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
