

Front 25

how do you diagnose asherman's syndrome? How do you tx it?

Back 25

diagnose: hysterosalpingogram for cavitary defects.
tx: hysteroscopic lysis of adhesions + post op estrogen/ foley bulb (to stimulate regeneration and prevent recollapse down of walls).

Front 26

35 year old female presents to your office w/ a vast weight gain, fatigue and complains of skipped menses. Dx and tx

Back 26

Dx: Hypothyroidism (confirm via TSH levels)
Tx: synthetic T4 (synthroid)

Front 27

22 year old female presents to your office complaining of milky discharge from her nipples and subsequent missed periods. She is not sexually active and has never had a child. You do blood work and discover that her serum prolactin levels are elevated. Dx, tx and explain what test you cannot miss w/ this diagnosis.

Back 27

Dx: hyperprolactinemia
TX: Bromocriptine- dopamine agonist
do not miss an MRI imaging of the sella turcica to assess for a pituitary adenoma.

Front 28

35 Year old female presents to your office complaining of vast weight gain, oily skin, missed periods and hair growth in abnormal places. Dx, explain MOA, and name a very common comorbid finding.

Back 28

dx: polycystic Ovarian syndrome (made via elevated LH:FSH ration of >3:1)
MOA: LH stimulate theca cells to make more androstenedione--> leading to estrone exerting more positive LH loop feedback. This results in ovulatory suppression, acne and hirsuitism
Comorbidity: Type 2 Diabetes.

Front 29

T/F

PCOS pts are more prone to endometrial hyperplasia developing into endometrial carcinoma.

Back 29

true- it is the major cause of anovulatory infertility.

Front 30

what do you give a pt who is suffering from amenorrhea who wants to get pregnant?

Back 30

Clomiphene Citrate

Front 31

what is the purpose of luteal phase progestin?

Back 31

to ensure highest level of progesterone in the second half of the cycle. This will cause an abrupt cessation of use which mimics progesterone crash to initiate menses.

Front 32

what are the four ways we can tx amenorrhea?

Back 32

progesterone challenge
Clomiphene Citrate
Luteal Phase progestin
Oral Contraceptives

Front 33

what do all oral contraceptives have?

Back 33

ethinyl estradiol

Front 34

how do oral contraceptives affect the H-P ovarian axis?

Back 34

downregulation