Podcast
Questions and Answers
What is the primary mechanism by which prostaglandins contribute to dysmenorrhea?
What is the primary mechanism by which prostaglandins contribute to dysmenorrhea?
- Triggering uterine smooth muscle contractions and vasoconstriction. (correct)
- Inhibiting uterine contractions, leading to prolonged bleeding.
- Decreasing uterine blood flow by causing vasodilation.
- Reducing the sensitivity of nerve endings in the uterus.
Central sensitization, associated with dysmenorrhea, involves which of the following processes?
Central sensitization, associated with dysmenorrhea, involves which of the following processes?
- A decrease in the nervous system's pain signaling threshold.
- Suppressed production of prostaglandins.
- Reduced inflammation in the endometrial tissues.
- The nervous system amplifying pain signals. (correct)
What characterizes primary amenorrhea?
What characterizes primary amenorrhea?
- No menses by age 15 (or age 13 without secondary sex characteristics). (correct)
- Heavy menstrual bleeding requiring frequent changes of sanitary products.
- Cessation of menses for at least three months in women with regular cycles.
- Irregular menstrual cycles with intervals longer than 35 days.
Which of the following is a common cause of secondary amenorrhea?
Which of the following is a common cause of secondary amenorrhea?
In anovulatory cycles, abnormal uterine bleeding (AUB) is often the result of what hormonal imbalance?
In anovulatory cycles, abnormal uterine bleeding (AUB) is often the result of what hormonal imbalance?
Endometrial hyperplasia, a consequence of unopposed estrogen, increases the risk of which condition?
Endometrial hyperplasia, a consequence of unopposed estrogen, increases the risk of which condition?
What is a typical symptom associated with dysmenorrhea?
What is a typical symptom associated with dysmenorrhea?
In secondary amenorrhea, estrogen deficiency can lead to which of the following?
In secondary amenorrhea, estrogen deficiency can lead to which of the following?
What is a potential hematological risk associated with abnormal uterine bleeding (AUB)?
What is a potential hematological risk associated with abnormal uterine bleeding (AUB)?
How does insulin resistance contribute to endocrine abnormalities in polycystic ovary syndrome (PCOS)?
How does insulin resistance contribute to endocrine abnormalities in polycystic ovary syndrome (PCOS)?
What role does estrone play in the hormonal dysregulation seen in polycystic ovary syndrome (PCOS)?
What role does estrone play in the hormonal dysregulation seen in polycystic ovary syndrome (PCOS)?
Which ultrasound finding is characteristic of polycystic ovary syndrome (PCOS)?
Which ultrasound finding is characteristic of polycystic ovary syndrome (PCOS)?
Which of the following is a sign of hyperandrogenism often seen in women with polycystic ovary syndrome (PCOS)?
Which of the following is a sign of hyperandrogenism often seen in women with polycystic ovary syndrome (PCOS)?
Which long-term risk is associated with unopposed estrogen exposure in conditions like polycystic ovary syndrome (PCOS)?
Which long-term risk is associated with unopposed estrogen exposure in conditions like polycystic ovary syndrome (PCOS)?
Besides menstrual irregularities and hyperandrogenism, what metabolic feature is commonly associated with polycystic ovary syndrome (PCOS)?
Besides menstrual irregularities and hyperandrogenism, what metabolic feature is commonly associated with polycystic ovary syndrome (PCOS)?
Leukotrienes are stimulated in dysmenorrhea and exacerbate symptoms, which of the following accurately describes their role?
Leukotrienes are stimulated in dysmenorrhea and exacerbate symptoms, which of the following accurately describes their role?
A patient with PCOS presents with abnormal GnRH pulsatility. What is the MOST likely consequence of this abnormality on follicular development?
A patient with PCOS presents with abnormal GnRH pulsatility. What is the MOST likely consequence of this abnormality on follicular development?
A patient is diagnosed with secondary amenorrhea after experiencing cessation of menses for six months. Initial labs reveal normal TSH and prolactin levels, but low levels of GnRH, FSH, and LH. Furthermore, she has no secondary sex charateristics. Which of the following is the MOST LIKELY underlying cause?
A patient is diagnosed with secondary amenorrhea after experiencing cessation of menses for six months. Initial labs reveal normal TSH and prolactin levels, but low levels of GnRH, FSH, and LH. Furthermore, she has no secondary sex charateristics. Which of the following is the MOST LIKELY underlying cause?
A researcher is studying the effects of a novel drug designed to treat dysmenorrhea, and wants to design a study that will test the efficacy of a drug designed to inhibit central sensitization. Which of the following biomarkers or patient-reported outcomes would be MOST appropriate for assessing the effectiveness of the intervention?
A researcher is studying the effects of a novel drug designed to treat dysmenorrhea, and wants to design a study that will test the efficacy of a drug designed to inhibit central sensitization. Which of the following biomarkers or patient-reported outcomes would be MOST appropriate for assessing the effectiveness of the intervention?
A 28-year-old woman with PCOS is undergoing evaluation for infertility, and has been prescribed clomiphene citrate (a selective estrogen receptor modulator) to induce ovulation. Despite clomiphene therapy, she does not ovulate. Her BMI is 35 kg/m2. Given her body habitus and lack of response to clomiphene, what is the MOST LIKELY underlying mechanism contributing to her anovulation?
