What percentage of PCOS patients are obese?
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30 - 75%
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What percentage of PCOS patients are obese?
30 - 75%
What diagnostic methods are used for secondary dysmenorrhea?
Pelvic sonogram and laparoscopy.
How is menopause defined?
No menstrual cycle for 1 year.
What is the mean age for menopause?
51 years old.
What are the most common symptoms treated by Hormone Replacement Therapy (HRT) during menopause?
Hot flushes and vaginal dryness.
What is one rare cause of primary amenorrhea in adolescents?
Pituitary defects.
What is the definitive method for diagnosing endometriosis?
Laparoscopy.
What is a rectocele?
Herniation of the rectum into the posterior wall of the vagina.
How is PMS usually diagnosed?
PMS is usually diagnosed clinically.
What is the likely physical exam finding in a 14-year-old girl with an XY karyotype who has not had menarche?
Underdeveloped female external genitalia
Which lab test is used in the diagnosis of endometriosis but has limited sensitivity?
CA 125.
In which age group are benign ovarian cysts most common?
Reproductive age group.
At what age does perimenopause usually start?
About age 47.
What changes in menstrual flow are associated with perimenopause?
Change in amount or duration of menstrual flow.
What are some lifestyle changes that can help reduce the symptoms of PMS or PMDD?
Regular exercise, a balanced diet, adequate sleep, stress management techniques, and reducing caffeine and alcohol intake.
What is the most common location for endometriosis lesions?
The ovary.
During which phase of the menstrual cycle is a transvaginal ultrasound typically performed to diagnose PCOS?
During the follicular phase of the menstrual cycle.
What receptors are found in leiomyomas?
Estrogen and progesterone receptors.
What are the two main functions of FSH in the menstrual cycle?
FSH causes the egg to mature and promotes estrogen secretion.
What is the most likely diagnosis for a 41-year-old female with intermittent vaginal bleeding and a dark red lesion coming out of the os?
Cervical polyp
What is a cystocele?
Prolapse of the bladder into the anterior wall of the vagina.
What are the current indications for starting HRT?
Significant hot flashes and vaginal dryness within 5 years of cessation of menses, and no family history of cancer.
What are some symptoms of secondary dysmenorrhea besides pelvic pain?
Infertility and dyspareunia (painful intercourse).
What are some risk factors for developing endometriosis?
Family history, early menarche, long menstrual flow each month, and heavy menses.
What happens to the levels of FSH during menopause?
FSH levels become high.
What is the most likely finding on physical exam for a 41-year-old female with intermittent vaginal bleeding for 3 months?
a) Enlarged, irregular uterus
What are common signs of menopause?
Decreased size of uterus and ovaries, and breasts.
Besides treating hot flushes and vaginal dryness, what other conditions can HRT help prevent?
Osteoporosis and colon cancer.
What are the three components of the classic triad of endometriosis?
Dysmenorrhea, dyspareunia, and infertility.
Which SSRI is most commonly used as an alternative therapy for hot flashes?
Paxil.
What is dyspareunia?
Painful intercourse.
What happens in hypothalamic-pituitary dysfunction when GnRH is produced but the pathway is blocked?
Tumors or destruction of the transport path or pulsation mechanism can block the pathway.
What is the most common presenting symptom of endometriosis?
Pelvic pain.
What is the age range generally considered for younger individuals?
4 to 8 years old.
What are nonfunctional ovarian cysts?
Cysts that do not arise from normal ovarian function and are not neoplastic.
How are endometriomas typically managed?
Through surgical incision.
Which imaging techniques are used in the diagnosis of endometriosis but have limited sensitivity?
Ultrasound and CT scan.
What is secondary dysmenorrhea?
Excessive menstrual pain arising in mid-reproductive years, usually pathologic.
What is uterine prolapse?
Prolapse of the uterus down the vaginal canal.
What are the characteristic appearances of ovaries in PCOS on a sonogram?
Ovaries appear enlarged with smooth, pearl-white surfaces without indentations, often described as 'oyster ovaries' or 'string of pearls'.
What does the management of ovarian cysts depend on?
The type of cyst.
What is the most common gynecological cancer?
Endometrial cancer.
What is the first-line pharmacologic treatment for premenstrual dysphoric disorder (PMDD)?
SSRIs
What are some common disorders found in younger individuals aged 4 to 8?
The text does not specify, but common disorders in this age group can include ADHD, autism spectrum disorders, and learning disabilities.
What are some late changes associated with menopause?
Osteoporosis and cardiovascular disease.
What causes the symptoms and signs of menopause?
Estrogen deficiency.
What aspects of a patient's history are important for diagnosing PMS?
Current medications, history of mental disorders, and history of substance abuse.
How can the cyclic pattern of PMS be determined?
By using a menstrual diary or app.
What is the most common cause of hypothalamic-pituitary dysfunction leading to primary amenorrhea?
Abnormal GnRH production with no pathology.
What alternative treatments might help with primary dysmenorrhea?
Vitamin B or magnesium supplements, and acupuncture.
What aspects of a patient's history are important for diagnosing PCOS?
History of onset/duration of signs, menstrual history, and history of infertility.
Why is breast cancer not considered a gynecological cancer?
Because it can affect men as well.
What is a common pattern in menstrual periods during perimenopause?
Skipping menstrual periods.
What does an increased LH/FSH ratio indicate in the context of PCOS?
Endocrine dysfunction.
Name two SSRIs commonly used for PMDD.
Fluoxetine (Prozac) and sertraline (Zoloft).
What are the primary goals in managing abnormal uterine bleeding?
Control current bleeding and reduce loss in subsequent cycles.
How long must menses be absent to diagnose secondary amenorrhea in someone with previously normal cycles?
3 months.
How long must menses be absent to diagnose secondary amenorrhea in someone with previously irregular cycles?
6 months.
What are some lifestyle management strategies for premenstrual syndrome (PMS)?
Stress management, exercise, yoga, regular sleep, and dietary changes.
