amenorrhea

Question 1

what is amenorrhea?

Answer 1

absence of menses
two types– primary and secondary

Question 2

primary amenorrhea vs secondary

Answer 2

primary means no menarche before 15yo but has secondary sex characteristics OR no menarche by 13yo w/o secondary sex characteristics
secondary is no menses for 3-6 months in previously menstruating ppl

Question 3

causes of amenorrhea

Answer 3

pregnancy
hypothalamic-pituitary dysfx
ovarian dysfx
alterations of genital outflow tract

Question 4

two examples of pituitary dysfx

Answer 4

hyperprolactinemia
cushings disease

Question 5

functional causes of hypothalamic-pituitary dysfx

Answer 5

wt loss/too much exercise, stress, anorexia
these lead to decreased gonadotropins; a hypothalamic GnRH deficiency

Question 6

name two neoplastic causes of hypothalamic-pituitary dysfx

Answer 6

craniopharyngioma
hypothalamic hamartoma

Question 7

three other causes of hypothalamic-pituitary dysfx (not functional or neoplastic)

Answer 7

thyroid-ism
PCOS
head injury

Question 8

5 conditions of ovarian dysfx that can cause amenorrhea

Answer 8

PCOS
turner syndrome (45,X)
premature menopause
savage syndrome (rare)
blizzard syndrome (rare)

Question 9

define savage syndrome

Answer 9

gonadotropin resistant ovary syn causing functional disturbance of gonadotropin receptor in ovarian follicles

Question 10

define blizzard syndrome

Answer 10

autoimmune multisystem ovarian failure

Question 11

list three outflow obstructions that can cause amenorrhea

Answer 11

imperforate hymen
asherman syndrome
other structural abnormalities – abnormal vaginal openings

Question 12

what is Asherman syndrome

Answer 12

scarring of uterine cavity which can happen after D & C esp. in endometriosis

Question 13

PE workup for amenorrhea

Answer 13

BMI
thyroid exam
pelvic exam
breast exam
tanner staging

Question 14

what is tanner staging

Answer 14

how we monitor development of secondary sex characteristics
for females, tracks pubic hair & breast development

Question 15

what are labs to get if considering amenorrhea?

Answer 15

pregnancy test
FSH, TSH
prolactin
imaging– US
LH

Question 16

how is US used in amenorrhea workup?

Answer 16

used in evaluating primary to r/o structural abnormalities as cause

Question 17

why would you do a hysteroscopy when doing amenorrhea work up?

Answer 17

to r/o ashermans syndrome

Question 18

why check LH if its not a first line test?

Answer 18

can help to see if it is hypothalamic amenorrhea or PCOS

Question 19

how do FSH & LH levels compare in hypothalamic amenorrhea vs PCOS?

Answer 19

PCOS– LH is higher than FSH

Question 20

expected lab levels if cause if hypo-pit dysfx?

Answer 20

high prolactin
abnormal TSH
low/normal FSH

Question 21

how do FSH & LH levels compare in ovarian dysfx vs PCOS?

Answer 21

ovarian dysx— high FSH
PCOS— 3:1 LH/FSH

Question 22

what is the progesterone challenge

Answer 22

give fake progesterone for about 2 wks then stop
if they bleed a week later—- patient is anovulatory or oligoovulatory
if they don’t bleed— low estrogen or anatomic abnormality

Question 23

anovulatory vs oligoovulatory

Answer 23

anovulation is no ovulation
oligoovulation is condition causing irregular ovulation

Question 24

is amenorrhea always bad?

Answer 24

no. its okay to be amenorrheic
it is only a problem if pregnancy is goal or if there is underlying issue that should be addressed

Question 25

how to treat hypothalamic-dysfx induced amenorrhea?

Answer 25

treat underlying cause of the dysfunction

Question 26

how to treat ovulatory dysfx induced amenorrhea?

Answer 26

contraceptives

Question 27

how to treat outflow alteration induced amenorrhea?

Answer 27

refer for surgery!

Question 28

What happens if they have primary but no secondary sex development?

Answer 28

Think genetics & check FSH levels

Question 29

What happens if they have primary WITH secondary sex development?

Answer 29

think structural cause!!