A 28-year-old woman with PCOS is undergoing evaluation for infertility, and has been prescribed clomiphene citrate (a selective estrogen receptor modulator) to induce ovulation. Despite clomiphene therapy, she does not ovulate. Her BMI is 35 kg/m2. Given her body habitus and lack of response to clomiphene, what is the MOST LIKELY underlying mechanism contributing to her anovulation?
Flashcards
Dysmenorrhea Pathophysiology
Dysmenorrhea Pathophysiology
Painful menstruation caused by excessive prostaglandin secretion, leading to uterine contractions, vasoconstriction, ischemia, and leukotriene stimulation.
Primary Amenorrhea
Primary Amenorrhea
No menses by age 15 (or 13 without secondary sex characteristics). Can be caused by hypothalamic dysfunction, pituitary issues, ovarian failure, anatomical defects.
Secondary Amenorrhea
Secondary Amenorrhea
Cessation of menses for ≥3 cycles (regular) or ≥6 months (irregular). Often due to hormonal dysregulation, weight loss, stress, or pituitary/ovarian conditions.
Abnormal Uterine Bleeding (AUB)
Abnormal Uterine Bleeding (AUB)
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Dysmenorrhea Symptoms
Dysmenorrhea Symptoms
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Amenorrhea Symptoms
Amenorrhea Symptoms
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AUB Symptoms
AUB Symptoms
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Insulin Resistance in PCOS
Insulin Resistance in PCOS
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Hormonal Dysregulation in PCOS
Hormonal Dysregulation in PCOS
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PCOS Clinical Manifestations
PCOS Clinical Manifestations
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PCOS diagnostic criteria
PCOS diagnostic criteria
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PCOS Long-Term Risks
PCOS Long-Term Risks
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Study Notes
Pathophysiology of Common Menstrual Disorders
- Dysmenorrhea is caused by excessive prostaglandin secretion in the endometrium
- Prostaglandins trigger uterine smooth muscle contractions and vasoconstriction
- Ischemia, pain, and leukotriene stimulation can exacerbate dysmenorrhea symptoms
- Dysmenorrhea is associated with central sensitization, where the nervous system amplifies pain signals
- Primary amenorrhea is the absence of menses by age 15 (or 13 without secondary sex characteristics)
- Causes of primary amenorrhea include hypothalamic dysfunction (GnRH failure), pituitary issues, ovarian failure (e.g., Turner syndrome), and anatomical defects
- Secondary amenorrhea is the cessation of menses for ≥3 cycles (in regular cyclers) or ≥6 months (irregular cyclers)
- Secondary amenorrhea is often due to hormonal dysregulation, weight loss, stress, or pituitary/ovarian conditions
- Abnormal Uterine Bleeding (AUB) often occurs in anovulatory cycles
- AUB leads to unopposed estrogen exposure
- Unopposed estrogen exposure results in endometrial hyperplasia
- Endometrial hyperplasia causes a thickened but unstable endometrial lining
- Endometrial hyperplasia can cause irregular, heavy bleeding
Clinical Manifestations of Menstrual Disorders
- Dysmenorrhea symptoms include low back pain, abdominal cramping, nausea, vomiting, diarrhea, and headache
- Dysmenorrhea onset is typically at the start of menstruation, lasting 8–72 hours, and often affects adolescents and young women (15-25 years old)
- Primary amenorrhea is characterized by delayed puberty and the absence of menstruation
- Secondary amenorrhea is characterized by the cessation of previously regular or irregular cycles
- Secondary amenorrhea may be accompanied by signs of estrogen deficiency like vaginal dryness, hot flashes, or infertility
- AUB includes irregular, heavy menstrual bleeding
- With AUB, spotting at the beginning may indicate low estrogen, while spotting at the end may indicate low progesterone
- AUB can lead to iron-deficiency anemia, infertility, or endometrial hyperplasia
Endocrine Abnormalities and PCOS
- Insulin resistance leads to hyperinsulinemia
- Insulin reduces SHBG, which increases free androgens
- Insulin directly stimulates theca cells, which produces more androgens
- Abnormal GnRH pulsatility causes low FSH, leading to poor follicular maturation
- Abnormal GnRH pulsatility causes high LH, leading to excess androgen production
- Reduced conversion of androgens to estrogens by granulosa cells causes a build-up of androgens
- Peripheral conversion of androgens to estrone in adipose tissue further suppresses FSH and promotes LH, perpetuating the cycle
- Hormonal imbalances result in anovulation, androgen excess, and the formation of multiple ovarian cysts
Clinical Manifestations of Polycystic Ovary Syndrome
- Menstrual dysfunctions include amenorrhea, oligomenorrhea, and abnormal uterine bleeding
- Signs of hyperandrogenism include hirsutism (excess body/facial hair), acne, oily skin, and male-pattern baldness
- Metabolic features include obesity, insulin resistance, and metabolic syndrome
- Infertility due to chronic anovulation
- Polycystic ovaries on ultrasound have a "string of pearls" appearance with multiple immature follicles
- Long-term risk for endometrial hyperplasia or cancer due to unopposed estrogen
- Screening may be required for sleep apnea, NAFLD, and cardiometabolic risks
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