What are common vasomotor symptoms experienced during menopause?
Hot flashes.
What vaginal symptom is commonly associated with menopause?
Decreased vaginal lubrication.
What is a potential reproductive consequence of hormone irregularity in PCOS?
Recurrent spontaneous abortion.
What is the most common type of abnormal uterine bleeding (AUB)?
Heavy menstrual bleeding.
What is Premenstrual Syndrome (PMS)?
PMS is a group of symptoms that occur in women, typically between ovulation and a period. Symptoms can include mood swings, tender breasts, food cravings, fatigue, irritability, and depression.
What are the treatment options for adenomyosis?
Oral contraceptives, endometrial ablation, and hysterectomy.
What is the normal frequency range of the menstrual cycle?
24 - 38 days, with an average of 28 days.
How can thyroid dysfunction affect menstruation?
It can cause secondary amenorrhea.
Which blood tests are included in the lab workup for abnormal uterine bleeding?
CBC, type and screen, TSH, Luteinizing hormone, prolactin.
What is a classic finding in the physical exam for diagnosing endometriosis?
Retroverted uterus with uterosacral ligament nodularity.
What did the cervical exam reveal in the case of the 41-year-old female with intermittent vaginal bleeding?
A dark red lesion coming out of the os.
What imaging technique is commonly used for diagnosing PCOS?
Sonogram (transvaginal ultrasound).
What type of tumor is a leiomyoma?
A benign smooth muscle tumor.
What is the first line of treatment for primary dysmenorrhea?
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs).
In which demographic are leiomyomas most commonly found?
Multiparous individuals in their 40s.
What causes a rectocele?
A rectocele is often caused by childbirth, heavy lifting, chronic constipation, or other activities that put strain on the pelvic floor muscles.
How is a rectocele diagnosed?
A rectocele is diagnosed through a pelvic exam, and sometimes imaging tests like MRI or ultrasound may be used for further evaluation.
What conditions are represented by the 'PALM' part of the PALM-COEIN classification?
'PALM' stands for Polyp, Adenomyosis, Leiomyoma, and Malignancy and hyperplasia.
What are some alternative treatments for vaginal dryness during menopause?
Commercial lubricants (e.g., K-Y) and topical estrogen.
What menstrual pattern is observed in patients with PCOS?
Normal menses followed by episodes of amenorrhea that become progressively longer.
What is the primary management approach for ovarian torsion?
Surgical intervention.
What is a common finding on a pelvic exam in patients with PCOS?
Palpable ovaries.
What genetic condition is listed as a cause of primary amenorrhea?
46, XY karyotype.
What is the first step in the diagnostic workup for secondary amenorrhea?
Pregnancy test.
How can hormone replacement therapy in menopause lead to abnormal uterine bleeding?
It can cause iatrogenic abnormal uterine bleeding.
What is the third-line treatment for inducing pregnancy in women with PCOS?
Metformin (alone or with clomiphene citrate), which increases ovulation and pregnancy rates and improves insulin sensitivity.
What role does exercise play in managing premenstrual syndrome (PMS)?
Exercise can help alleviate PMS symptoms by improving mood and reducing stress.
What serious condition can cause abnormal uterine bleeding (AUB) in postmenopausal women?
Malignancy.
Why is liver dysfunction or disease an absolute contraindication to HRT?
Because the liver metabolizes hormones, and dysfunction can lead to improper hormone processing and increased risk of side effects.
How do the symptoms of PMS and PMDD differ?
While both PMS and PMDD include physical and emotional symptoms, PMDD symptoms are more severe and can significantly interfere with daily life and relationships.
Name three common locations where endometriosis lesions can be found.
Ovary, cul-de-sac, and broad ligaments.
What is Hormone Replacement Therapy (HRT) used for?
HRT is used for the management of menopause symptoms.
Do many benign ovarian cysts resolve on their own?
Yes, many resolve spontaneously.
How are ovarian cysts in postmenopausal women considered until proven otherwise?
Malignant.
What should you look for during the physical examination for abnormal uterine bleeding?
Growths/masses and trauma to the area.
What is the #1 cause of androgen excess and hirsutism?
Polycystic Ovarian Syndrome (PCOS).
What are the potential complications of ovarian torsion?
Occlusion of blood supply leading to necrosis, peritonitis, loss of ovary, and fertility.
Which syndrome is associated with primary amenorrhea and ovarian dysgenesis?
Turner's Syndrome.
What topical treatment can be used for vaginal dryness during menopause?
Topical estrogen.
What alternative test can be used to assess insulin resistance if an oral glucose tolerance test is not available?
Fasting glucose.
Which supplements are mentioned as part of PMDD treatment?
Calcium, B6, magnesium, and St. John’s wort.
How is a cystocele typically diagnosed?
A cystocele is typically diagnosed through a pelvic exam and may be confirmed with imaging tests like a cystourethrogram.
What is a subserous leiomyoma?
A type of leiomyoma that deforms the external serosa.
What is a possible pathophysiologic factor for PMS?
Low serotonin levels.
What are the most common symptoms of iatrogenic abnormal uterine bleeding?
Spotting and intermittent bleeding.
What is the first-line treatment for menstrual irregularity in PCOS patients not trying to get pregnant?
Oral contraceptives.
How can light therapy be beneficial for premenstrual syndrome (PMS)?
Light therapy can help improve mood and reduce PMS symptoms.
What are some causes of metrorrhagia?
Endometrial polyps, endometrial/cervical carcinoma, oral contraceptives.
What type of cancer is a long-term risk for individuals with PCOS?
Endometrial carcinoma.
What are the symptoms of thyroid dysfunction that can lead to secondary amenorrhea?
Weight loss or gain, sleeping irregularity.
What can cause secondary amenorrhea due to hypothalamic-pituitary-ovarian feedback system disruption?
Weight loss, eating disorder, excessive exercise.
What is Leuprolide and how is it used in endometriosis management?
