gyn-menstrual disord
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| MC cause of ovarian insufficiency | Turner Syndrome (single X). sx: underdeveloped breasts, shield chest, genital hypoplasia, webbed neck, cardio abnormalities, short stature
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| failure of the uterus, fallopian tubes and vagina to develop | Mullerian agenesis
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| MC common cause for 2ndary amenorrhea | pregnancy!
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| female athlete triad | insufficient caloric intake, amenorrhea, and low bone density or osteoporosis
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| hyperprolactinemia can be a SE of what? (3) | many dopamine-lowering meds, pituitary tumor or hypothyroidism
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| in a pt w/ 2nd amenorrhea (and - preg test and med review) order _____ and _____ levels as an initial work up | TSH and prolactin
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| if prolactin is high, order_______ | MRI of sella turcica
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| premature ovarian failure can be associated with? (4) | radiation, chemo, infx, autoimmune process
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| should pts w/ premature ovarian failure be considered infertile? | NO!
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| FSH values of _______ on 2 occasions confirms ovarian failure | FSH >40 IU/mL
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| pts w/ POF should be tx with _______ until normal age of menopause to reduce risk of _______ and _________ | hormones; osteoporosis and heart dz
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| PCOS is a multifactorial disorder that usually includes ________ | hyperandrogenism
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| what are the Rotterdam Criteria? | for PCOS (must have 2 of 3): clinical OR lab hyperandrogenism, oligo-ovulation or anovulation, polycystic ovaries
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| how do you test for lab hyperandrogenism? | total testosterone >50 ng/mL (but if >200 ng/mL it suggests an androgen secreting tumor)
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| other common findings in pts w/ PCOS | obesity, central adiposity, insulin resistance, acanthosis nigricans, skin tags, abnormal LH:FSH ratio where the LH is 2-3x the FSH
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| pts w/ PCOS are at higher risk for what? (4) | T2DM, atherosclerosis, dyslipidemia, and cardiovascular dz
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| ______ is a common cause of infertility | PCOS
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| tx of PCOS? | 1st line: weight loss and exercise, OCPs, Metformin, spironolactone (hirsutism)
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| pts w/ PCOS should be screened for _____ and ______ | dyslipidemia and diabetes
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| 4 causes for secondary amenorrhea | PCOS, hyperprolactinemia, hypothalamic dysfunction, premature ovarian failure
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| ______ and ______ are effective tx for PMS and PDD | SSRIs and SNRIs
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| causes for menorrhagia (5) | fibroids, adenomyosis, endometrial hyperplasia, von Willebrand dz, thrombocytopenia
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| spotting (metrorrhagia) can be caused by? (3) | cervical polyps, cervical CA, infection
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| causes of AUB w/ anovulatory pattern (7) | PCOS, thyroid dysfunction, hyperprolactinemia or med, uncontrolled DM, hypothalamic dysfunction/athlete triad, first 1-2 yrs after menarche or perimenopause, pregnancy
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| causes of AUB w/ ovulatory pattern (5) | thyroid dysfunction, coag defects/bleeding disorder, fibroids, polyps, advanced liver disease
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| first 3 tests ordered for AUB? | pregnancy, TSH, prolactin level
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| if the etiology of AUB can't be determined, pt has _________ | DUB (dysfunctional uterine bleeding)
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| primary tx for anovulatory DUB | hormonal therapy
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| occurs when simple proliferation advances to abnormal proliferation that involves glandular and stromal elements of the endometrium | endometrial hyperplasia
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| endometrial hyperplasia is caused by continuous exposure to endogenous or exogenous ________ stimulation in the absence of ________ | estrogen, progesterone
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| endogenous and exogenous source of estrogen? | endogenous: obese women (commonly seen in PCOS)
exogenous: HRT w/o progesterone
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| additional RF of endometrial hyperplasia? | HTN and DM
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| which histologic variation has the highest and lowest chance of progressing to CA? | highest=atypical complex hyperplasia
lowest: simple hyperplasia
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| US can be utilized to evaluate _______ ______ | endometrial stripe (<4mm in postmenopausal women)
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| test of CHOICE in endometrial hyperplasia | endometrial biopsy
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| tx of endometrial hyperplasia | hysterectomy (atypical complex hyperplasia) REFER ALL ATYPICAL PTS,
progestin therapy (but relapse is common in atypical types after therapy stops), D&C (pts w/o atypical changes)
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| who should be evaluated for endometrial hyperplasia or CA? (4) | >45yo w/ AUB, <45yo w/ AUB, anovulation and obesity, pts who fail to respond to med tx for AUB, certain findings on Pap
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| endometrial CA has a ______ prognosis | good!
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| endometrial CA mostly occurs in _______ women | postmenopausal
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| Type 1 endometrial CA is usually related to prolonged exposure to _______ w/o _______ | estrogen, progesterone
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| Type 2 endometrial CA are not preceded by _______ ________ and have a ______ prognosis than Type 1 | endometrial hyperplasia, worse!
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| gold standard for dxing endometrial CA? | endometrial biopsy
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| tx for endometrial CA? | total abd hysterectomy and bilateral salpingo-oophorectomy
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| f/u time for endometrial CA? | every 3-6months for 2yrs, then annually after that
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| what does staging and grading mean? | stage I-IV describes extend of CA spread. Grade describes the % of tumor that is solid
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| most common finding of endometrial CA? prognosis? | adenocarcinoma, positive prognosis
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