WOMEN'S HEALTH PAEA - OBSTETRICS, WOMEN'S
HEALTH PAEA – GYNECOLOGY QUESTIONS WITH
VERIFIED ACCURATE ANSWERS
absence of menses by 16 years old with normal growth and secondary sexual
characteristics
*OR*
absence of menses by age 13 with no secondary sexual characteristics - Answers -
Primary Amenorrhea
absence of menses for >6 months in a woman who previously had normal menses.
Usually caused by underlying medical condition. - Answers - Secondary Amenorrhea
MCC of primary amenorrhea ? - Answers - gonadal dysgenesis
breasts absent, uterus present have no ______________ ___________. - Answers -
Ovarian Estrogen
- PRIMARY AMENORRHEA
- ovaries are replaced by band of fibrous tissue called gonadal streak
- due to absence of ovarian follicles there is no synthesis of ovarian steroids.
- no estrogen =/= breast development
- *FSH and LH are markedly elevated* due to dec levels of estrogen. Body is not
provided the negative feedback needed to dec FSH and LH levels. - Answers - Gonadal
Dysgenesis
Why do patients with Gonadal Dysgenesis have phenotypical external and internal
genitalia of a female? - Answers - Estrogen is not necessary for mullerian duct
development of wolffian duct regression or the internal and external genitalia are
phenotypically the same.
-PRIMARY AMENORRHEA
45, x
- primary amenorrhea + absent breasts
- short stature, webbed neck, short fourth metacarpal and cubitus valgus
- cardiac abnormalities like coarctation of aorta/ renal / hypothyroidism
- given estrogen and progesterone at puberty to allow secondary sexually
characteristics to develop.// may receive growth hormone. - Answers - TURNER'S
SYNDROME; gonadal dysgenesis
- PRIMARY AMENORRHEA
- 46, XX OR 46 XY
- *decreased cortisol levels and adrenal/gonadal sex steroid secretion*
,- HTN, Hypernatremia, Hypokalemia due to excess mineral corticoid
- need replacement sex steroids and cortisol
- can achieve pregnancy with IVF in XX
- *46, XY Breasts Absent, Uterus Absent.*
- *46, XX Breast Absent, Uterus Present* [can carry with IVF] - Answers - 17 alpha
hydroxylase deficiency
- PRIMARY AMENORRHEA
- *XY*
- *breasts present; uterus absent*
- scant/ absent pubic hair.
- *testes may be located intra-abdominally or in the inguinal canal and have an
increased risk of malignancy*
- normal male hormone levels
- Remove gonads/testes after puberty to avoid risk of malignancy (gonadoblastoma or
dysgerminoma) and to allow for breast development and adequate bone growth.
- Estrogen is then given after removal
- Raised as females. - Answers - Androgen
Insensitivity
- (Testicular Feminization.)
- PRIMARY AMENORRHEA
- XX
- *no uterus*
- shortened vagina
- *normally functioning ovaries; normal female levels*
- *normal breast development*
- normal axillary and pubic hair
- a/w renal and skeletal abnormalities and should be screened with an U/S or MRI
- normal endocrine function
- do not need supplemental hormones
- may need surgery to make vagina functional. - Answers - Mullerian Agenesis (Mayer-
Rokitansky-Kuster-Hauser Syndrome)
what is the result of mullerian failure? - Answers - absent uterus
2nd mcc of primary amenorrhea? - Answers - mullerian agenesis / failure
- PRIMARY AMENORRHEA
- breasts present and uterus present
What should you suspect? - Answers - imperforate hymen, transverse vaginal septum
imperforate hymen; transverse septum - Answers - - normal breast and pubic hair
- uterus present
,- *cyclic pelvic pain* due to menstrual blood not having an egress
- *hematocolpos (accumulation of menstrual blood from the imperforate hymen.*
- can be palpated as a *perirectal mass* on PE
[*bulging blue mass at introitus*]
- tx is to excise obstruction.
