Amenorrhea Flashcards
- Define primary and secondary amenorrhea.
Primary Amenorrhea: absence of menses with secondary sexual characteristics at the age of 16, OR absence of menses in the absence of secondary sexual characteristics at the age of 14.
Secondary Amenorrhea: absence of menses for more than 3 cycle intervals or 6 months in women who were previously menstruating.
Pregnancy is the most common cause of amenorrhea
what is functional hypothalamic primary amenorrhea? Causes?
Functional hypothalamic amenorrhea
Abnormal hypothalamic GnRH secretion/decrease GnRH pulsation leads to low or normal LH, normal FSH, low estradiol
Absence of normal follicular development and anovulation
Causes: eating disorders, exercise, stress (emotional or physical), medical illness
Kallman’s Syndrome: ___ amenorrhea, absent ___ __ __, and ___. Aka hypogonadotropic hypogonadism.
Kallman’s Syndrome: primary amenorrhea, absent secondary sexual characteristics, and ANOSMIA. Aka hypogonadotropic hypogonadism.
3 syndromes that can cause gonadal dysgenesis
Gonadal Dysgenesis: Premature depletion of all ovarian oocytes and follicles
Turners Syndrome (45X)
Fragile X gonadal dysgenesis (46XX)
- Fragile X has FMR1 gene, CGG repeats>200
- Balanced translocations, turner’s mosaic (46XX/X0)
Sweyers Syndrome: gonadal dysgenesis due to (46XY) (streak gonads)
Complete androgen insensitivity syndrome:
X linked recessive, 46XY. Resistant to testosterone via defect in androgen receptor. MIF is still produced from sertoli cells but NO MULLERIAN STRUCTURES are present aka NO UTERUS.
Testosterone is produced from Leydig cells but receptors don’t respond, leading to sparse pubic and axillary hair.
HIGH testosterone, 46XY.
Diagnosis: no breast development on exam, inc FSH. FSH may be normal, blind vagina, abnormal US with NO uterus
Gonadal dysgenesis →do karyotype
Androgen insensitivity (MRKH) vaginal agenesis.
If FSH normal→ breast and uterus normal → hypothalamic or pituitary cause.
Treatment: remove dysgenetic gonads, vaginal dilation for ultimate intercourse, consider counseling, hormone replacement.
what is an imperforate hymen
normally, hymen ruptures spontaneously during the perinatal period. These patients have normal secondary sexual characteristics but may have absent menses with cyclical pain, acute urinary retention.
Treatment: surgical → cruciate incision with excision of central portion.
Transverse vaginal septum
Mullerian agenesis
Typical presenting feature: pelvic pain, cyclical.
Treatment: surgical correction of obstruction (may be delayed until later age depending on the type of obstructive process), vaginal dilation for intercourse, consider counselling.
female athlete triad causing hypothalamic amenorrhea
Hypothalamic Amenorrhea: decrease in GnRH secretion, low estradiol, amenorrhea.
Causes: weight loss (eating disorders), stress (emotional or physical), infiltrative lesions (lymphoma, langerhans cell histiocytosis, sarcoidosis– look for associated headaches, change in personality and mood changes), female athlete triad: amenorrhea, disordered eating, osteopenia/osteoporosis.
key pituitary etiologies that cause secondary amenorrhea
Lactotroph adenoma (20% of cases): suppresses GnRH and secondarily estradiol. Leads to Galactorrhea
Pituitary stalk compression secondary to other tumors
Sheehan’s Syndrome
Radiation, infection, infiltrative lesions.
Asherman’s Syndrome:
scarring of the endometrial lining
Could be secondary to PPH and post partum endometritis resulting in a D and C, secondary to multiple uterine proceduers, or to other uterine infection
Treatment: surgical correction of uterine synechia
