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34 Cards in this Set

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What is the biggest concern w/ amenorrhea?
endometrial cancer d/t endometrial hyperplasia.
what is primary amenorrhea? secondary?
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.
define oligomenorrhea.
greater than 35 consistent days between cycles
define hypermenorrhea.
less than 21 days between cycles
define: menometrorrhagia
dysfunctional uterine bleeding w/ anovulatory cycles
what are the 5 things that need to be addressed when a pt comes in w/ a menstrual problem?
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)
what surge induces ovulation? when does this occur?
LH surge- day 11-13
what does FSH induce?
granulosa cells- stimulates ovarian estradiol production (the most potent form of estrogen)
what is secreted by the corpus luteum post ovulation? what is the purpose?
progesterone- prepares endometrium for implantation. The corpus luteum regulates progesterone production during the remainder of the cycle or the subsequent development of pregnancy.
If patient has irregular intervals with their menstuation, which half of the cycle is usually the culprit?
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.
what affect does the progesterone shift have on basal body temperature?
upward by 0.6 to 1.0 degrees.
what are 4 the causes of primary amenorrhea?
Delayed puberty
imperforate hymen
gonadal failure (turner's sydnrome and karotyping studies)
Gonadal agenesis
what are the 3 causes of secondary amenorrhea?
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
T/F

Women can still get a period while breast feeding.
FALSE

They will not see a menses while breast feeding
T/F

Women can still get pregnancy while breast feeding
True

Breast feeding confers birth control, but it is not fool proof.
levels of what five hormones need to be tested when a pt presents w/ amenorrhea?
FSH
LH
TSH
Prolactin
DHEA-S
why should you not order estrogen levels? which other hormone is helpful?
Estrogen levels vary w/ time of day and are therefore useless. Progesterone levels are helpful.
As far as the hypothalamic pituitary causes of amenorrhea ar concerned, what functional cause will impact menstruation? medication induce? neoplastic? psychogenic?
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
how can obesity result in amenorrhea? why do long distance runners not menstruate?
obesity- peripheral estrogen stores in body fat--> leading to amenorrhea
runners: often don't menstruate d/t low body fat
At what age can you get premature ovarian failure? how do you diagnose?
(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).
How do you tx anovulatory cycles?
by transitioning into secretory endometrium by giving luteal phase progestin.
What is Asherman's syndrome? what causes it?
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.
what is the most frequent anatomical cause of secondary amenorrhea?
Asherman's syndrome
T/F

Pts w/ asherman's syndrome get the cramps, the bloating, but never get the bleeding.
true
how do you diagnose asherman's syndrome? How do you tx it?
diagnose: hysterosalpingogram for cavitary defects.
tx: hysteroscopic lysis of adhesions + post op estrogen/ foley bulb (to stimulate regeneration and prevent recollapse down of walls).
35 year old female presents to your office w/ a vast weight gain, fatigue and complains of skipped menses. Dx and tx
Dx: Hypothyroidism (confirm via TSH levels)
Tx: synthetic T4 (synthroid)
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.
Dx: hyperprolactinemia
TX: Bromocriptine- dopamine agonist
do not miss an MRI imaging of the sella turcica to assess for a pituitary adenoma.
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.
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.
T/F

PCOS pts are more prone to endometrial hyperplasia developing into endometrial carcinoma.
true- it is the major cause of anovulatory infertility.
what do you give a pt who is suffering from amenorrhea who wants to get pregnant?
Clomiphene Citrate
what is the purpose of luteal phase progestin?
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.
what are the four ways we can tx amenorrhea?
progesterone challenge
Clomiphene Citrate
Luteal Phase progestin
Oral Contraceptives
what do all oral contraceptives have?
ethinyl estradiol
how do oral contraceptives affect the H-P ovarian axis?
downregulation