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bbbbbbbbbbbbbbbbbbbbbbhhhNotesMCCQE 2000 Review Notes
and Lecture SeriesGynecology 11 REPRODUCTIVE
ENDOCRINOLOGY. . . CONT.History and Physical ExamPregnancy TestTSH and
Prolactinhigh/lowhigh (> 100) or symptomsof
hyperprolactinemiahypothyroidism/hyperthyroidismCT to rule out tumorProgesterone Challenge+
withdrawal bleedno withdrawal bleedAnovulationEnd-Organ Failureor Outlet ObstructionFSH,
LHhighlowOvarian Failure Hypothalamic DysfunctionFigure 3. Diagnostic Approach to
Amenorrheaoprogesterone challenge to assess estrogen status• medroxyprogesterone
acetate (Provera) 10 mg OD for 10 days•
ipppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp
pppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppf
withdrawal bleeding occurs —> adequate estrogen• if no bleeding occurs —>
hypoestrogenismokaryotype if indicatedoU/S to rule out cyst, polycystic ovarian
diseaseTreatmentohypothalamic dysfunction• stop drugs, reduce stress, adequate
nutrition, and decrease excessive exercise• clomiphene citrate (Clomid) if pregnancy
desired• otherwise BCP to induce
menstruationohyperprolactinuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
uuuuuuuuuuuuuuuuuuuuuuuuemia• bromocriptine• surgery for
macroadenomaopremature ovarian failure• treat associated autoimmune disorders•
HRT to prevent osteoporosis and other manifestations of hypoestrogenic
stateohypoestrogenism• karyotype • removal of gonadal tissue if Y chromosome
presentopolycystic ovarian disease• see Polycystic
hhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhOvarian Disease sectionABNORMAL
UTERINE BLEEDINGo90% anovulatory, 10%
ovulatoryHypermenorrhea/Menorrhagiaocyclic menstrual bleeding that is excessive in
amount (>80 mL) or duration (> 7 days)• adenomyosis• endometriosis• leiomyomata•
endometrial hyperplasia or cancer• hypothyroidismHypomenorrhea odecreased
menstrual flow or vaginal spNotesMCCQE 2000 Review Notes and Lecture

SeriesGynecology 11 REPRODUCTIVE ENDOCRINOLOGY. . .

CONT.History and Physical ExamPregnancy TestTSH and Prolactinhigh/lowhigh (> 100) or
symptomsof hyperprolactinemiahypothyroidism/hyperthyroidismCT to rule out tumorProgesterone
Challenge+ withdrawal bleedno withdrawal bleedAnovulationEnd-Organ Failureor Outlet
ObstructionFSH, LHhighlowOvarian Failure Hypothalamic
DyhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhsfunctionFigure 3. Diagnostic
Approach to Amenorrheaoprogesterone challenge to assess estrogen status•
medroxyprogesterone acetate (Provera) 10 mg OD for 10 days• if withdrawal bleeding
occurs —> adequate
estrobbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
bbbbbbbbbbbbbbbbbbbbbbbbgen• if no bleeding occurs —>
hypoestrogenismokaryotype if indicatedoU/S to rule out cyst, polycystic ovarian
diseaseTreatmentohypothalamic dysfunction• stop
druglllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllls, reduce
stress, adequate nutrition, and decrease excessive exercise• clomiphene citrate
(Clomid) if
pregnahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh
hhhhhhhhhhhhhhhhhhhhhhhncy desired• otherwise BCP to induce
menstruationohyperprolactinemia• bromocriptine• surgery for
macroadenomaopremature ovarian failure• treat associated autoimmune disorders•
HRT to prevent osteoporosis and other manifestations of hypoestrogenic
stateohypoestrogenism• karyotype • removal of gonadal tissue if Y chromosome
presentopolycystic ovarian disease• see Polycystic Ovarian Disease
sectionABNORMAL
UTnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn
nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnERI
NE BLEEDINGo90% anovulatory, 10% ovulatoryHypermenorrhea/Menorrhagiaocyclic
menstrual bleeding that is excessive in amount (>80 mL) or duration (> 7 days)•
adenomyosis• endometriosis• leiomyomata• endometrial hyperplasia or cancer•
hypothyroidismHypomenorrheaodecreased menstrual flow or vaginal
spNotesMCCQE 2000 Review Notes and Lecture SeriesGynecology

