Amenorrhea
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Questions and Answers

Which of the following is a common cause of secondary amenorrhea in young women?

  • Stress from athletic training (correct)
  • Chronic endometriosis
  • Uterine fibroids
  • Polycyclic ovary syndrome

    • What is an important aspect to evaluate when conducting a thorough menstrual history?

  • The frequency of missed periods (correct)
  • Only the method of birth control used
  • Only the age at menarche
  • Family history of heart disease

    • Which examination is critical to assess estrogen status during a pelvic exam?

  • Ultrasound of the ovaries
  • Endometrial biopsy
  • Laparoscopic examination
  • Vaginal epithelium and cervical mucus assessment (correct)

    • Which of the following lifestyle factors can significantly impact menstrual health?

    <p>Disordered eating behavior</p> Signup and view all the answers

    What kind of systemic illness can be indicated through a review of systems during the evaluation?

    <p>Thyroid dysfunction</p> Signup and view all the answers

    Which condition is often associated with primary amenorrhea?

    <p>Imperforate hymen</p> Signup and view all the answers

    What is a common cause of secondary amenorrhea related to lifestyle factors?

    <p>Endurance sports</p> Signup and view all the answers

    Which of the following hormonal influences can lead to hyperprolactin amenorrhea?

    <p>Prolactin-secreting pituitary tumors</p> Signup and view all the answers

    Which of the following conditions may contribute to hypogonadotropic amenorrhea?

    <p>Severe stress</p> Signup and view all the answers

    How can the discontinuation of oral contraceptive pills (OCPs) affect menstruation?

    <p>It may result in secondary amenorrhea.</p> Signup and view all the answers

    Which age range is most commonly associated with the onset of primary dysmenorrhea?

    <p>6-12 months after menarche</p> Signup and view all the answers

    What is a common physical examination finding in secondary dysmenorrhea?

    <p>Pelvic mass</p> Signup and view all the answers

    Which of the following is associated with primary dysmenorrhea symptoms?

    <p>Back pain</p> Signup and view all the answers

    What management option is recommended for moderate to severe dysmenorrhea?

    <p>Use of stronger NSAIDs</p> Signup and view all the answers

    What is a key dietary recommendation for managing symptoms of dysmenorrhea?

    <p>Low fat diet rich in fish and vegetables</p> Signup and view all the answers

    Which of the following is NOT a sign of secondary dysmenorrhea?

    <p>Normal pelvic examination findings</p> Signup and view all the answers

    What is the believed etiology behind primary dysmenorrhea?

    <p>Hormonal and endocrine-related factors</p> Signup and view all the answers

    Which factor is a common misconception about managing dysmenorrhea symptoms?

    <p>Over the counter analgesics are unnecessary.</p> Signup and view all the answers

    What type of history is crucial for understanding potential causes of amenorrhea?

    <p>Complete sexual history</p> Signup and view all the answers

    Which physical exam finding could suggest a thyroid dysfunction during an assessment for amenorrhea?

    <p>Presence of masses or nodules</p> Signup and view all the answers

    Which symptoms might indicate systemic illness during the review of systems for amenorrhea?

    <p>Headaches and visual disturbances</p> Signup and view all the answers

    What aspect of nutritional history is particularly important when evaluating amenorrhea?

    <p>Recent weight loss or gain</p> Signup and view all the answers

    In assessing a young woman for primary amenorrhea, which family medical aspect should be highlighted?

    <p>Age at menopause of family members</p> Signup and view all the answers

    What characterizes primary amenorrhea?

    <p>Absence of menstrual bleeding by age 16 regardless of sexual characteristics</p> Signup and view all the answers

    Which of the following is a common cause of secondary amenorrhea?

    <p>Early menopause</p> Signup and view all the answers

    What physiological factor can lead to hyperprolactin amenorrhea?

    <p>Lactation</p> Signup and view all the answers

    Which condition is most often linked to hyperandrogenic amenorrhea?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    What is a potential cause of hypothalamic amenorrhea?

    <p>Congenital defects</p> Signup and view all the answers

    What is indicated by an FSH level greater than 20?

    <p>Ovarian failure</p> Signup and view all the answers

    Which imaging modality is effective in evaluating primary amenorrhea?

    <p>MRI</p> Signup and view all the answers

    What does a positive response to the progesterone challenge test indicate?

    <p>Adequate estrogen stores</p> Signup and view all the answers

    What is a potential consequence of having a high LH/FSH ratio greater than 0.2?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    Which of the following conditions is associated with an increased risk of amenorrhea due to nutritional factors?

