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primary amenorrhea
absence of spontaneous menstruation by age 16
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Secondary amenorrhea
absence of period for 6 months or longer
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Amenorrhea in woman with no secondary sexual characteristics suggests:
gonadal agenesis or dysgenesis, ovarian resistance syndrome, galactosemia, GnRH deficiency, constitutional pubertal delay, CNS lesion, stress, or hyperprolactinemia
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Amenorrhea with breast development but no pubic or axillary hair
androgen insensitivity
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Amenorrhea in woman with nl secondary sex characteristics
imperforate hymen, transverse vaginal septum, or cervical or mullerian agenesis
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primary amenorrhea in women with incompletely developed sexual characteristics
- tumor of hypothalamus or pituitary
- hypothyroidism
- premature ovarian failure
- hyperprolactinemia
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Secondary amenorrhea in women with nl estrogen
Asherman's syndrome (intrauterine synechiae) or PCOS
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Secondary amenorrhea in women with low estrogen
- CNS tumor
- stress
- hyperprolactinemia
- hypophysitis
- Sheehan's syndrome
- premature ovarian syndrome
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How do you determine the presence or absence of sufficient estrogen?
progesterone challenge test
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enlarged, boggy uterus
adenomyosis (implantation of endometrial tissue in the myometrium)
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premature menopause
cessation of menstruation before 40 yo
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tx of vasomotor sx
- estrogen replacement therapy will resolve sx in 3-6 weeks
- sx resolve in 2-3 years if on their own
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Lab studies in menopause
FSH > 30
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DUB
abnl uterine bleeding in the absence of an anatomic lesion, usually caused by a problem with the hypothalamic-pituitary-ovarian hormonal axis
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m/c cause of DUB
after menarche and during perimenopause bc of increased anovulatory cycles
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m/c gynecologic malifnancy
endometreial ca
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Tx of endometrial ca
total hysterectomy with B/L BSO is the basis of tx and staging
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m/c location for endometriosis
pelvis or ovary
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adenomyosis
extenstion of endometrial glands into the uterine musculature
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presentation of adenomyosis
may present with severe secondary dysmenorrhea, but most pts are asx
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classic adenomyosis pt
middle aged, parous, severe secondary dysmenorrhea and menorrhagia and a symmetricall enlarged uterus
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tx of adenomyosis
d&c, GnRH agonist, or mifepristone; hysterectomy is definitive
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m/c ovarian growths
cysts
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Tx of ovarian cysts
- follow for one or two cycles in premenopausal women with cysts < 8 cm
- large or persistent cysts require laparoscopic eval
- cysts in postmenopausal women are malignant until proven otherwise
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Use of OCPs in relation to ovarian Ca
long term use is protective
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m/c type of vulvar ca
SCC
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women with in utero exposure to DES is at risk for what type of Ca?
clear cell adenocarcinoma of the vagina
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m/c benign condition of breast
fibrocystic changes
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Paget's dz
ductal carcinoma presenting as an eczematous lesion of the nipple
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Failure rates for OCPs
- theoretical: 1%
- actual: 4-6%
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