Amenorrhea Flashcards
Primary Amenorrhea Definition: the absence of menarche at __ years of age despite normal development of____
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secondary sexual characteristics
Primary Amenorrhea Definition: Also: absence of menses at __years of age in female individuals with ________
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no secondary sexual characteristics
Causes of primary amenorrhea include
Gonadal dysgenesis (Turner syndrome) Müllerian agenesis Delay of puberty Polycystic ovary syndrome (PCOS) Hypopituitarism
Also remember that _____amenorrhea can
present as ___amenorrhea,
secondary
primary
Initial testing for primary amenorrhea includes:
β-HCG TSH Prolactin FSH Pelvic ultrasound (to assess for presence of a uterus)
Primary Amenorrhea tx
depends on the cause of the amenorrhea
Secondary Amenorrhea is the absence of menses for more than __ months in a
female who menstruates regularly or absence of menses for _ months in a female who menstruates irregularly.
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6
Causes of secondary amenorrhea include:
Pregnancy (the most common cause of secondary amenorrhea) Hypothalamic amenorrhea Hyperprolactinemia Primary ovarian insufficiency Polycystic ovarian syndrome Thyroid abnormalities
Best initial test for secondary amenorrhea is
β-HCG—this is done first.
what to do if β-HCG is negative
TSH.
what to do if high free t4
treat hypothyroidism with Levothryroxine
what to do if low free t4
treat hyperthyroidism with propylthiouracil (PTU) or methimazole
what to do if TSH is normal
ask Prolactin
what to do if high prolactin
primary ovarian insufficency: check for symptoms: hot flashes, vaginal dryness
what to do if normal prolactin
ask estradiol
what to do if low estradiol
hypogonadotropic hypogonadism; ask MRI.
what to do if normal estradiol
ask testorsetone or look for clinical hyperandrogenism
high testorsetone or + clinical hyperandrogenism mean?
PCOS
what to do if normal testorsetone and no clinical hyperandrogenism
progesterone wthdrawal test
what does a + progesterone wthdrawal test mean?
withdrawal bleed= anovulation
what does a - progesterone wthdrawal test mean?
no bleeding
alter progesterone
what to do if you got a - progesterone wthdrawal test?
Estrogen-progesterone challenge test
what does it mean a + Estrogen-progesterone challenge test
+ withdrawal bleed
Estrogen deficency.
Get an MRI
cuz could be pituitary disorder
what does it mean a -ve Estrogen-progesterone challenge test
- no bleeding
hysteroscopy or hysterosalpingogram
Think about Outflow tract obstruction