    <p>Anorexia-related disorders</p> Signup and view all the answers

    What should be ruled out first before any diagnostic evaluation for amenorrhea?

    <p>Pregnancy</p> Signup and view all the answers

    Which of the following treatments involves restoration of the hypothalamic-pituitary-thyroid axis?

    <p>Pulsatile GnRH therapy</p> Signup and view all the answers

    What is a potential reason for hospitalization in women with anorexia nervosa related to amenorrhea?

    <p>Loss of more than 30% of desired body weight</p> Signup and view all the answers

    At what age is secondary dysmenorrhea most commonly identified?

    <p>30-40 years old</p> Signup and view all the answers

    What is a recommended form of relief for dysmenorrhea that involves the application of warmth?

    <p>Heat application</p> Signup and view all the answers

    Which of the following symptoms would indicate a potential red flag for secondary dysmenorrhea?

    <p>Unilateral dysmenorrhea</p> Signup and view all the answers

    What is the primary diagnostic approach for primary dysmenorrhea?

    <p>Clinical diagnosis without testing</p> Signup and view all the answers

    Which of the following nutritional supplements is NOT recommended for managing dysmenorrhea?

    <p>Iron</p> Signup and view all the answers

    What is the usual duration of cramping associated with dysmenorrhea?

    <p>1-3 days</p> Signup and view all the answers

    Which of the following is a common pathologic cause of secondary dysmenorrhea?

    <p>Endometriosis</p> Signup and view all the answers

    What is the physiological mechanism believed to contribute to primary dysmenorrhea?

    <p>Hormonal and endocrine factors</p> Signup and view all the answers

    What symptom may indicate thyroid dysfunction during the evaluation for amenorrhea?

    <p>Visual disturbances</p> Signup and view all the answers

    Which factor in a woman's medical history is essential for understanding potential causes of amenorrhea?

    <p>History of missed periods</p> Signup and view all the answers

    Which physical examination aspect is crucial for assessing estrogen status?

    <p>Vaginal epithelium</p> Signup and view all the answers

    Which lifestyle factor can contribute to the risk of amenorrhea in young women?

    <p>Excessive athletic training</p> Signup and view all the answers

    What primary action should be taken before pursuing diagnostic evaluation for amenorrhea?

    <p>Rule out pregnancy</p> Signup and view all the answers

    What does an elevated LH/FSH ratio greater than 0.2 typically indicate?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    What should be indicated by the restoration of the hypothalamic-pituitary-thyroid axis in a patient with amenorrhea?

    <p>Potential resolution of menstrual issues</p> Signup and view all the answers

    Which laboratory value indicates potential ovarian failure?

    <p>FSH &gt; 20</p> Signup and view all the answers

    Which condition is most commonly associated with inadequate estrogen stores or outflow tract obstruction?

    <p>Negative response to progesterone challenge test</p> Signup and view all the answers

    In the context of amenorrhea, what condition could indicate the need for imaging such as MRI or CT scan?

    <p>Abnormally high prolactin levels</p> Signup and view all the answers

    What is a key indicator for hospitalization in women with amenorrhea related to anorexia nervosa?

    <p>Failure to gain weight after dietary intervention</p> Signup and view all the answers

    What is a potential indication for psychiatric counseling in the management of amenorrhea?

    <p>Presence of suicidal ideation</p> Signup and view all the answers

    What might the absence of vaginal bleeding following progesterone cessation suggest?

    <p>Estrogen deficiency or obstructed outflow tract</p> Signup and view all the answers

    What defines primary amenorrhea?

    <p>Absence of uterine bleeding and secondary sexual characteristics by age 14 or absence of menarche by age 16.</p> Signup and view all the answers

    Which of the following is a common factor leading to secondary amenorrhea?

    <p>Physiological effects of significant weight loss or gain.</p> Signup and view all the answers

    What condition is most often associated with hyperandrogenic amenorrhea?

    <p>Polycystic ovary syndrome (PCOS).</p> Signup and view all the answers

    What could be indicated by a hypothalamic-pituitary-ovarian axis dysfunction?

    <p>Secondary amenorrhea linked to prolonged physical activity.</p> Signup and view all the answers

    Which of the following drugs could potentially lead to hyperprolactin amenorrhea?

    <p>Oral contraceptive pills (OCPs) that alter hormonal balance.</p> Signup and view all the answers

    What is the typical age range for the onset of secondary dysmenorrhea?

    <p>30-40 years old</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with primary dysmenorrhea?

    <p>Pelvic mass</p> Signup and view all the answers

    What dietary changes are recommended to help manage dysmenorrhea symptoms?