How does FSH help distinguish between gonadal failure and hypogonadotropic
hypogonadism? - Answers - *FSH is high with gonadal failure* [ trying to respond to low
levels of estrogen] and low with hypogonadotropic hypogonadism
What causes secondary amenorrhea? - Answers - - pregnancy (MCC)
- hypothalamus
- pituitary
- ovary
- uterus
- other: cervical/ endocrine
Ovarian failure may be due to - Answers - hypothalamus not producing GnRH
OR
ovaries not responding to FSH
- Secondary Amenorrhea; _______________
- *low levels of gonadotropins*, estrogen, *absent withdrawal bleed with progesterone*
- caused by Lesions, Drugs, Stress and Exercise, Weight Loss/ Anorexia, Functional
Hypothalmic Amenorrhea (rare) - Answers - Hypothalamic
- Secondary Amenorrhea; ______________
- caused by Neoplasms at the site of concern OR lesions such as hemorrhage,
destruction from anoxia or thrombosis,
- may be a/w dec section of other hormones produced/ secreted at the site like ACTH,
TSH, LH, FSH (hint hint)
- Sheehan Syndrome
- Simmonds Disease - Answers - Pituitary; Hypoestrogenic Amenorrhea
- Pituitary cell destruction occurs due to hypotensive episode during pregnancy (usually
due to catastrophic hemorrhage)
- leads to secondary ammenorhea
- tx: replacement of pituitary hormones
- aka pituitary necrosis - Answers - Sheehan Syndrome
- similar to sheehan's syndrome
- pituitary damage except NOT related to pregnancy like Sheehans' - Answers -
Simmonds Dz
- can cause secondary amenorrhea
- Depletion of oocytes resulting in secondary amenorrhea before the age of 40
, - idiopathic but can be caused by *radiation or chemo/ autoimmune dz/ fragile x /
turner's*
- tx: hormone replacement/ bone protection - Answers - Premature Ovarian Failure
PCOS can cause secondary amenorrhea. How do you diagnose PCOS? - Answers - -
U/S
- signs of androgen excess
- oligomenorrhea/ secondary amenorrhea
- other signs: obesity, acne, hirsutism, acanthosis nigricans, premature pubarche,
precocious puberty
- intrauterine adhesions/scarring can obliterate the endometrial cavity causing
secondary amenorrhea
- MCC endometrial curettage a/w pregnancy
- adhesions may form from myomectomy, metroplasty or C section
- confirm dg with hysterosalpingogram (HSG) or hysteroscopy
- tx: resection of adhesions. Estrogens to stimulate regrowth of endometrium - Answers
- Asherman's Syndrome
(Uterine cause of 2ndary amenorrhea)
Stenosis due to loop electrosurgical excision procedure (LEEP) or cold knife cone may
cause __________________ ________________
- tx: cervical dilation - Answers - secondary amenorrhea; cervical
Endocrine causes of Secondary Amenorrhea - Answers - - hypo/hyper thyroidism
- diabetes mellitus
- hyperandrogenism (neoplasm/ exogenous andoregens)
Progestin Challenge Test - Answers - - give oral progestin for 10 days
- if the endometrium has been primed with estrogen from ovaries or peripheral fat then
the withdrawal of progestin after 10 days will cause endometrial sloughing *with
resultant menses = no pathology*
- no menses --> absence of ovaries, estrogen deficiency or outflow obstruction. (obvious
pathology) [d/t very low levels of estrogen]
Naegele's Rule - Answers - add 7 days to LMP, subtract 3 months, add 1 year
to find EDD
Hegar's Sign - Answers - Uterine/cervix softening
Chadwicks sign - Answers - Bluish purple discoloration of the cervix, vagina, and labia
during pregnancy as a result of increased vascular congestion.
Fundal Height - Answers -
HEALTH PAEA – GYNECOLOGY QUESTIONS WITH
VERIFIED ACCURATE ANSWERS
absence of menses by 16 years old with normal growth and secondary sexual
characteristics
*OR*
absence of menses by age 13 with no secondary sexual characteristics - Answers -
Primary Amenorrhea
absence of menses for >6 months in a woman who previously had normal menses.
Usually caused by underlying medical condition. - Answers - Secondary Amenorrhea
MCC of primary amenorrhea ? - Answers - gonadal dysgenesis
breasts absent, uterus present have no ______________ ___________. - Answers -
Ovarian Estrogen
- PRIMARY AMENORRHEA
- ovaries are replaced by band of fibrous tissue called gonadal streak
- due to absence of ovarian follicles there is no synthesis of ovarian steroids.
- no estrogen =/= breast development
- *FSH and LH are markedly elevated* due to dec levels of estrogen. Body is not
provided the negative feedback needed to dec FSH and LH levels. - Answers - Gonadal
Dysgenesis
Why do patients with Gonadal Dysgenesis have phenotypical external and internal
genitalia of a female? - Answers - Estrogen is not necessary for mullerian duct
development of wolffian duct regression or the internal and external genitalia are
phenotypically the same.
-PRIMARY AMENORRHEA
45, x
- primary amenorrhea + absent breasts
- short stature, webbed neck, short fourth metacarpal and cubitus valgus
- cardiac abnormalities like coarctation of aorta/ renal / hypothyroidism
- given estrogen and progesterone at puberty to allow secondary sexually
characteristics to develop.// may receive growth hormone. - Answers - TURNER'S
SYNDROME; gonadal dysgenesis
- PRIMARY AMENORRHEA
- 46, XX OR 46 XY
- *decreased cortisol levels and adrenal/gonadal sex steroid secretion*
,- HTN, Hypernatremia, Hypokalemia due to excess mineral corticoid
- need replacement sex steroids and cortisol
- can achieve pregnancy with IVF in XX
- *46, XY Breasts Absent, Uterus Absent.*
- *46, XX Breast Absent, Uterus Present* [can carry with IVF] - Answers - 17 alpha
hydroxylase deficiency
- PRIMARY AMENORRHEA
- *XY*
- *breasts present; uterus absent*
- scant/ absent pubic hair.
- *testes may be located intra-abdominally or in the inguinal canal and have an
increased risk of malignancy*
- normal male hormone levels
- Remove gonads/testes after puberty to avoid risk of malignancy (gonadoblastoma or
dysgerminoma) and to allow for breast development and adequate bone growth.