Leuprolide is a GnRH agonist administered IM or nasally every 3 months to create a pseudomenopause state.
What reproductive structures are absent in Mullerian Dysgenesis?
The uterus and the upper 2/3 of the vagina.
At what age are cervical polyps most common?
Over 40 years old.
What is the treatment for symptomatic cervical polyps?
Excision.
What is a common sonogram finding in the diagnosis of Polycystic Ovary Syndrome (PCOS)?
A 'string of pearls' appearance.
What does the management of secondary dysmenorrhea depend on?
It depends on the cause.
How does increased prolactin affect the menstrual cycle in the context of primary amenorrhea?
Increased prolactin stops the normal feedback system.
What is an endometrioma?
A unilateral hemorrhagic or 'chocolate cyst' that is a type of nonfunctional ovarian cyst.
What is the risk associated with using estrogen alone in HRT?
Using estrogen alone increases the risk of endometrial cancer.
How long is it considered safe to use HRT?
3 to 5 years.
What type of pain is associated with secondary dysmenorrhea?
Pelvic pain that is dull and aching, related to the menstrual cycle but timing depends on the cause.
What is the most common uterine tumor?
Leiomyoma (Fibroids).
What should you consider in the patient's history when diagnosing abnormal uterine bleeding?
Age, sexual history, risk factors, good menstrual history, and other bleeding history.
What symptom is commonly associated with leiomyomas?
Heavy and/or prolonged bleeding.
What does anovulation refer to in the context of PCOS?
The absence of ovulation.
What is ovarian torsion?
Ovarian torsion is when the ovary flips on the fallopian tube.
What are common symptoms of a rectocele?
Common symptoms include a feeling of pressure or fullness in the rectum or vagina, difficulty with bowel movements, and discomfort during sexual intercourse.
What characterizes polycystic ovaries in PCOS?
The presence of multiple cysts in the ovaries.
What are some non-pharmacological treatments for hot flashes during menopause?
Yoga and acupuncture.
What are the most common causes of ovarian torsion?
Most commonly due to a cyst or neoplasm, but sometimes idiopathic, especially in premenarchal girls (10-15 years old).
What are the characteristics of follicular cysts?
They are unilateral and typically resolve within 60 days.
What does the acronym PALM-COEIN stand for in the context of abnormal menstrual bleeding etiology?
PALM-COEIN stands for Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified.
Name two herbal or dietary supplements used as alternative therapies for hot flashes.
Black cohosh and soy.
What type of dysfunction is associated with primary amenorrhea related to the brain's regulatory centers?
Hypothalamic-pituitary dysfunction.
What causes endometrial hyperplasia?
Unopposed estrogen.
How does PCOS affect the risk of miscarriage during pregnancy?
PCOS increases the risk of miscarriage.
Which gland's defects can lead to primary amenorrhea?
Pituitary gland defects.
What are the two main functions of LH in the menstrual cycle?
LH causes the egg to be released and regulates estrogen and progesterone secretion.
What specific pituitary defect can lead to primary amenorrhea?
Pituitary microadenoma.
What conditions can result from weakened pelvic floor muscles during menopause?
Cystocele, rectocele, and uterine prolapse.
What are the characteristics of the vaginal bleeding described by the 41-year-old female?
Intermittent vaginal bleeding for 3 months, regular cycles with average flow for 4 days, and random spotting.
Which hormones are commonly used together in Hormone Replacement Therapy (HRT)?
Estrogen and Progesterone.
What are some common causes of secondary dysmenorrhea?
Endometriosis, pelvic adhesions, fibroids, and polyps.
What is the most likely diagnosis for a 14-year-old girl with no menarche, known XX karyotype, and no significant height increase?
Gonadal dysgenesis.
How common are cystocele, rectocele, and uterine prolapse after menopause?
They are common, occurring in about 50% of postmenopausal women.
What are the nonstructural causes of AUB related to the endometrium?
Infection and inflammation.
What lab tests are commonly conducted when diagnosing PMS?
CBC, basic chemistry, and TSH.
What are common symptoms of leiomyomas?
Abnormal menstrual bleeding, pain, pressure, and infertility.
Which NSAID is commonly used first for primary dysmenorrhea?
Ibuprofen.
Who first described Polycystic Ovary Syndrome (PCOS) and when?
Stein and Leventhal in 1935.
What are the three components of the classic triad of PCOS?
Anovulation, Polycystic ovaries, Androgen excess (hyperandrogenism).
What type of backache is associated with dysmenorrhea in endometriosis?
Low sacral backache premenstrually that resolves with menses.
What is primary dysmenorrhea?
Primary dysmenorrhea is menstrual pain without a pathologic cause.
How does the menstrual cycle length change during perimenopause?
There is a change in the length of the menstrual cycle.
When is primary dysmenorrhea most common?
It is most common within 2 years of menarche but can occur at any age.
How are functional ovarian cysts diagnosed?
Using a sonogram that shows mobile, simple, fluid-filled cysts.
What type of medication is generally used for PMDD pharmacotherapy?
Nonsteroidal anti-inflammatory drugs (NSAIDs).
Which lab test is used to detect excessive androgen levels in PCOS diagnosis?
Free testosterone.
What is the initial management strategy for functional ovarian cysts?
Observation for 30-60 days.
What imaging technique is commonly used to diagnose ovarian torsion?
Ultrasound.
Which test is preferred for assessing insulin resistance in PCOS diagnosis?
Oral glucose tolerance test.
What are the findings on a physical exam for someone with primary dysmenorrhea?
The physical exam is normal.
How does PCOS influence the likelihood of developing preeclampsia during pregnancy?
PCOS increases the risk of preeclampsia.
What is a non-surgical device used to manage pelvic organ prolapse?
Pessary.
What is endometriosis?
Endometriosis is the presence of endometrial tissue outside the uterine cavity.
What is the most common type of ovarian cyst?
Functional cysts.
What are some causes of hypothalamic-pituitary insufficiency leading to primary amenorrhea?