    <p>Low fat diet rich in fish and vegetables</p> Signup and view all the answers

    Which statement about the diagnosis of primary dysmenorrhea is true?

    <p>Diagnosis is made based on clinical findings</p> Signup and view all the answers

    Which of the following indicates a potential red flag for secondary dysmenorrhea?

    <p>Unilateral pelvic pain</p> Signup and view all the answers

    What is the initial therapy recommended for managing moderate to severe dysmenorrhea?

    <p>Over the counter analgesics, preferably ibuprofen</p> Signup and view all the answers

    In terms of supportive measures for dysmenorrhea, which option is considered complementary therapy?

    <p>Heat application</p> Signup and view all the answers

    What is a common misconception about the management of dysmenorrhea symptoms?

    <p>All dysmenorrhea is caused by pelvic pathology</p> Signup and view all the answers

    What defines primary amenorrhea in terms of the age and characteristics of a young woman?

    <p>Absence of uterine bleeding and secondary sexual characteristics by age 14 or 16.</p> Signup and view all the answers

    Which of the following conditions is most strongly associated with hyperandrogenic amenorrhea?

    <p>Polycystic Ovary Syndrome (PCOS)</p> Signup and view all the answers

    What physiological factor may commonly lead to hyperprolactin amenorrhea?

    <p>Nipple stimulation through breastfeeding.</p> Signup and view all the answers

    Which of the following is a potential cause of hypothgonadotropic amenorrhea?

    <p>Psychological stress</p> Signup and view all the answers

    What is the primary cause of amenorrhea linked to lifestyle factors, as noted in the content?

    <p>Poor nutrition and eating disorders.</p> Signup and view all the answers

    What type of history is essential to gather regarding previous pregnancies when assessing amenorrhea?

    <p>Number of pregnancies</p> Signup and view all the answers

    Which physical examination finding could indicate a potential issue with thyroid function during an assessment for amenorrhea?

    <p>Palpable nodules in the neck</p> Signup and view all the answers

    Which symptom might suggest an underlying systemic illness during the review of systems for amenorrhea?

    <p>Galactorrhea</p> Signup and view all the answers

    When assessing nutritional and exercise history for a woman with amenorrhea, what is a key factor to evaluate?

    <p>Recent weight fluctuations</p> Signup and view all the answers

    Which aspect of the sexual history is particularly important in understanding possible causes of amenorrhea?

    <p>Type of contraceptive used</p> Signup and view all the answers

    What hormonal factors are believed to contribute to primary dysmenorrhea?

    <p>Hormonal and endocrine dysregulation</p> Signup and view all the answers

    At what age range does secondary dysmenorrhea most commonly present?

    <p>30-40 years old</p> Signup and view all the answers

    Which symptom is considered a red flag when evaluating dysmenorrhea?

    <p>Unilateral dysmenorrhea</p> Signup and view all the answers

    Which dietary recommendation is advised to manage symptoms of dysmenorrhea?

    <p>Low fat diet rich in diverse nutrient sources</p> Signup and view all the answers

    What is one recommended non-pharmacological support measure for managing dysmenorrhea?

    <p>Heat application via hot water bottle</p> Signup and view all the answers

    How is primary dysmenorrhea diagnosed?

    <p>Clinical diagnosis without the need for testing</p> Signup and view all the answers

    Which symptom is commonly associated with dysmenorrhea but not exclusive to it?

    <p>Nausea and vomiting during the menstrual cycle</p> Signup and view all the answers

    Which treatment option is usually indicated for moderate to severe dysmenorrhea?

    <p>Stronger NSAIDs beyond over-the-counter options</p> Signup and view all the answers

    What does a negative result from the progesterone challenge test indicate?

    <p>Inadequate estrogen stores or outflow tract obstruction</p> Signup and view all the answers

    Which laboratory test is the first step in evaluating amenorrhea?

    <p>Serum human chorionic gonadotropin (hCG)</p> Signup and view all the answers

    Which condition is associated with an LH/FSH ratio greater than 0.2?

    <p>Polycystic Ovary Syndrome (PCOS)</p> Signup and view all the answers

    Which treatment may help restore menstrual function in individuals with anorexia nervosa?

    <p>Increased nutritional intake</p> Signup and view all the answers

    What is a common feature of Turner’s syndrome that could cause amenorrhea?

    <p>Structural abnormalities of the reproductive organs</p> Signup and view all the answers

    When may hospitalization be necessary for a woman with amenorrhea related to anorexia nervosa?

