Women's Health Puberty, Menstrual Cycle & PMS
What is the criteria for PMDD?
*1 of the following:* Irritability Tension Dysphoria Mood lability *AND 5 of the following:* Depressed mood Anxiety Affective lability Irritability Decreased interest in daily activities Concentration difficulties Lack of energy Change in appetite or food cravings Sleep disturbances Feeling overwhelmed Physical Sx
Average age of Menarche?
8-13
Vaginal septum
A congenital anomaly. Extra tissue divides the vagina either longitudinally or horizontally. Painful tx by making a cruciate incision and taking everything out to ensure a normal vagina
WHAT DO YOU ALWAYS NEED TO GET DURING DIAGNOSTIC TESTING??
A dang URINE PREGNANCY TEST!
Triad of PCOS
Amenorrhea, obesity, hirsuitism
When does estrogen switch from negative feedback to positive feedback?
Around days 12-14 in the menstrual cycle
What day does the dominant follicle start producing estradiol?
Day 7
What is hypergonadotropic hypogonadism?
Elevated gonadotropins (FSH & LH) and low estradiol (seen in 1ry ovarian failure)
Tx for PCOS?
If desiring pregnancy: Metformin, weight loss, femara or clomid If not desiring pregnancy: Metformin, weight loss, BCPs, management of acne & Hirsuitism
Treatment of PMS/PMDD
Limit: caffeine, alc, tobacco, chocolate, sodium exercise NSAIDs SSRIs GNRH agonists hormonal contraceptives
Vaginal agenesis
NOT-REPARABLE most don't have a cervix either and endometriosis often forms from back bleeding from uterus into abdominal cavity
What is primary amenorrhea?
No period by age 13 in absence of 2ry sex characteristics or No period by age 16 in presence of normal growth of 2ry sex characteristics
What is the MCC of ovulatory dysfunction?
PCOS
Signs of Tuner's Syndrome (45XO)
Short web-neck, shield chest, increased elbow carrying angle (<63' tall) bicuspid aortic valve, aortic dissection, horseshoe kidney decreased estrogen and androgen levels if not treated, FSH & LH increased
Whats the difference between PMS and PMDD
Similar symptoms but PMDD results in disruption of daily functioning and can be classified in the DSM 5
What specific tests need to be checked if pt has a potential pituitary adenoma or hyperprolactinemia?
TSH, PRL
What counts as Day 0 of the menstrual cycle?
The first day that bleeding begins
What does sexual development depend on?
The presence of functioning testes & responsive end organs (NOT ON PRESENCE OF OVARIES)
What is androgen insensitivity?
XY testicular feminization. -end organs don't have proper androgen receptors -normal female development externally (tissue not sensitive to androgen) -Sparse body hair -No internal female anatomy, no menses -Testes in labia or intra-abdominal (cancer risk so remove @ age 18) -Genetically male -Psychosocially and physiologically female
When does GnRH begin to have pulsatile release again?
after the LH surge
Thelarche
beginning of breast development
What is clomid?
clomiphene citrate; estrogen agonist properties Used in infertile women with amenorrhea or oligomenorrhea
Kallman's syndrome
congenital absence of GnRH; patients have amenorrhea and can't smell
Mullarian anomalies
congenital absence of the uterus and upper 2/3 of vag
Progesterone challenge?
give progesterone 5-10mg PO QD x10 days if bleed within 5-7 days after stopping, uterus is ok and able to menstruate but if don't menstruate, give estrogen and progesterone challenge if still no bleeding, its a structural issue (Asherman's or HPO)
What are some long term complications with PCOS?
infertility, chronic anovulation, obesity, metabolic syndrome, dyslipidemia, sleep apnea, T2DM, CVD, & endometrial CA
What is oligomenorrhea?
infrequent periods that last more than 35 days between each period
PMS occurs in what age range the most?
late 20s, early 30s
The withdrawal of estrogen and progesterone lead to what kind of feed back to the CNS?
negative feedback (the FSH & LH decreases GnRH being released)
What is hypogonadotropic hypogonadism?
normal or low gonadotropins and low estradiol (seen in 2ry ovarian failure)
What is a congenital issue among compartment 1?
not having a uterus
Asherman's syndrome
numerous uterine adhesions, scarred down, 2ry to D&C usually treat with curative procedure
Pubarche
onset of development of pubic and axillary hair
Premature Ovarian Failure
onset of spontaneous menopause before the age of 40 a hypergonadotropic hypogonadism dx: 2 levels of FSH >40 at least 1mo apart
Sheehan's syndrome
post-partum hemorrhage (or low BP) causes lack of O2 to pituitary possibly leading to necrosis and hypo-pituitary function might never menstruate or ovulate again
#1 cause of amenorrhea?
pregnancy
What are some examples of 2ry sex characteristics?
rounding of the breasts waists and hips growth of under arm and pubic hair (all influenced by estrogens)
What make up the ripe uterine environment for an egg?
spiral arterioles
What are some chromosomal abnormalities seen in compartment 2 (ovary)?
streaked gonads, Turner's syndrome, 45XO (50%), mosaicism (25%), 46XX (25%)
To be classified as PMS...
sx must occur during the luteal phase with a symptom-free period of at least 7 days in the first half of the cycle for 2 consecutive cycles
What is secondary amenorrhea?
the absence of menses for more than 3 cycle intervals or 6 consecutive months
Menarche
the first period 12-18mo before menstruation is at regular intervals