Eating disorders, extreme weight loss (anorexia), excessive exercise (The Female Triad), stress, and idiopathic causes.
What physical characteristics might be observed in individuals with hypothalamic-pituitary dysfunction leading to primary amenorrhea?
Delayed secondary sex characteristics and short stature.
Why do patients with PCOS most commonly present to a healthcare provider?
Because of hirsutism or infertility.
What are some proposed etiologies of endometriosis?
Retrograde reflux of menstrual tissue during menses, altered immune response, and a possible genetic link.
What vasomotor symptoms are associated with perimenopause?
Hot flashes and day/night sweats.
What percentage of women experience vasomotor symptoms during perimenopause?
75%.
What is secondary amenorrhea?
No menses for 3 months if previous cycles were normal, or no menses for 6 months if previous cycles were irregular.
What is the impact of PCOS on the risk of gestational diabetes?
PCOS increases the risk of gestational diabetes.
What should be done in addition to treating amenorrhea in individuals not desiring pregnancy?
Treat underlying medical conditions and provide reassurance.
What are some treatment options for a cystocele?
Treatment options include pelvic floor exercises, pessary devices, and in severe cases, surgical repair.
Where is an intramural leiomyoma located?
Within the uterine wall.
What is the third step in the diagnostic workup for secondary amenorrhea?
FSH test.
What are some common causes of abnormal uterine bleeding (AUB) in non-pregnant reproductive age women?
Pituitary, polycystic ovaries, thyroid, and ovarian dysfunction.
What internal reproductive feature is present but underdeveloped in individuals with Androgen Insensitivity Syndrome (AIS)?
Atrophic testes.
What are some conditions included in the differential diagnosis of endometriosis?
Ectopic pregnancy, acute appendicitis, PID, adhesions, irritable bowel syndrome, fibroids, ovarian cysts.
What are some treatments for hirsutism in PCOS patients?
Hair removal, bleaching, combination oral contraceptives with anti-androgenic component, spironolactone, shaving, electrolysis, and laser.
What is the purpose of using continuous progesterone in endometriosis management?
To create a pseudopregnancy state.
Which condition involving the formation of scar tissue is part of the differential diagnosis for endometriosis?
Adhesions.
What symptoms are associated with ovarian failure that can cause secondary amenorrhea?
Hot flashes, vaginal dryness, low libido.
What is the purpose of using GnRH agonists like Lupron in the management of leiomyomas?
To reduce the size of leiomyomas, but usage is limited to 6 months.
What is premature ovarian failure and how does it relate to secondary amenorrhea?
Premature ovarian failure is menopause before the age of 40, leading to secondary amenorrhea.
What are Cox-2 inhibitors, and why might they be used for primary dysmenorrhea?
Cox-2 inhibitors, such as celecoxib (Celebrex), are equally effective as other NSAIDs but have fewer gastrointestinal side effects, although they are more expensive.
What characterizes functional ovarian cysts?
An excessive response to otherwise normal function.
What are common symptoms of cystocele, rectocele, and uterine prolapse?
Vaginal fullness, pressure, and feeling of incomplete voiding or defecation.
What are the treatment options for a rectocele?
Treatment options include pelvic floor exercises, lifestyle changes, pessary devices, and in severe cases, surgical repair.
What is the chromosomal pattern in Turner's Syndrome?
XO chromosomes.
What causes primary dysmenorrhea?
It is caused by increased prostaglandins and increased leukotriene levels.
How can ovarian and ovulation dysfunction contribute to primary amenorrhea?
They can prevent the normal menstrual cycle from occurring.
What other type of medication can be used for PMDD besides NSAIDs and SSRIs?
Oral contraceptives.
Which lab test is used to check for lipid abnormalities in PCOS diagnosis?
Fasting lipid profile.
Name two types of antidepressants that can cause iatrogenic abnormal uterine bleeding.
Tricyclic antidepressants and SSRIs.
What dietary changes can help manage premenstrual syndrome (PMS)?
Eating small frequent meals, more complex carbs, fruits and vegetables, more calcium/low-fat dairy, and decreasing caffeine, alcohol, tobacco, chocolate, and sodium.
How can stress management help with premenstrual syndrome (PMS)?
Stress management can help reduce the severity of PMS symptoms.
What type of carcinoma is an absolute contraindication to HRT?
Breast or estrogen-dependent carcinoma.
What is the second-line treatment for menstrual irregularity in PCOS patients not trying to get pregnant?
Metformin.
What urinary symptoms are commonly associated with menopause?
Urinary frequency, dysuria, nocturia, and increased UTIs.
What are the management options for endometriosis if the patient has mild symptoms?
Observation, OTC NSAIDs, oral contraceptives, continuous progesterone (DepoProvera IM or Provera PO).
Which condition characterized by infection of the female reproductive organs is part of the differential diagnosis for endometriosis?
Pelvic Inflammatory Disease (PID).
What are common symptoms of PMS?
Common symptoms of PMS include mood swings, tender breasts, food cravings, fatigue, irritability, and depression.
What is the maximum duration for using Leuprolide in endometriosis management?
6 months total.
What imaging technique is used in the diagnosis of abnormal uterine bleeding?
Sonogram.
What phase is characterized by high levels of progesterone?
Proliferative/Follicular Phase.
What type of bleeding do both cervical and endometrial polyps cause?
Intermenstrual bleeding or spotting.
What is the karyotype and lab finding for pituitary microadenomas in primary amenorrhea?
Karyotype: 46, XX; Lab finding: High prolactin
What are some of the emotional symptoms listed in Column 1 for PMS and PMDD according to DSM-5 criteria?
Depression or hopelessness, anxiety/tension, mood swings (sudden sadness, sensitivity to rejection), anger or irritability.
How does the uterus typically present on examination in a patient with leiomyomas?
The uterus is enlarged, firm, nontender, and asymmetrical.
Besides NSAIDs, what other medication can be used to manage primary dysmenorrhea?
