What phase is day 1-14 of menstruation?
follicular phase
describe the hormones related to follicular phase (day 1-14)
- FSH, LH receptors upregulate
- low progesterone levels
- estrogen is the dominant hormone
What happens on day 14 of menstruation?
ovulation occurs and LH surge
what phase is day 15-28?
luteal phase
describe what happens during the luteal phase (day 15-28)
- corpus luteum develops and produces progesterone and estrogen
- progesterone is the dominant hormone
- endometrial vascularity and secretory action increase
- increases basal body temp
When is the proliferation phase?
days 1-14
endometrium
When is the secretory phase?
days 15-28
When is the secretory phase?
days 15-28
symptoms (wt gain, edema, mood changes, breast tenderness, anxiety, depression) occur in the luteal phase (day 15-28)
symptoms end 1-2 days after onset of menses
premenstrual syndrome (PMS)
must have somatic and affective symptoms
if premenstrual symptoms are severe enough to cause dysfunction of daily living?
premenstrual dysphoric disorder (PMDD)
Treatment for premenstrual syndrome?
- NSAID
- Diuretics
- SSRI (fluoxetine, sertraline, paroxetine)
- OCP
- diet and behavior changes = decrease caffeine, low carbs, vit b6, water, calcium, exercise
primary dysmenorrhea?
painful menstruation = excess prostaglandin and leukotriene levels
- onset within 2 years of menarche
- no pathologic abnormality
Secondary dysmenorrhea?
- painful menstruation = later in life
- identifiable cause
Examples of causes for secondary dysmenorrhea?
- cervical stenosis
- endometriosis
- adenomyosis
- pelvic infection
- adhesion
- pelvic congestion
- conditioned behavior
- stress
- GI
- IUD
- fibroids
- PID
Treatment for primary dysmenorrhea?
- NSAID before onset of menses and continue for 2-3 days (first line)
- OCP (2nd line), vit b, magnesium, heat, exercise
treatment for secondary dysmenorrhea?
treat underlying condition
- remove IUD
- symptomatic
treatment for secondary dysmenorrhea?
treat underlying condition
- remove IUD
- symptomatic
high fever, hypotension, v/d, rash, confusion, HA, seizures, retained tampon… suspect? cause? treatment?
toxic shock syndrome
cause: toxins from staphylococcus aureus or group a streptococcus
Tx: Clindamycin IV
- surgical debridement
- consider MRSA
high fever, hypotension, v/d, rash, confusion, HA, seizures, retained tampon… suspect? cause? treatment?
toxic shock syndrome
cause: toxins from staphylococcus aureus or group a streptococcus
Tx: Clindamycin IV
- surgical debridement
- consider MRSA
What is the absence of menstruation by age 16?
primary amenorrhea
Causes of primary amenorrhea?
- gonadal agenesis or dysgenesis (turner syndrome)
- GNRH deficiency
- constitutional pubertal delay
- hyperprolactinemia
- ovarian resistance syndrome
- stress
- CNS mass
absence of menstruation at age 16, has breast development, no pubic or axillary hair… what type of primary amenorrhea?
androgen insenstivity
absence of menstruation by age 16, has normal secondary sexual characteristics.. what could be some of the causes for this type of primary amenorrhea?
- imperforate hymen
- vaginal septum
- mullerian agenesis
Workup for primary amenorrhea?
- full H&P
- quantitative beta-hCG
- FSH, prolactin, TSH, T3,T4, estrogen, progesterone
- US, MRI/CT r/o CNS, abdominal, pelvic mass
- genetic testing
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