GYN Endocrine, AUB, DUB, Menstrual disorders
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| the 4 layers of endocrine control in the female reproductive system | hypothalamus, pituitary, ovaries, endometrial lining (uterus)
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| hypothalamus secretes: | GnRH
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| pituitary secretes: | FSH and LH
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| ovaries secrete: | estrogen (follicles), progesterone (corpus luteum), and testosterone
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| primary amenorrhea | has never had a period, may be congenital
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| secondary amenorrhea | has had at least one menstrual cycle
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| underlying conditions of amenorrhea | pregnancy (95% of amenorrhea), hypothalamic dysfunction (thyroid, stress, exercise), pituitary dysfunction (adenomas), ovarian dysfunction (PCOS, menopause, chromosomal), outflow tract abnormalities (congenital)
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| metrorrhagia | irregular and frequent bleeding
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| menorrhagia | heavy and excessive bleeding
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| menometrorrhagia | irregular, frequent, heavy, and excessive bleeding
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| oligomenorrhea | infrequent menstrual flow
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| DUB (dysfunctional uterine bleeding) | bleeding source is uterine/hormonal, abnormal bleeding, anovulatory or ovulatory (often anovulatory); abnormal bleeding caused by hormonal changes/shifts
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| postmenopausal bleeding | after menopause, ALWAYS abnormal, cancer until proven otherwise
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| estrogen/progesterone preparations | irregular bleeding commonly occurs during the first 3 months of treatment, initial breakthrough bleeding usually resolves spontaneously
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| AUB etiology | may be due to too much or too little estrogen or progesterone
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| AUB common causes | PCOS, OCPs, cancer, adolescent anovulatory cycles, thyroid dysfunction, prolactinomas, fibroids, onset of menopause
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| AUB empiric therapy | < 35 y.o. = try progesterone withdrawal check TSH, FSH/LH, prolactin, (possibly testosterone); > 35 y.o. = r/o cancer, endometrial biopsy (perimenopausal or postmenopausal), sonohysterogram (postmenopausal)
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| Hirsutism/hypergonadism cause | increased ovarian androgens
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| Hirsutism/hypergonadism treatment options | OCPs, spironolactone
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| Anovulatory/infertility cause | too much estrogen, not enough progesterone leads to immature uterine lining
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| Anovulatory/infertility treatments | weight loss (decrease endogenous estrogen), clomiphene (blocks estrogen feedback), glucophage (metformin, insulin sensitizer)
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| Insulin resistance/diabetes cause | obesity + possible other factors
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| Insulin resistance/diabetes treatments | metformin
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| Obesity cause | insulin resistance + possible other factors
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| Obesity treatments | diet and exercise, metformin
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| Endometrial hyperplasia cause | unopposed proliferative phase (again, endogenous estrogen)
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| Endometrial hyperplasia treatments | combined OCPs, progesterone-only OCPs (intermittent or continuous), possibly metformin
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| PCOS key points | excess estrogen, common cause of infertility and menorrhea, if endometrium is allowed to build up may cause endometrial hyperplasia, sometimes hyperplasia may turn atypical (precancerous), avoid atypical hyperplasia by progesterone cycling
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| Uterine cancer key points | any postmenopausal bleeding is abnormal, AUB in perimenopause requires endometrial biopsy, FH plays a significant role, prolonged estrogen increases risk, evaluate the cervix as well as the uterus
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| Dysmenorrhea | recurring pain that occurs consistently with the menstrual cycle
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| Primary dysmenorrhea | pain resulting from the normal menstrual cycle, a diagnosis of exclusion, usually starts within first 2-4 years, s/s mediated by sloughing & PGs production & progesterone levels, tx with NSAIDs or OCPs or both
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| Secondary dysmenorrhea | pain resulting from a pathologic menstrual process (pelvic adhesions, pelvic congestion, endometriosis, cervical stenosis, etc.)
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| Pelvic congestion diagnosis | clinical, imaging (US, CT, arteriogram), laparoscopy
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| Pelvic congestion medical treatment | progesterone
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| Pelvic congestion surgical treatment | embolization, sclerotherapy
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| Pelvic congestion | varicose veins
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| Hx of scant flow: | cervical stenosis
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| Hx of worsening pain at night or when standing: | pelvic congestion
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| Hx of accompanying dyspareunia: | endometriosis, pelvic adhesions
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| Hx of infertility: | pelvic adhesions
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| Hx of pain worsening with stress: | somatization
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| Hx of mood swings: | depression
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| Premenstrual s/s (dysphoric disorder and syndrome) | bloating, fatigue, labile mood, increased appetite, headaches, mastalgia
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| Premenstrual incidence | syndrome: 30%, dysphoric disorder: 5%
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| Premenstrual treatments | SSRIs (continuous or luteal phase [symptomatic days have higher doses]), BZDs (alprazolam), spironolactone, calcium (600 mg bid), GnRH agonist therapy/oophorectomy (last resort)
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| Amenorrhea may result from: | any disorder involving hypothalamus, pituitary, ovary, or outflow tract
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| Most common cause of secondary amenorrhea: | pregnancy
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| DUB may result from: | any abnormality in estrogen or progesterone levels
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| Uterine cancer must be suspected in: | middle-aged women or older with unexpected vaginal bleeding
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| Dysmenorrhea usually improves with use of: | NSAIDs or OCPs, regardless of cause
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| Premenstrual mood disorders usually respond to: | medical therapy
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Created by:
Carrie D.
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