Oral contraceptives.
What is a rectocele?
A rectocele is a condition where the rectum bulges into the vagina due to a weakening of the pelvic floor muscles.
Which age group is most commonly affected by endometriosis?
Women of reproductive age.
What is the #1 cause of ovulatory dysfunction?
Polycystic Ovarian Syndrome (PCOS).
What factors are associated with a lower risk of endometriosis?
Regular exercise (> 4 hours per week), higher parity, and longer duration of lactation.
What are some pregnancy-related risks associated with Polycystic Ovary Syndrome (PCOS)?
Increased risk of miscarriage, preterm labor, preeclampsia, and gestational diabetes.
Which class of drugs is considered best for treating depressive symptoms in PMDD?
Selective serotonin reuptake inhibitors (SSRIs).
What exercises can help treat cystocele, rectocele, and uterine prolapse?
Pelvic strengthening exercises.
What is post-menopausal bleeding considered until proven otherwise?
Hyperplasia.
What is the first choice of treatment for amenorrhea in individuals not desiring pregnancy?
Oral contraceptive pills.
What are some hormonal treatments for abnormal uterine bleeding?
Birth control pills and progesterone-only treatments.
What are some physical characteristics of individuals with Androgen Insensitivity Syndrome (AIS)?
Slightly longer limbs, larger hands and feet, and typical female external genitalia.
Why is regular sleep important in managing premenstrual syndrome (PMS)?
Regular sleep helps regulate mood and reduce PMS symptoms.
What mental health issues are associated with PCOS?
Depression and anxiety.
What is a common symptom of Androgen Insensitivity Syndrome (AIS) related to menstruation?
Absent menses.
What are common symptoms of pregnancy that can indicate secondary amenorrhea?
Fatigue, nausea, breast tenderness.
What is Premenstrual Dysphoric Disorder (PMDD)?
PMDD is a severe form of PMS characterized by significant mood disturbances, such as severe irritability, depression, or anxiety, that occur in the week or two before menstruation.
What physical change does adenomyosis cause in the uterus?
It causes an enlarged uterus.
What is the normal duration of menstrual bleeding?
Up to 8 days.
How is PMDD diagnosed?
PMDD is diagnosed based on the severity and impact of symptoms on daily life, typically requiring a detailed medical history and symptom tracking over at least two menstrual cycles.
What ovarian dysfunction can lead to secondary amenorrhea?
Hormonal imbalances in the ovaries.
When is an endometrial biopsy recommended in the diagnosis of abnormal uterine bleeding?
For women over 35 with obesity, hypertension, diabetes, and all women after menopause.
How can cervical polyps appear in terms of color?
They can appear red, purple, or flesh-colored.
What are some alternative therapies to HRT for managing hot flashes during menopause?
SSRIs (Paxil most common), yoga, acupuncture, black cohosh, and soy.
What is hyperandrogenism in the context of PCOS?
An excess of androgens (male hormones) in females.
Does the extent of endometriosis disease correlate with the severity of symptoms?
No, the extent of disease does not equal the severity of symptoms.
What are the symptoms of primary dysmenorrhea?
Symptoms include lower abdominal-pelvic cramping/pain 1-3 days around the start of menses, nausea/vomiting, diarrhea, and headache.
What percentage of PCOS patients experience hirsutism?
50%
At what age is primary amenorrhea diagnosed if secondary sex characteristics are present?
By 15 years.
What does 'iatrogenic' mean in the context of abnormal uterine bleeding (AUB)?
Caused by a medical treatment.
Which contraceptive method can cause iatrogenic abnormal uterine bleeding?
Oral contraception pills.
What is a definitive treatment option for severe cases of pelvic organ prolapse?
Surgical repair.
What are the treatment options for amenorrhea in individuals who want to become pregnant?
Treatment varies by cause, including dopamine agonists (bromocriptine, cabergoline), surgery, clomiphene citrate (Clomid), and referral to a fertility specialist.
What surgical options are available for patients with abnormal uterine bleeding who do not desire future fertility?
Uterine artery embolization, endometrial ablation, and hysterectomy.
What are some structural causes of abnormal uterine bleeding (AUB) in reproductive age women?
Fibroids and polyps.
What are some non-structural causes of abnormal uterine bleeding (AUB) in reproductive age women?
Anovulation and hormonal abnormalities.
What psychological symptoms are commonly associated with menopause?
Depression, mood swings, irritability, and insomnia.
What medication-related factor can cause abnormal uterine bleeding (AUB) in postmenopausal women?
Hormone replacement therapy.
What type of diabetes is a long-term consequence of PCOS?
Type 2 Diabetes Mellitus (DM).
Which reproductive condition involving abnormal tissue growth is part of the differential diagnosis for endometriosis?
Fibroids.
What lifestyle changes are recommended for managing obesity in PCOS patients?
Diet and exercise.
What is the general management approach for leiomyomas?
Most leiomyomas do not require treatment and can be managed conservatively.
What condition is indicated by galactorrhea and can lead to secondary amenorrhea?
Prolactinoma.
What phase occurs during days 1-7 of the menstrual cycle?
Menstrual phase.
What are the two types of polyps associated with abnormal uterine bleeding (AUB)?
Cervical polyps and endometrial polyps.
What is a risk factor for developing endometrial polyps?
Obesity.
How does Hormone Replacement Therapy (HRT) affect sexual desire?
HRT increases sexual desire.
What lab test is used to rule out pregnancy in the diagnosis of PCOS?
B - hCG (pregnancy test).
What physical signs are commonly assessed in the diagnosis of PCOS?
Acne, hirsutism, distribution of body hair, obesity, and palpable ovaries on pelvic exam.
What are some common associations with PCOS?
Truncal obesity, acne, and insulin resistance.
What type of commercial product can be used to alleviate vaginal dryness?
Commercial lubricants such as K-Y.
What is the relationship between PCOS and preterm labor?
PCOS increases the risk of preterm labor.
