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Reproductive System
Part I
| Question | Answer |
|---|---|
| menarche average age | 12-13 |
| anovulatory cycles (irregular), or post OC termination | 6mon - 1 year after menarche |
| follicular phase | FSH = ovarian follicle growth. ovarian follicle produces estrogen. which causes uterine lining to proliferate. |
| estrogen surge at day 14 causes what to spike? | LH, stimulates release of ovum from follicle. |
| When does luteal phase begin? | post release of ovum from follicle. follicle reminants in ovary become corpus luteum and secrete progesterone |
| what does progesterone do? | maintain uterine lining for ovum implant |
| IF FERTILIZATION OCCURS...developing trophoblast syntehsizes human chorionic gonadotrophin (hCG) and what does this do? | maintains corpus luteum until placenta |
| IF NO FERTILIZATION... | corpus luteum degenerates (hCG is not there to sustain Corp Lut) progesterone fall. |
| endometrial lining sloughs | no progesterone |
| remove estrogen and progesterone... | FSH increase (follicular phase) |
| Dysfunctional bleeding causes? | primary menorrhagia from hypothalamic-pituitary gonadal axis = continuous estrogen stimulation, endometrium overgrows, sloughs off at irregular times and varying amounts ( timing near menarche, menopause) |
| endometrial sampling is the gold standard to determine if ovulation is messed up | dx for dysfunctoinal bleeding |
| tX for dysfunctional bleeds | oral contraceptives first line (uncomplicated). excessive bleeds - conjugated estrogens. NSAIDS reduce menstrual blood loss. surgerical: dilate curettage, hysterectomy (refractory) |
| most common gynecologic cancer in US? | endometrial cancer |
| median age for dx of endometrial cancer? | 60 |
| prognostic for endometrial cancer? | histological, myometrial invasion, histologic type |
| DM, Obesity, nulliparity (never giving birth), late menopause, unopposed estrogen therapy, tamoxifen (works as agonist in uterus, but works against breast ca) | risk factors for endometriosis |
| irregular bleeding, prolonged heavy periods, or spotting. normal pelvic exam, endometrial biopsy. pelvic US r/o fibroids, polyps, and hyperplasia | endometrial cancer |
| depends on staging, treatment: sugreical hysterectomy, salpingo-oophorectomy and postoperative radidation therapy | endometrial ca |
| endometrial tissue in ovary, pelvic periotoneum, round ligament, sigmoid colon in women of reproductive age | endometriosis |
| dysmenorrhea, dyspareunia (pain in intercourse), infertile, abnorm bleeding, chronic pelivic pain | endometriosis sx |
| progressive uterosacral nodules, fixed retroverted uterus, (if ovary invovled = tender fixed adnexal mass noted) | endometriosis |
| laparoscopy required for dx to visualize structures of uterus | endometriosis |
| endometriosis treatment | supression: OC or medroxyprogesterone supression of FSH/LH = eliminates estrogen: Danazol |
| dysmenorrhea tx for NSAIDS | start onset of menses until sxs abate, or prior to menses if sx severe. max dose 800mg ibuprofen q 8 hours. take with food to minimize GI - OC: suppression of ovulation - decreased prostaglandins |
| failure to improve with NSAID, OC; onset of sx iwth menarche, pelvic pain outside of menses, worsening sx, hx of STI | RED Flags - consider referral to laparoscpy |
| when to proscribe paragard (copper IUD for contraception and dysmenorrhea) | severe pain with menses for year. (missed work, borderline uterine enlarged. Recommend pamprin) |
| differentiating between primary and secondary dysmenorrhea | secondary: pain with age. primary: loss of pain with age (after pregnant) |
| endometriosis (enlarged uterus, IUD for contra 3 yrs), adenomyosis (lining grows into muscular boarder), leiomyomata, ovarian cyst, pelvic adhesion, chronic PID, cervical stenosis, copper IUD, IBS, inflammtory Bowel dz, interstitial cystitis | secondary dysmenorrhea |
| Dx for causes of pain in menses | laparoscopy, hysteroscpy |
| tx for causes of pain in menses | underlying: abx (PID), cautery (implant), hormonal (endometriosis), resection (fibroid), cystectomy ovarian (for cysts), hysterectomy (cancer), drugs for IBD, cystitis |
| abn Serotonin in luteal phase possible cause | PMS |
| Dx for PMS | menstrual hx of sx, general medical hx, TSH, FSH, HcG, prolactin if menses irregular. r/o somatic (r/o mood, premenopause, thyroid, substance abuse |
| Tx for PMS | exercise, stress reduce, SSRI (fluoxetine, OC -= shorten placebo), GnRH (lupron) for refractory. |
| heavy periods - menorrhagia clinical pearls | >80ml, prolonged >7 days, irregular btw menses espcially. anovulatory bleeding, cycle length less than 24 days. |
| anovulation = menorrhagia or none | common in adolescence, perimenopause, PCOS, thyroid dz. |
| menorrhagia differential | endometrial polyp, leiomyomata (submucus), adenomyosis, uterine malignancy |
| abnormal bleeding hx (easy bruisability), on conraceptives, assoc. pain/discharge/pressure/hot flashes, on IUDs | Dx questions for menorrhagia |
| PE: thyroid, contour of uterus, adnexal mass, pelvic pain, bleeding site | PE for excess/irregular bleeding |
| Labs: hcG, CBC (r/o anemia, thrombocytopenia) cerical cytology (pap smear), STI screening (Gc/Chl), TSH, coag tests (PT, PTT, Factor VIII, vWillebrand) | labs for menorrhagia |
| anovulatory menorrhagia | OC cycling, progestin withdrawal bleeds scheduled, IUD (Mirena) |
| Hysteroscopic resection (endometrial polyps, myoma) OC/IUD (adenomyosis/myoma heavy bleeds), endometrial ablation, hysterectomy | Menorrhagia treatment options |
| if menopause before age... considered premature | 40 |
| diminished estrogen leads to increased... | FSH, LH (lab tests indicate high FSH for menopausal women - amenorrhea) |
| lose benefits of estrogen (natural) in menopause | lipid profile, vascular endothelium damage, loss of bone resorption (osteopenia) |
| progesterone with estrogen decreases risk of ... | endometrial hyperplasia, cancer |
| hepatic dysfunction, estrogen neoplasm, DVT, undiagnosed vaginal bleed | OC risk factors |
Created by:
jamieseals
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