    <p>If more than 30% of desired body weight is lost</p> Signup and view all the answers

    Which imaging technique is recommended when prolactin levels are elevated?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    What aspect of a woman's medical history is particularly crucial when evaluating for amenorrhea?

    <p>Age at menarche and menopause for family members</p> Signup and view all the answers

    Which of the following findings during a physical examination may suggest thyroid dysfunction?

    <p>Presence of thyroid masses or nodules</p> Signup and view all the answers

    What may a thorough review of systems reveal when evaluating amenorrhea?

    <p>Indications of systemic illness such as headaches</p> Signup and view all the answers

    Which examination technique is critical for assessing estrogen status during a pelvic exam?

    <p>Vaginal examination of epithelium and cervical mucus</p> Signup and view all the answers

    What type of history should be gathered to understand the potential causes of amenorrhea?

    <p>Detailed sexual history including number of partners</p> Signup and view all the answers

    Which of the following statements about secondary amenorrhea is true?

    <p>It can occur in women who have previously menstruated.</p> Signup and view all the answers

    Which physiological cause can lead to hyperprolactin amenorrhea?

    <p>Drug usage including OCPs and phenothiazines</p> Signup and view all the answers

    What is indicated by a positive result in the progesterone challenge test?

    <p>Patency of the outflow tract</p> Signup and view all the answers

    What does an FSH level greater than 30 indicate?

    <p>Early menopause</p> Signup and view all the answers

    Which condition is most likely indicated by an elevated LH/FSH ratio greater than 0.2?

    <p>Polycystic Ovary Syndrome (PCOS)</p> Signup and view all the answers

    Which diagnostic test is recommended if prolactin levels are high?

    <p>MRI or CT scan</p> Signup and view all the answers

    What management option is suggested for women with anorexia nervosa and amenorrhea?

    <p>Psychiatric counseling</p> Signup and view all the answers

    Which condition is included in the differential diagnosis for amenorrhea associated with abnormal X chromosomes?

    <p>Turner’s syndrome</p> Signup and view all the answers

    What is the primary reason for hospitalization of women with anorexia nervosa related to amenorrhea?

    <p>Suicidal ideation</p> Signup and view all the answers

    What does an initial diagnostic evaluation for amenorrhea typically rule out first?

    <p>Pregnancy</p> Signup and view all the answers

    What is the most common age range for the onset of primary dysmenorrhea?

    <p>6-12 months after menarche</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with dysmenorrhea?

    <p>Severe fever</p> Signup and view all the answers

    Which management strategy is considered the best initial therapy for dysmenorrhea?

    <p>Over-the-counter analgesics, preferably ibuprofen</p> Signup and view all the answers

    What red flag symptom may suggest a more serious underlying condition in dysmenorrhea cases?

    <p>Unilateral dysmenorrhea</p> Signup and view all the answers

    What is a crucial factor in diagnosing secondary dysmenorrhea?

    <p>Testing based on suspected underlying causes</p> Signup and view all the answers

    Which dietary recommendation is suggested for alleviating dysmenorrhea symptoms?

    <p>Low fat diet rich in fish and whole grains</p> Signup and view all the answers

    What is the primary etiology believed to contribute to primary dysmenorrhea?

    <p>Hormonal and endocrine-related factors</p> Signup and view all the answers

    Which of the following is a common finding in secondary dysmenorrhea during a physical exam?

    <p>Pelvic mass</p> Signup and view all the answers

    Study Notes

    Women's Health - Evaluation and Management of Gynecologic Concerns

    • Amenorrhea: Absence or abnormal cessation of menstrual bleeding.

    Primary Amenorrhea

    • Characterized by the absence of both spontaneous uterine bleeding and secondary sexual characteristics by age 14.
    • Alternatively, it's the absence of menarche (first menstrual period) by age 16, regardless of secondary sexual development.
    • Half of primary amenorrhea cases stem from a failure of the gonads to develop.
    • Other causes include structural abnormalities (e.g., imperforate hymen, vaginal abnormalities,) and disorders of the hypothalamic-pituitary-ovarian (HPO) axis, malnutrition, and PCOS.

    Secondary Amenorrhea

    • Absence of menstruation in a woman who previously had regular periods.
    • Frequent causes are pregnancy, breastfeeding (lactation), weight loss/eating disorders, intense athletic training (e.g., ballet, running) and early menopause.
    • Discontinuation of birth control pills (OCPs) or Depo-Provera can also contribute.
    • Similar to primary amenorrhea, disorders of the HPO axis can also cause secondary amenorrhea.