What is a common height characteristic of individuals with Turner's Syndrome?
They are typically short, around 4'8".
What considerations should be taken into account when managing abnormal uterine bleeding?
Treat the underlying problem and consider whether the patient is trying to get pregnant or maintain fertility.
How can an IUD contribute to abnormal uterine bleeding?
It can cause iatrogenic abnormal uterine bleeding.
What lifestyle changes are recommended for women with PCOS trying to get pregnant?
Diet and exercise (weight loss).
What is a common cause of abnormal bleeding in PCOS?
Hormone irregularity due to anovulation.
Why is undiagnosed abnormal vaginal bleeding an absolute contraindication to HRT?
Because it could indicate a serious underlying condition that needs to be diagnosed before starting HRT.
How is adenomyosis usually diagnosed?
It is usually diagnosed after a hysterectomy.
Which gastrointestinal condition is part of the differential diagnosis for endometriosis?
Irritable bowel syndrome.
What non-pharmacological methods can be used to manage hirsutism in PCOS?
Shaving, electrolysis, and laser.
What is dysfunctional uterine bleeding?
Bleeding due to an anovulatory cause.
Which type of pregnancy is included in the differential diagnosis for endometriosis?
Ectopic pregnancy.
What is the treatment of choice for endometriosis if the patient is trying to get pregnant?
Surgical treatment, specifically adhesion lysis.
When is surgical treatment indicated for endometriosis?
When the patient is trying to get pregnant or when medical treatment is contraindicated or has failed.
What is the definitive surgical treatment for leiomyomas in women who do not desire future fertility?
Hysterectomy.
Which type of polyp is more common in the cervical region?
Cervical polyps.
What is the management for Hypothalamic-Pituitary Dysfunction in primary amenorrhea?
Surgery or cyclic estrogens and progestins
What is the prevalence of Premenstrual Dysphoric Disorder (PMDD) among women?
10%
What is the management for androgen insensitivity in primary amenorrhea?
Remove testes, start estrogen
What are the main causes of primary amenorrhea?
Hypothalamic-pituitary dysfunction, pituitary defects, ovarian and ovulation dysfunction, anatomic abnormalities, and 46, XY karyotype.
What is a treatment option specifically for cystocele?
Topical estrogen therapy.
What conditions are represented by the 'COEIN' part of the PALM-COEIN classification?
'COEIN' stands for Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified.
What factors increase the risk of endometrial hyperplasia?
Aging, obesity, and diabetes.
What are the three types of leiomyomas?
Subserous, Intramural, and Submucous.
What medications are used to treat elevated prolactin levels in individuals with amenorrhea who want to become pregnant?
Dopamine agonists such as bromocriptine and cabergoline.
What is the second-line medication for inducing pregnancy in women with PCOS?
Clomiphene citrate (Clomid) with a 19% pregnancy rate.
When do symptoms of Androgen Insensitivity Syndrome (AIS) typically appear?
Symptoms do not appear until puberty.
What is a common cause of abnormal uterine bleeding (AUB) in postmenopausal women?
Trauma, such as vaginal atrophy.
What type of disorders are absolute contraindications to HRT?
Thromboembolic disorders.
What is the typical vaginal depth in individuals with Androgen Insensitivity Syndrome (AIS)?
Short vaginal depth.
What condition is associated with symptoms such as overweight, hirsutism, acne, and infertility?
Polycystic Ovarian Syndrome (PCOS).
What are the side effects of Danazol, a testosterone used in endometriosis management?
Hot flashes, acne, weight gain, and deepening of voice (which can be permanent).
What is postmenopausal bleeding?
Bleeding after 1 year of no menses.
What treatments are available for PMS?
Treatments for PMS may include lifestyle changes, dietary adjustments, exercise, stress management, and over-the-counter pain relievers.
What is an imperforate hymen?
A structural cause of primary amenorrhea where the hymen completely covers the vaginal opening.
What is Asherman's syndrome?
A condition characterized by adhesions or scarring of the endometrial lining, often due to complicated D&C.
What impact does Hormone Replacement Therapy (HRT) have on mood swings?
HRT stabilizes mood swings.
What cerebrovascular risk is increased by Hormone Replacement Therapy (HRT)?
HRT increases the risk of stroke.
What are the common symptoms of ovarian torsion?
Pain (90%), mass (85-95%), nausea/vomiting (40-70%), and fever (less than 20%).
At what age is primary amenorrhea diagnosed if there are no secondary sex characteristics?
By 13 years.
When is surgical evaluation recommended for functional ovarian cysts?
If the cysts are present without change for greater than 60 days.
What are potential causes of a cystocele?
Potential causes include childbirth, heavy lifting, chronic coughing, and aging.
How long can PMS symptoms last?
From 1 day to 2 weeks.
What is the first-line medication for inducing pregnancy in women with PCOS?
Letrozole (off-label) with a 27.5% pregnancy rate.
What is considered a last resort surgical treatment for abnormal uterine bleeding?
Hysterectomy.
Why might individuals with PCOS experience infertility?
Due to hormone irregularity and anovulation.
What is metrorrhagia?
Irregular bleeding between cycles.
What age group is most commonly affected by adenomyosis?
Women between the ages of 40 and 50.
What is prolonged menstrual bleeding?
Menstrual bleeding that exceeds 8 days.
How long can Danazol be used for endometriosis management?
Up to 9 months.
What happens during days 1-7 of the menstrual cycle?
FSH begins to rise, waking up the follicle.
What treatments are available for PMDD?
Treatments for PMDD may include antidepressants, hormonal treatments, lifestyle changes, dietary adjustments, and cognitive-behavioral therapy.
What is endometrial ablation and when is it used?
A procedure to destroy the lining of the uterus, used in the management of leiomyomas for women who do not desire future fertility.
What is another name for the secretory phase of the menstrual cycle?
Progestational phase or luteal phase.
What is the management for pituitary microadenomas in primary amenorrhea?
Surgery
Is social impairment required for a diagnosis of PMS?
