1. primary amenorrhea
    absence of spontaneous menstruation by age 16
  2. Secondary amenorrhea
    absence of period for 6 months or longer
  3. 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
  4. Amenorrhea with breast development but no pubic or axillary hair
    androgen insensitivity
  5. Amenorrhea in woman with nl secondary sex characteristics
    imperforate hymen, transverse vaginal septum, or cervical or mullerian agenesis
  6. primary amenorrhea in women with incompletely developed sexual characteristics
    • tumor of hypothalamus or pituitary
    • hypothyroidism
    • premature ovarian failure
    • hyperprolactinemia
  7. Secondary amenorrhea in women with nl estrogen
    Asherman's syndrome (intrauterine synechiae) or PCOS
  8. Secondary amenorrhea in women with low estrogen
    • CNS tumor
    • stress
    • hyperprolactinemia
    • hypophysitis
    • Sheehan's syndrome
    • premature ovarian syndrome
  9. How do you determine the presence or absence of sufficient estrogen?
    progesterone challenge test
  10. enlarged, boggy uterus
    adenomyosis (implantation of endometrial tissue in the myometrium)
  11. premature menopause
    cessation of menstruation before 40 yo
  12. tx of vasomotor sx
    • estrogen replacement therapy will resolve sx in 3-6 weeks
    • sx resolve in 2-3 years if on their own
  13. Lab studies in menopause
    FSH > 30
  14. DUB
    abnl uterine bleeding in the absence of an anatomic lesion, usually caused by a problem with the hypothalamic-pituitary-ovarian hormonal axis
  15. m/c cause of DUB
    after menarche and during perimenopause bc of increased anovulatory cycles
  16. m/c gynecologic malifnancy
    endometreial ca
  17. Tx of endometrial ca
    total hysterectomy with B/L BSO is the basis of tx and staging
  18. m/c location for endometriosis
    pelvis or ovary
  19. adenomyosis
    extenstion of endometrial glands into the uterine musculature
  20. presentation of adenomyosis
    may present with severe secondary dysmenorrhea, but most pts are asx
  21. classic adenomyosis pt
    middle aged, parous, severe secondary dysmenorrhea and menorrhagia and a symmetricall enlarged uterus
  22. tx of adenomyosis
    d&c, GnRH agonist, or mifepristone; hysterectomy is definitive
  23. m/c ovarian growths
  24. 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
  25. Use of OCPs in relation to ovarian Ca
    long term use is protective
  26. m/c type of vulvar ca
  27. women with in utero exposure to DES is at risk for what type of Ca?
    clear cell adenocarcinoma of the vagina
  28. m/c benign condition of breast
    fibrocystic changes
  29. m/c female ca
  30. Paget's dz
    ductal carcinoma presenting as an eczematous lesion of the nipple
  31. Failure rates for OCPs
    • theoretical: 1%
    • actual: 4-6%
  32. m/c cause of PID
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