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Day 3a and 3b
Menstrual and Endometriosis
| Question | Answer |
|---|---|
| Diag criteria of PMS | At least one "Affective" and "Somatic" during five days befores menses for AT LEAST 3 previous menstrual cycles |
| Diag criteria of PMDD | During Luteal phase (5 - 1 from primary). Preset for most months of previous year. No longer present the week of and after menses |
| Diet supplement of PMS and PMDD | Vit B6 (avoid dose >100 mg/d), Calcium Carbonate (1200mg/d) |
| Pharmacologic theray of PMDD (after 3 mo of non-pharmacologic) | CHC, SSRI, Diuretics (Spirinolactone = during Lutenal), NSAIDS, GnRH agonist |
| What not recommend treatment of PMDD | Benzo, Other antidepressants, Bromocriptine (because of ADR) |
| What drugs - helpful for bloating, breast tenderness, and water wt gain (monitor electrolytes) | Diuretics - spinolactone |
| What drugs - Intermittent therapy (luteal phase only) is as effective as continuous treatment | SSRI |
| Mefenamic acid | NASID -- Naproxen |
| Commorbid psychologic disorder of PMDD | Depression, Bipolar, Postpartum depression (major), Substance abuse, FH of mood disorders |
| Symptoms no longer present the week of and after menses | PMDD |
| Risk factors of PMDD | Age >30 (as early as 14), FH |
| Etiology of Menstrual disorder | Decrease GABA, 5-HT, Prostaglandin. Sex hormones sensitive to sligh fluctuation. Symptoms improved when ovulation is inhibit |
| Symptoms during 5 days before mens for at least 3 previous menstrual cycles | PMS |
| Prevelence of Endometriosis | Peak 30-40s, pelvic pain and infertility but also aymptomatic |
| Treatmnet Endometriosis: Minimal to Mild | NSAIDS and Contraceptive |
| Treatmnet Endometriosis: Mod to severe | Surgery |
| Drugs - First choice for mod to severe of Endometriosis | GnRH Agonist (6 mo max --> bone effect) |
| Drugs? Inhibit Estrogen production by causing (-) FB o LH and FSH | GnRH Agonist |
| Adminster of GnRH | Inject (SubQ) monthly or q3 mos depending on dose |
| What meds need to "add back" to relieve symptoms | GnRH agonist |
| Goserelin Acetate (Zoladex) | GnRH agonist |
| Leuprolide Acetate (Lupron Depot) | GnRH agonist |
| Nefareline Acetate (Synarel) | GnRH agonist |
| One study, post-operative use was superior to Goserlin Acetate (GnRH agonist) with respect to ----? | Mirena (IDU) -- to dysmenorrhea (painful menstruation) |
| Drug - No deleterious efects o bone mireal density | Danazol (Inhibit LH and FSH) |
| Have androgenic properties ADR | Danazol (does not treat pain NOR restore fertility) |
| PCOS Menstrual problems | Women don't ovulate and may be oligomenorrheic or amenorrheic |
| PCOS: Acanthosis Nigrican? | Skin hyperplasia = brown or gray around the neck |
| PCOS Complications | Glu intolerance, diabetes, HTN, Dyslipidemia and CHD. Endometrial hyperplasia and cancer (insufficient progesterone) |
| DecreaseInsuline sensitivity | Metformin, TZD (Pioglitazone, Rosiglitazone), Acarbose |
| Recommend for intfertility | Clomiphene Citrate and Urofollitrofin (Bravelle) |
| Drugs - Lowering Testosterone concentration and promote ovulation | Metformin |
| BBW: heart failure? | TZD (thiazolidiediones) |
| Drugs - Decrease androgen concentration. also Absorption of Carb and decrease BMI | Acararbose |
| Flutamide | Androgen Antagonist |
| Finasteride | Androgen Antagonist |
| Spironolactone | Diurectic - Androgen antagonist |
| BBW: hepatoxiticy | Flutamide |
| Preg X | finasteride |
| Non-pharmacologic Therapy for PMS or PMDD | Supportive therapy, A structure sleep schedule, Dietary restriction (Na, Caffeine restriction), Fiber, low fat, complex carb. Aerobic excercise |
| PMM Treatment: Mild to Moderate | Good nutrition, excercise, Calcium Supplement |
| PMM Treatment: Predominatly Physical symptoms | NSAIDS, Spirinolactone, or CHC |
| PMM Treatment: Predominantly mood symptoms and impariment in functioning | Inititiate SSRI, then initiate GnRH agonist with add-back |
| PMM Treatment: Combo Hormonal Contraceptive NOTES | Only improve physical symptoms (not mood), Drosperione ?better. NO PROGESTERONE ALONE |
| ADR or GnRH agonist | Hot flushes, sweating, vaginal dryness, loos bone density, emotional liabiltiy, decrease libido. NO longer period. (must use add-back) |
| ADR of Continuous progesting (Depo-Provera) | Breakthrough bleeding, wt gain, fluid retention, delayed menstrual cycle recovery |
| MOA of GnRH agonist | binding to pituitary receptors cuasing (-) FB on LH and FSH release --> LH receoptor down regulation (initialy they increase release) |
| MOA of Danazol | Inhibiting secretion of LH and FSH. No deleterious effect on bone density but have Angrogenic properties |
| Drugs cause local endometrial stabilization (pseudo-decidualization) | IUD ( better than GnRH for post-operative used to treat dysmenorrhea (painful menstrual) |
Created by:
_Tom_
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