No, but it may be present.
What imaging techniques are used to diagnose adenomyosis?
Ultrasound and MRI are commonly used to diagnose adenomyosis.
Why do individuals with Turner's Syndrome experience primary amenorrhea?
They have no functioning ovaries.
What is a cystocele?
A cystocele is a condition where the bladder prolapses into the vagina.
What are common symptoms of a cystocele?
Common symptoms include a feeling of fullness or pressure in the pelvis and vagina, discomfort when straining, and urinary incontinence.
What are some facial features associated with Turner's Syndrome?
Downslanting eyes, droopy eyelids, prominent earlobes, and crowding of teeth.
What is Dilation and Curettage (D&C) used for in the context of abnormal uterine bleeding?
It is a surgical treatment option to manage abnormal uterine bleeding.
What is the most common cause of abnormal uterine bleeding (AUB) in reproductive years?
Pregnancy.
What causes amenorrhea in individuals with PCOS?
Hormone irregularity due to anovulation.
What imaging tests might be performed depending on symptoms in the diagnostic workup for secondary amenorrhea?
MRI of the head, pelvic ultrasound, and hysteroscopy.
What are common causes of menorrhagia?
Ectopic pregnancy, Von Willebrand’s Disease, submucous myomas, endometrial hyperplasia, IUDs, tumors.
What cardiovascular risk factors are associated with PCOS?
Dyslipidemias and hypertension.
What imaging studies are used to diagnose leiomyomas?
Sonogram and hysterosalpingogram.
Which acute abdominal condition is part of the differential diagnosis for endometriosis?
Acute appendicitis.
Which ovarian condition involving fluid-filled sacs is part of the differential diagnosis for endometriosis?
Ovarian cysts.
What syndrome associated with androgen excess can cause secondary amenorrhea?
Polycystic ovary syndrome (PCOS).
What is the result of the LH surge during the menstrual cycle?
The follicle bursts, leading to ovulation.
In which group of women are endometrial polyps common?
Post-menopausal women on tamoxifen.
What is leiomyoma and its role in abnormal uterine bleeding?
Leiomyoma, also known as fibroids, are benign tumors of the uterus that can cause abnormal uterine bleeding.
What are some of the physical and behavioral symptoms listed in Column 2 for PMS and PMDD according to DSM-5 criteria?
Decreased interest in activities, sleep changes, appetite changes, decreased concentration, feeling overwhelmed, bloating/breast tenderness, lethargy, fatigue.
What is the management for anatomic imperforate hymen in primary amenorrhea?
Surgically open
What type of therapy can assist in treating pelvic organ prolapse?
Pelvic Physical Therapy.
When do the symptoms of Premenstrual Syndrome (PMS) occur?
During the second half of the menstrual cycle.
What skin feature is commonly seen in individuals with Turner's Syndrome?
Several moles on the skin.
What is the immediate change that occurs during menopause?
Cessation of menses.
What tests are performed in the second step of the diagnostic workup for secondary amenorrhea?
Prolactin and TSH.
What conditions are linked to an increased risk due to PMS?
Perimenopausal depression and postpartum depression.
What reproductive organs are absent in individuals with Androgen Insensitivity Syndrome (AIS)?
Uterus and ovaries.
What confirms ovulatory dysfunction in the progestin challenge test for secondary amenorrhea?
Bleeding 2-7 days later.
What is the increased risk associated with menstrual irregularity in PCOS?
Increased risk of endometrial cancer.
What is menometrorrhagia?
Irregular frequency of bleeding plus heavy and prolonged flow.
What pituitary-related issue can cause secondary amenorrhea?
Hormonal imbalances.
What surgical option is available for women with leiomyomas who want to maintain fertility?
Myomectomy.
Name two causes of postmenopausal bleeding.
Vaginal atrophy and hormone replacement therapy (HRT).
What is one of the skeletal benefits of Hormone Replacement Therapy (HRT)?
HRT reduces the risk of osteoporosis.
What is the management for Mullerian dysgenesis in primary amenorrhea?
Surgery to create vaginal elongation
What is adenomyosis?
Adenomyosis is a condition where the inner lining of the uterus breaks through the muscle wall of the uterus, causing heavy periods and pain.
What is endometriosis?
Endometriosis is a condition where tissue similar to the lining inside the uterus grows outside the uterus, causing pain and potentially infertility.
What are the most severe complaints associated with PMS?
Anger and irritability.
What is the genetic makeup of individuals with Androgen Insensitivity Syndrome (AIS)?
XY karyotype.
Why do individuals with Androgen Insensitivity Syndrome (AIS) exhibit female physical traits?
They are genetically male but resistant to male hormones.
What is a submucous leiomyoma?
A type of leiomyoma that deforms the uterine cavity.
How does menopause typically affect sexual activity?
Decreased interest in sexual activity.
What is adenomyosis?
A condition where endometrial glands grow within the myometrium (uterine musculature).
How is heavy menstrual bleeding subjectively defined?
Excessive blood loss that interferes with physical, social, or emotional quality of life.
What are some causes of menometrorrhagia?
Molar pregnancy, malignant endometrial tumors, premenopause.
What is intermenstrual bleeding?
Irregular episodes of bleeding between normal periods.
What are common symptoms of PMDD?
Common symptoms of PMDD include severe irritability, depression, anxiety, mood swings, and physical symptoms similar to PMS but more intense.
What reproductive structures are present in Mullerian Dysgenesis?
Ovaries.
What significant event occurs on day 14 of the menstrual cycle?
Ovulation, where the egg is released.
What is the treatment for symptomatic endometrial polyps?
Excision.
How does Hormone Replacement Therapy (HRT) affect platelet aggregation?
HRT reduces platelet aggregation.
What is the karyotype and lab finding for Mullerian dysgenesis in primary amenorrhea?
Karyotype: 46, XX; Lab finding: Normal hormone levels/MRI
What is the karyotype and diagnostic method for anatomic imperforate hymen in primary amenorrhea?