- Estrogen is then given after removal
- Raised as females. - Answers - Androgen
Insensitivity
- (Testicular Feminization.)
- PRIMARY AMENORRHEA
- XX
- *no uterus*
- shortened vagina
- *normally functioning ovaries; normal female levels*
- *normal breast development*
- normal axillary and pubic hair
- a/w renal and skeletal abnormalities and should be screened with an U/S or MRI
- normal endocrine function
- do not need supplemental hormones
- may need surgery to make vagina functional. - Answers - Mullerian Agenesis (Mayer-
Rokitansky-Kuster-Hauser Syndrome)
what is the result of mullerian failure? - Answers - absent uterus
2nd mcc of primary amenorrhea? - Answers - mullerian agenesis / failure
- PRIMARY AMENORRHEA
- breasts present and uterus present
What should you suspect? - Answers - imperforate hymen, transverse vaginal septum
imperforate hymen; transverse septum - Answers - - normal breast and pubic hair
- uterus present
,- *cyclic pelvic pain* due to menstrual blood not having an egress
- *hematocolpos (accumulation of menstrual blood from the imperforate hymen.*
- can be palpated as a *perirectal mass* on PE
[*bulging blue mass at introitus*]
- tx is to excise obstruction.
How does FSH help distinguish between gonadal failure and hypogonadotropic
hypogonadism? - Answers - *FSH is high with gonadal failure* [ trying to respond to low
levels of estrogen] and low with hypogonadotropic hypogonadism
What causes secondary amenorrhea? - Answers - - pregnancy (MCC)
- hypothalamus
- pituitary
- ovary
- uterus
- other: cervical/ endocrine
Ovarian failure may be due to - Answers - hypothalamus not producing GnRH
OR
ovaries not responding to FSH
- Secondary Amenorrhea; _______________
- *low levels of gonadotropins*, estrogen, *absent withdrawal bleed with progesterone*
- caused by Lesions, Drugs, Stress and Exercise, Weight Loss/ Anorexia, Functional
Hypothalmic Amenorrhea (rare) - Answers - Hypothalamic
- Secondary Amenorrhea; ______________
- caused by Neoplasms at the site of concern OR lesions such as hemorrhage,
destruction from anoxia or thrombosis,
- may be a/w dec section of other hormones produced/ secreted at the site like ACTH,
TSH, LH, FSH (hint hint)
- Sheehan Syndrome
- Simmonds Disease - Answers - Pituitary; Hypoestrogenic Amenorrhea
- Pituitary cell destruction occurs due to hypotensive episode during pregnancy (usually
due to catastrophic hemorrhage)
- leads to secondary ammenorhea
- tx: replacement of pituitary hormones
- aka pituitary necrosis - Answers - Sheehan Syndrome
- similar to sheehan's syndrome
- pituitary damage except NOT related to pregnancy like Sheehans' - Answers -
Simmonds Dz
- can cause secondary amenorrhea
- Depletion of oocytes resulting in secondary amenorrhea before the age of 40
, - idiopathic but can be caused by *radiation or chemo/ autoimmune dz/ fragile x /
turner's*
- tx: hormone replacement/ bone protection - Answers - Premature Ovarian Failure
PCOS can cause secondary amenorrhea. How do you diagnose PCOS? - Answers - -
U/S
- signs of androgen excess
- oligomenorrhea/ secondary amenorrhea
- other signs: obesity, acne, hirsutism, acanthosis nigricans, premature pubarche,
precocious puberty
- intrauterine adhesions/scarring can obliterate the endometrial cavity causing
secondary amenorrhea
- MCC endometrial curettage a/w pregnancy
- adhesions may form from myomectomy, metroplasty or C section
- confirm dg with hysterosalpingogram (HSG) or hysteroscopy
- tx: resection of adhesions. Estrogens to stimulate regrowth of endometrium - Answers
- Asherman's Syndrome
(Uterine cause of 2ndary amenorrhea)
Stenosis due to loop electrosurgical excision procedure (LEEP) or cold knife cone may
cause __________________ ________________
- tx: cervical dilation - Answers - secondary amenorrhea; cervical
Endocrine causes of Secondary Amenorrhea - Answers - - hypo/hyper thyroidism
- diabetes mellitus
- hyperandrogenism (neoplasm/ exogenous andoregens)
Progestin Challenge Test - Answers - - give oral progestin for 10 days
- if the endometrium has been primed with estrogen from ovaries or peripheral fat then
the withdrawal of progestin after 10 days will cause endometrial sloughing *with
resultant menses = no pathology*
- no menses --> absence of ovaries, estrogen deficiency or outflow obstruction. (obvious
pathology) [d/t very low levels of estrogen]
Naegele's Rule - Answers - add 7 days to LMP, subtract 3 months, add 1 year
to find EDD
Hegar's Sign - Answers - Uterine/cervix softening
Chadwicks sign - Answers - Bluish purple discoloration of the cervix, vagina, and labia
during pregnancy as a result of increased vascular congestion.
Fundal Height - Answers -
