amenorrhea Flashcards
what is amenorrhea?
absence of menses
two types– primary and secondary
primary amenorrhea vs secondary
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
causes of amenorrhea
pregnancy
hypothalamic-pituitary dysfx
ovarian dysfx
alterations of genital outflow tract
two examples of pituitary dysfx
hyperprolactinemia
cushings disease
functional causes of hypothalamic-pituitary dysfx
wt loss/too much exercise, stress, anorexia
these lead to decreased gonadotropins; a hypothalamic GnRH deficiency
name two neoplastic causes of hypothalamic-pituitary dysfx
craniopharyngioma
hypothalamic hamartoma
three other causes of hypothalamic-pituitary dysfx (not functional or neoplastic)
thyroid-ism
PCOS
head injury
5 conditions of ovarian dysfx that can cause amenorrhea
PCOS
turner syndrome (45,X)
premature menopause
savage syndrome (rare)
blizzard syndrome (rare)
define savage syndrome
gonadotropin resistant ovary syn causing functional disturbance of gonadotropin receptor in ovarian follicles
define blizzard syndrome
autoimmune multisystem ovarian failure
list three outflow obstructions that can cause amenorrhea
imperforate hymen
asherman syndrome
other structural abnormalities – abnormal vaginal openings
what is Asherman syndrome
scarring of uterine cavity which can happen after D & C esp. in endometriosis
PE workup for amenorrhea
BMI
thyroid exam
pelvic exam
breast exam
tanner staging
what is tanner staging
how we monitor development of secondary sex characteristics
for females, tracks pubic hair & breast development
what are labs to get if considering amenorrhea?
pregnancy test
FSH, TSH
prolactin
imaging– US
LH
how is US used in amenorrhea workup?
used in evaluating primary to r/o structural abnormalities as cause
why would you do a hysteroscopy when doing amenorrhea work up?
to r/o ashermans syndrome
why check LH if its not a first line test?
can help to see if it is hypothalamic amenorrhea or PCOS
how do FSH & LH levels compare in hypothalamic amenorrhea vs PCOS?
PCOS– LH is higher than FSH
expected lab levels if cause if hypo-pit dysfx?
high prolactin
abnormal TSH
low/normal FSH
how do FSH & LH levels compare in ovarian dysfx vs PCOS?
ovarian dysx— high FSH
PCOS— 3:1 LH/FSH
what is the progesterone challenge
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
anovulatory vs oligoovulatory
anovulation is no ovulation
oligoovulation is condition causing irregular ovulation
is amenorrhea always bad?
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
how to treat hypothalamic-dysfx induced amenorrhea?
treat underlying cause of the dysfunction
how to treat ovulatory dysfx induced amenorrhea?
contraceptives
how to treat outflow alteration induced amenorrhea?
refer for surgery!
What happens if they have primary but no secondary sex development?
Think genetics & check FSH levels
What happens if they have primary WITH secondary sex development?
think structural cause!!