Karyotype: 46, XX; Diagnostic method: Physical examination
Is social impairment required for a diagnosis of PMDD?
Yes, it is required.
When must PMS symptoms be absent?
During the first 2 weeks of the menstrual cycle.
What is a common medication used to induce ovulation in individuals with amenorrhea who want to become pregnant?
Clomiphene citrate (Clomid).
What test is performed if all labs are normal and ovulatory dysfunction is suspected in secondary amenorrhea?
Progestin challenge.
What is dyspareunia and how is it related to menopause?
Dyspareunia is painful intercourse, which can occur due to decreased vaginal lubrication during menopause.
Why is thrombophlebitis an absolute contraindication to HRT?
Because HRT can increase the risk of blood clots, worsening thrombophlebitis.
What are the common symptoms of adenomyosis?
Heavy and painful prolonged periods.
What is a common cause of secondary amenorrhea?
Pregnancy.
What karyotype is associated with Mullerian Dysgenesis?
46, XX.
What are the management options for leiomyomas in peri-menopausal women who do not desire fertility?
GnRH agonists (e.g., Lupron, limited to 6 months), uterine artery embolization, endometrial ablation, and hysterectomy.
What happens during days 7-14 of the menstrual cycle?
Estrogen increases, causing proliferation of follicles and some endometrial growth.
What is the purpose of a progestin trial in the context of abnormal uterine bleeding?
To determine if the bleeding stops, indicating an ovulatory problem.
What receptors do endometrial polyps have that allow them to behave like endometrial tissue?
Estrogen and progesterone receptors.
What is adenomyosis and how does it relate to abnormal uterine bleeding?
Adenomyosis is a condition where the inner lining of the uterus breaks through the muscle wall of the uterus, leading to abnormal uterine bleeding.
What is the management for gonadal dysgenesis (Turner's syndrome) in primary amenorrhea?
Cyclic estrogen and progestins
What pulmonary risk is increased by Hormone Replacement Therapy (HRT)?
HRT increases the risk of pulmonary embolism.
What are leiomyomas?
Leiomyomas, also known as fibroids, are benign tumors of the uterus that can cause heavy menstrual bleeding, pelvic pain, and pressure symptoms.
What are common treatments for leiomyomas?
Treatments for leiomyomas include medication, non-invasive procedures, and surgical options such as myomectomy or hysterectomy.
What is prolactinoma and how does it relate to secondary amenorrhea?
Prolactinoma is a benign pituitary tumor that produces excess prolactin, leading to secondary amenorrhea.
What is uterine artery embolization used for in the context of leiomyomas?
To reduce blood flow to the leiomyomas, causing them to shrink.
What are polyps in the context of abnormal uterine bleeding?
Polyps are growths that occur in the inner lining of the uterus and can cause abnormal uterine bleeding.
How do malignancy and hyperplasia contribute to abnormal uterine bleeding?
Malignancy and hyperplasia involve abnormal growth of the uterine lining, which can lead to abnormal uterine bleeding.
How many symptoms are required to diagnose PMDD according to DSM-5 criteria?
5 out of 11 symptoms.
What type of bleeding is associated with polyps?
Polyps often cause irregular or heavy menstrual bleeding.
What effect does increased estrogen have on the pituitary gland during days 7-14?
It causes the pituitary to increase LH levels.
What role does progesterone play in the menstrual cycle?
It works on the endometrium to convert it to thickly vascularized tissue.
How does the transition into menopause affect ovulation?
The transition into menopause can cause ovulatory dysfunction.
What are some risks associated with Hormone Replacement Therapy (HRT)?
Increased risk for cardiac disease, breast cancer, stroke, pulmonary embolism, irregular bleeding, bloating, and weight gain.
What is primary dysmenorrhea?
Primary dysmenorrhea refers to common menstrual cramps that are recurrent and not due to other diseases.
What is the karyotype and lab finding for Hypothalamic-Pituitary Dysfunction in primary amenorrhea?
Karyotype: 46, XX; Lab finding: Low FSH, LH
What type of cancer risk is increased by Hormone Replacement Therapy (HRT)?
HRT increases the risk of breast cancer.
Is prospective charting required for diagnosing PMS?
No, but it is recommended.
What are some benefits of Hormone Replacement Therapy (HRT)?
Improves vaginal atrophy, hot flashes, increases sexual desire, stabilizes mood swings, enhances insulin sensitivity, reduces risk of osteoporosis, and reduces platelet aggregation.
How does Hormone Replacement Therapy (HRT) affect insulin sensitivity?
HRT enhances insulin sensitivity.
What is the karyotype and lab finding for gonadal dysgenesis (Turner's syndrome) in primary amenorrhea?
Karyotype: 45, X; Lab finding: High FSH
How many symptoms are required to diagnose PMS according to DSM-5 criteria?
At least 1 symptom from each column (minimum 2 total).
What cardiovascular risk is increased by Hormone Replacement Therapy (HRT)?
HRT increases the risk of cardiac disease.
What is a polyp in the context of gynecology?
A polyp is a growth that protrudes from the lining of the uterus, often causing irregular bleeding.
What is the prevalence of Premenstrual Syndrome (PMS) among women?
80%
What are some side effects of Hormone Replacement Therapy (HRT) related to weight and digestion?
HRT can cause irregular bleeding, bloating, and weight gain.
What is the karyotype and lab finding for androgen insensitivity in primary amenorrhea?
Karyotype: 46, XY; Lab finding: High testosterone
Is prospective charting required for diagnosing PMDD?
Yes, it is required.
How does age affect the likelihood of developing polyps, adenomyosis, leiomyomas, or endometriosis?
Polyps and adenomyosis are more common in women over 40, leiomyomas are common in women of reproductive age, and endometriosis often affects women in their 30s and 40s.
Where and when is pain typically experienced in endometriosis?
Pain in endometriosis is often experienced in the pelvic region, especially during menstruation.
