Amenorrhea Flashcards
definition of primary amenorrhea
failure to menstruate by age 15 in the presence of normal secondary sexual development or within 5 years of breast development
definition of secondary amenorrhea
amenorrhea lasting three months
definition of oligomenorrhea
less than nine cycles a year
four most common causes of pathologic amenorrhea (excluding pregnancy, lactation, menopause)
PCOS, hypothalamic amenorrhea, hyperprolactinemia and ovarian failure
WHO group I is defined by
no evidence of exogenous estrogen, normal or low FSH levels, normal prolactin and pituitary lesions
WHO group II is defined by
evidence of estrogen production and normal levels of PRL and FSH
WHO group III is defined by
elevated serum FSH (gonadal failure)
initial workup for amenorrhea
history, physical examination, FSH, TSH and prolactin
if there is gonadal failure in a woman less than 30 years of age, what should be performed
karyotype
Mullerian agenesis accounts of ____% of primary amenorrhea
10%
urogenital malformations associated with mullerian agenesis
unilateral renal agenesis, pelvic kidney, horseshoe kidney, hydronephrosis and ureteral duplication
ways to distinguish mullerian agenesis and complete androgen insensitivity
testosterone levels, karyotype, lack of pubic hair in CAS
chance of gonadal malignancy in CAS
22%
when should the gonads be removed in CAS
after breast development
imperforate hymen, transverse vaginal septum or isolated absence of the vagina or cervix may lead to
cyclic pain, endometriosis and pelvic adhesions
phenotype for genetically XX with gonadal failure before sexual maturation (genitalia/breast)
female genitalia, incomplete breast development
phenotype for genetically XY with gonadal failure (genitalia)
female genitalia
percent of women with a Y chromosome that develop gonadal tumors
25%
phenotype of Turner’s
short stature, webbed neck and low hairline
when does oocyte loss accelerate in Turners
after 18 weeks
when should karyotype be obtained for POF
women under 30
percent of fragile X premutation carriers that have POF
16%
autosomal disorders associated with ovarian failure
phosphomannomutase 2 (PMMS), galactose-1-phosphate uridultransferase (GALT), FSH receptor (FSHR), chromosome 3q blepharophimosis gene, autoimmune regularor (AIRE) gene
when should progestin start to mimic pubertal development in adolescents with gonadal failure
after breast mound and areola have developed with low dose estrogen