    Types of Secondary Amenorrhea

    • Hyperprolactinemia: Caused by drugs (e.g., OCPs, phenothiazines), pituitary tumors, or systemic illnesses (acromegaly, hypothyroidism). Nipple stimulation and breastfeeding can also elevate prolactin levels.
    • Hyperandrogenism: Often linked to PCOS, obesity, Cushing's syndrome, adrenal or thyroid disorders, or androgen-secreting tumors.
    • Hypogonadotropic Amenorrhea: A result of congenital or acquired disorders affecting the HPO axis. Commonly seen in young women under significant stress—emotional, physical or nutritional deficiencies or eating disorders.

    Clinical Presentation - Absent Bleeding

    • Comprehensive menstrual history (age at menarche, frequency, duration, flow, missed periods.)
    • Detailed sexual history (number of partners, last intercourse, birth control methods)
    • Medical history (pregnancies, abortions, ectopic pregnancies, surgical procedures, family history of infertility) and medication history (including OTC and illicit drugs).
    • Nutritional and exercise history (disordered eating habits, recent weight changes, athletic activity levels)
    • Review of other symptoms (e.g., headaches, visual disturbances, galactorrhea, thyroid issues) and social history (stressful life events, substance use).

    Physical Exam and Diagnostics

    • Thorough physical exam, focussing on general growth and development, and the assessment of visual acuity, thyroid, pelvic region, and cervical region.
    • Initial laboratory tests: Ruling out pregnancy (serum hCG), assessing hormonal function (FSH, LH), thyroid function (TSH), and prolactin levels.
    • Imaging: MRI or CT scans may be necessary if prolactin levels are high to identify pituitary tumors.

    Differential Diagnoses

    • Turner syndrome
    • Abnormal chromosomes
    • Chromosomal deletions
    • Structural abnormalities
    • Malnutrition
    • Systemic illnesses
    • Tumors
    • Early menopause
    • Pregnancy
    • Primary ovarian insufficiency
    • PCOS
    • Medication-related amenorrhea

    Management

    • Psychiatric counseling (when indicated), especially for disordered eating behaviors.

    • Medication: Progesterone challenge test if imaging is normal (medroxyprogesterone for 5-7 days), hormonal therapy.

    • Restoration of hypothalamic-pituitary-adrenal axes: Treating conditions like Kallmann syndrome or pituitary lesions, head injuries, or infections which impact the hormonal axis

    • Lifestyle modifications for anorexia nervosa: Increased nutritional intake, weight restoration and reduced exercise to re-establish menstruation.

    Hospitalization

    • Necessary for women with anorexia nervosa who have lost more than 30 percent of their desired body weight and fail to gain weight, and those with suicidal ideation.

    Dysmenorrhea

    • Primary Dysmenorrhea: Painful menstruation without an identifiable underlying medical condition, most common in adolescents, typically starting 6-12 months after menarche.
    • Secondary Dysmenorrhea: Painful menstruation with an underlying medical condition like endometriosis, PID, or fibroids, typically after childbearing age (30-40s).

    Signs and Symptoms (both primary and secondary dysmenorrhea)

    • Cramping and painful menses
    • Lower abdominal pain, possibly worsening during menstruation
    • Back pain, nausea, headache, diarrhea
    • Unilateral pain or signs of acute abdomen suggest more serious underlying issues that require additional medical evaluation.

    Laboratory/Diagnostics (Dysmenorrhea)

    • Primary Dysmenorrhea: No specific testing; diagnosis is clinical.
    • Secondary Dysmenorrhea: Testing based on suspected underlying cause (e.g., pelvic exam, hormonal testing).

    Management (Dysmenorrhea)

    • Education on menstruation, diet, and lifestyle choices can be beneficial.
    • Heat application like hot water bottles, relaxation techniques, and biofeedback are simple strategies that can support managing painful periods.
    • Over-the-counter pain relievers (NSAIDs, ibuprofen) can provide relief. For severe cases, stronger NSAIDS, or other medications may be considered.
    • Nutritional supplements like B vitamins, zinc, and calcium may play a role in managing pain.
    • Oral contraceptives can regulate the menstrual cycle and reduce cramping.
    • Referral to a specialist is recommended if pain is severe or does not respond to treatment.

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    NURS 7045 Chapter 137 - Women's Health PDF

    Description

    Test your knowledge on the evaluation and management of gynecologic concerns, focusing on amenorrhea. Understand the differences between primary and secondary amenorrhea and learn about its causes and implications. This quiz is essential for those studying women's health and reproductive systems.

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