this lecture looked at some more disorders of the female reproductive tract: amenorrhea, dysfunctional uterine bleeding, PMS, PCOS, premature ovarian failure, and menopause.
questions
amenorrhea...
1. what are some signs that could indicate primary amenorrhea?
2. what are some signs in a reproductive age woman that could indicate secondary amenorrhea?
3. what are some general symptoms / signs to look for that could be correlated to amenorrhea?
4. obesity plus amenorrhea might suggest...
5. amenorrhea plus moon facies might suggest...
6. what is a maturation index and how might it help in the diagnosis of amenorrhea?
7. decreased DTR's might indicate...
8. what are the first two tests to perform on a patient with amenorrhea?
9. what are some other tests that might help with a diagnosis of amenorrhea?
10. hypothyroid is associated with amenorrhea and...
11. elevated TSH levels also cause the elevation of...
12. what can amenorrhea plus high FSH levels indicate?
13. what might amenorrhea plus low / low normal FSH levels indicate?
14. what might amenorrhea plus an elevation of free testosterone or DHEAS indicate?
15. if all the above tests are normal, what is the next diagnostic step?
16. what are the most common causes of secondary amenorrhea?
DUB...
17. what is dysfunctional uterine bleeding?
18. what is the most common age for DUB?
19. what is the etiology of DUB?
20. what are the signs / symptoms of DUB?
21. what are some tests that might aid in the diagnosis of DUB?
22. what is the salivary progesterone good for detecting?
dysmenorrhea...
23. what are the characteristics of primary dysmenorrhea?
24. what are the most common causes of secondary dysmenorrhea?
25. what are the signs and symptoms of dysmenorrhea?
26. how might primary and secondary dysmenorrhea be distinguished based on treatment?
PMS...
27. what are the theories of etiology for PMS?
28. diagnosis of PMS is made by...
29. what are some differential diagnoses of PMS?
PCOS...
30. how common is PCOS?
31. PCOS is characterized by...
32. what is a test that can aid in the diagnosis of PCOS?
33. what are the "cysts" in PCOS?
34. what are the possible sequelae for PCOS?
35. what are some common symptoms for PCOS?
36. what is a good lab test to diagnose PCOS?
37. what would be seen in the TVUS for a PCOS patient?
38. what is a hormone that further increases estrogen sensitivity in the uterus?
premature ovarian failure...
39. what is premature ovarian failure?
40. what are the etiologies for premature ovarian failure?
41. what are the signs / symptoms of premature ovarian failure?
42. what are labs that can aid in the diagnosis of premature ovarian failure?
menopause...
43. physiologic menopause occurs when menses stops for how long?
44. what is the average age for physiologic menopause in the US?
45. what is the hallmark symptom for the perimenopausal period?
46. describe the hormonal shifts that occur during the perimenopausal period.
47. what are some causative factors for premature menopause?
48. what is the most common reason that women with menopause seek treatment? what is the cause of this symptom?
49. what are some other common symptoms related to menopause?
50. if a patient comes in with symptoms of menopause, what is an important test to perform first?
51. what are the potential issues in menopause related to osteoporosis?
52. what are some factors that can increase a menopausal woman's risk for osteoporosis?
53. what are some tests to screen for the potential CV disease that might be associated with menopause?
answers
1. no signs of puberty before 13
menarche 16yo
2. negative pregnancy test, missed menses for over 3 months, have less than nine menses per year.
3. hypo or hyperthyroid symptoms
virilization (hypertrichosis, hirsuitism)
obesity
4. PCOS
5. Cushing's.
6. a microscopic assessment of (endometrial?) cells that looks at the stage of development of cells present which is an indication of the degree of estrogen influence. (superficial cells: high estrogen influence. basal cells: low estrogen influence)
7. hypothyroid.
8. thyroid panel and prolactin.
9. pregnancy test
CMP
CBC, sed rate
celiac panel
bone age
10. infertility.
11. prolactin levels.
12. primary ovarian insufficiency.
13. hypothalamic amenorrhea.
14. pituitary tumor, ovarian, adrenal tumor.
15. TVUS to see any structural abnormalities.
16. PCOS and hypothalamic.
17. abnormal bleeding in the absence of signs of structural abnormality, inflammation or pregnancy.
18. puberty and perimenopause.
19. related to anovulation, can be caused by PCOS or idiopathic.
20. polymenorrhea, menorrhagia, metrorrhagia.
21. thyroid panel
TVUS
progesterone test
EMB
22. good for detecting if patient is ovulating in general: test on day 21.
23. due to prostaglandin excess, pain related to excess contraction, begins in menarche and has consistent episodes.
24. structural abnormality: endometriosis, adenomyosis, fibroids.
25. colicky pain that begins 1-3 days prior to menses and lasts until 2-3 days after.
26. NSAID's and OCP's will alleviate symptoms of primary dysmenorrhea and not secondary dysmenorrhea.
27. fluctuations of estrogen / progesterone levels, increased sensitivity of tissues to E/P levels, fluid retaining effects of estrogen.
28. PMS journals.
29. thyroid disease
other hormonal disorders
affective disorders
30. 5-10% of women.
31. anovulation plus androgen excess symptoms.
32. test FSH/LH levels on day 3 of cycle, can be 1:3 instead of 3:1. high LH levels indicate chronic anovulation.
33. follicles that have not ovulated.
34. CV disease
diabetes
endometrial carcinoma
35. irregular menses
hirsuitism, acne, alopecia
mild to severe obesity
36. salivary hormone levels: estrogen, testosterone, progesterone, DHEA, cortisol
37. polycystic ovary; string of pearls morphology.
38. hyperinsulinemia.
39. premature menopause that results from insufficient estrogen production from ovaries despite high gonadotropin hormone levels.
40. autoimmune
chemotherapy / pelvic irradiation
congenital thymic aplasia
galactosemia
gonadal dysgenesis
41. amenorrhea plus estrogen deficiency symptoms.
42. high serum FSH combined with low serum estradiol.
43. one year.
44. 51.
45. increased menses frequency followed by oligomenorrhea.
46. estrogen and progesterone production decrease while testerone stays the same.
47. smoking, high altitude, malnutrition.
48. hot flashes, caused by low estrogen / high gonadotropin levels.
49. vaginal dryness / atrophic vaginitis / dyspareunia
neuropsychiatric changes
night sweats
urinary frequency or incontinence
Gi disturbances
musculoskeletal changes
decreased libido
50. thyroid function to rule out hypothryoid.
51. decreased estrogen levels causes increased bone resorption by osteoclasts which increases likelihood for fractures, etc.
52. alcohol/cigarettes
caucasian/asian race
family history of osteoporosis
GI malabsorption issues
53. lipid profile
glucose
BMI
inflammatory markers
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