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REPRODUCTIVE ENDOCRINOLOGY . . . CONT.

Notes

Secondary menstrual pain due to organic disease begins in women who are in their 20’s worsens with age associated dyspareunia, abnormal bleeding, infertility etiology • endometriosis • adenomyosis • fibroids • PID • ovarian cysts • IUD

PREMENSTRUAL SYNDROME

Definition variable cluster of symptoms that appear to occur on a regular basis prior to each menstrual episode more correctly called OVARIAN CYCLE SYNDROME since symptoms depend on ovulation etiology is unknown

Symptoms occur 7-10 days before menses and relieved by onset of menses 7 day symptom-free interval must be present in first half of cycle physical - see Progestin Deficiency and Estrogen Excess Symptoms psychological • irritability • anxiety • depression • sleep disturbance • appetite change • libido change • fatigue • suicidal ideation

Treatment no proven beneficial treatment, only suggested treatment psychological support diet • decreased sodium, fluids, carbohydrates • increased protein • avoidance of caffeine and alcohol medications • vitamins - B6 (pyridoxine) • BCP • progesterone suppositories • diuretics for severe fluid retention • NSAIDs for discomfort, pain • evening of primrose oil (linoleic acid) • danazol (Danocrine) • SSRI antidepressants in selected cases regular exercise

MENOPAUSE

physiological (average age 51) premature ovarian failure surgical

Definitions menopause • cessation of menses for > 6 months or 1 year (depending upon source) climacteric • period characterized by cessation of menses • includes vasomotor, endocrine, somatic changes

Symptoms symptoms associated with estrogen deficiency vasomotor (hot flushes)

Gynecology 14

MCCQE 2000 Review Notes and Lecture Series

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