11 REPRODUCTIVE ENDOCRINOLOGY. . . CONT.History and Physical

ExamPregnancy TestTSH and Prolactinhigh/lowhigh (> 100) or symptomsof
hyperprolactinemiahypothyroidism/hyperthyroidismCT to rule out tumorProgesterone Challenge+
withdrawal bleedno withdrawal bleedAnovulationEnd-Organ Failureor Outlet ObstructionFSH,
LHhighlowOvarian Failure Hypothalamic DysfunctionFigure 3. Diagnostic Approach to
Amenorrheaoprogesterone challenge to assess estrogen status• medroxyprogesterone
acetate (Provera) 10 mg OD for 10 days• if withdrawal bleeding occurs —> adequate
estrogen• if no bleeding occurs —> hypoestrogenism okaryotype if indicatedoU/S to
rule out cyst, polycystic ovarian diseaseTreatment ohypothalamic dysfunction• stop
drugs, reduce stress, adequate nutrition, and decrease excessive exercise• clomiphene
citrate (Clomid) if pregnancy desired• otherwise BCP to induce
menstruationohyperprolactinemia• bromocriptine• surgery for
macroadenomaopremature ovarian failure• treat associated autoimmune disorders•
HRT to prevent osteoporosis and other manifestations of hypoestrogenic
stateohypoestrogenism• karyotype • removal of gonadal tissue if Y chromosome
presentopolycystic ovarian disease• see Polycystic Ovarian Disease
sectionABNORMAL UTERINE BLEEDINGo90% anovulatory, 10%
ovulatoryHypermenorrhea/Menorrhagiaocyclic menstrual bleeding that is excessive in
amount (>80 mL) or duration (> 7 days)• adenomyosis• endometriosis• leiomyomata•
endometrial hyperplasia or cancer• hypothyroidismHypomenorrhea odecreased
menstrual flow or vaginal spNotesMCCQE 2000 Review Notes and Lecture

SeriesGynecology 11 REPRODUCTIVE ENDOCRINOLOGY. . .

CONT.History and Physical ExamPregnancy TestTSH and Prolactinhigh/lowhigh (> 100) or
symptomsof hyperprolactinemiahypothyroidism/hyperthyroidismCT to rule out tumorProgesterone
Challenge+ withdrawal bleedno withdrawal bleedAnovulationEnd-Organ Failureor Outlet
ObstructionFSH, LHhighlowOvarian Failure Hypothalamic DysfunctionFigure 3. Diagnostic
Approach to Amenorrheaoprogesterone challenge to assess estrogen status•
medroxyprogesterone acetate (Provera) 10 mg OD for 10 days• if withdrawal bleeding
occurs —> adequate estrogen• if no bleeding occurs —> hypoestrogenism okaryotype if
indicatedoU/S to rule out cyst, polycystic ovarian diseaseTreatment ohypothalamic
dysfunction• stop drugs, reduce stress, adequate nutrition, and decrease excessive
exercise• clomiphene citrate (Clomid) if pregnancy desired• otherwise BCP to induce
menstruationohyperprolactinemia• bromocriptine• surgery for
macroadenomaopremature ovarian failure• treat associated autoimmune disorders•
HRT to prevent osteoporosis and other manifestations of hypoestrogenic
stateohypoestrogenism• karyotype • removal of gonadal tissue if Y chromosome
presentopolycystic ovarian disease• see Polycystic Ovarian Disease
sectionABNORMAL UTERINE BLEEDINGo90% anovulatory, 10%
ovulatoryHypermenorrhea/Menorrhagiaocyclic menstrual bleeding that is excessive in
amount (>80 mL) or duration (> 7 days)• adenomyosis• endometriosis• leiomyomata•
endometrial hyperplasia or cancer• hypothyroidismHypomenorrhea odecreased
menstrual flow or vaginal sp