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29 Cards in this Set
- Front
- Back
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What are the 2 stages of normal menstrual cycle? |
1. Follicular phase 2. Ovulation 3. Luteal phase (Secretory) |
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What phase corresponds with the first day of menstrual bleeding?
What else occurs during this phase? |
follicular phase
menstruate 3-5 days prostaglandin- causes cramping estradiol (day 4)- stimulates LH receptors
(last from onset of menses to day 5) |
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What occurs during the ovulation phase? |
LH surge stimulates follicle release corpus luteum is formed |
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what is secreted by the corpus luteum post ovulation? what is the purpose?
What phase does this occur in? |
progesterone- prepares endometrium for implantation. No fertilization= progesterone drops & menstruation is initated (begins follicular phase again)
Luteal phase (Secretory) |
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define oligomenorrhea.
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greater than 35 consistent days between cycles
= few periods |
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define hypermenorrhea. |
less than 21 days between cycles
= many periods |
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define Menorrhagia |
abnormally heavy periods (regular intervals) |
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define metrorrhagia |
menstrual bleeding at irregular intervals |
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define: menometrorrhagia
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dysfunctional uterine bleeding (DUB) |
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A young woman w/ secondary sexual characteristics has not menstruated by age 16......this is considered: |
primary amenorrhea |
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what are the causes of primary amenorrhea? |
Delayed puberty vaginal atresia (no vaginal canal) labial adhesions (labia fused shut) |
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How would a pt w/ Turners sydrome/Gonadal dysgenesis present?
tx? |
short stature, broad chest, webbed neck
typically do not have functioning ovaries--> tx w estrogen replacement (can concieve w this tx) |
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Why would a pt w Mullerian Agenesis not get their period? |
congenital malformation of Mullerian duct--> complete/partial lack of uterus, cervix, vagina
*normal ovaries but no pathway out |
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what is secondary amenorrhea? |
(if it has been less than 6 mnths = suppressed menstruation) |
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what are the causes of secondary amenorrhea? |
-pregnancy- MC -post partum (normal for 6-8 wks) -breast feeding (d/t Prolactin) -ovaraian dysfxn/anovulation- 2nd MC -anatomical abnormalities (Asherman, polyps, fibroids) -Hypothalamic-pituitary dysfunction -drugs (anything that effects brain) |
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What causes anovulatory cycles?
How do you tx? |
Lack of ovulation d/t being stuck in follcular phase--> over-lapping of cycles = continuous build-up of proliferative endometrium
tx: by transitioning into secretory endometrium by giving luteal phase progestin. |
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what is the most frequent anatomical cause of secondary amenorrhea?
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Asherman's syndrome
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What is Asherman's syndrome?
what causes it? |
scarring of the uterine cavity- formation of intrauterine adhesions.
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As far as the hypothalamic pituitary causes of amenorrhea ar concerned, what nutritional causes will impact menstruation? what pathological causes? |
nutrition: excessive weight loss/malnutrition, anorexia nervosa, female athelete triad
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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)
(hyperthyroidism also causes- tx by restoring normal levels) |
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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
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When can you get premature ovarian failure? how do you diagnose? |
(also called premature menopause)- occurs before the normal age of menopause. (may be d/t neoplasm or chemo/radiation med)
Diagnose using FSH levels: extremely elevated (FSH level is indicative of menopause) |
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17 Year old female presents to your office complaining of vast weight gain, acne, missed periods and facial hair growth. Dx, What causes this, and what is a very common comorbid finding? |
dx: polycystic Ovarian syndrome (made via elevated LH:FSH ration of >3:1)
--> results in anovulatory cycels, excess androgens, obesity & hirsuitism
Comorbidity: Type 2 insulin resistent Diabetes. |
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T/F |
true- it is the major cause of anovulatory infertility. |
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What is the tx for PCOS? |
*Metformin (helps w/ glycemic levels & reduce angrogens)
-oral contraceptives to regulate menses -clomid for pts seeking conception |
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What should you test when pt comes in w/ amenorrhea? |
1. clinical hx & full PE (including pelvic) 2. Pregnancy test (hCG) 3. Blood test: CBC, CMP, FSH, LT, TSH, Prolactin 4. Transvaginal ultrasound (or pelvic for virgin) 5. endometrial biopsy 6. other imaging (MRI of sella turica, etc) |
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What can be used to determine is a pt has adequate/competent endometrium & to assess the outflow tract (for obstruction)? |
Progesterone challenge |
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How does the progesterone challenge work? |
-inject 100mg progesterone + 10 days of oral provera (mimic luteal phase) -7 days after completion of 10 days pt should begin period = no anatomical problem |
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what are the ways we can tx amenorrhea? |
Tx underlying cause**
Clomiphene Citrate: selective estrogen receptor modulator- resets HPG axis) |
