amenorrhea Flashcards

1
Q

what is amenorrhea?

A

absence of menses
two types– primary and secondary

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2
Q

primary amenorrhea vs secondary

A

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

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3
Q

causes of amenorrhea

A

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

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4
Q

two examples of pituitary dysfx

A

hyperprolactinemia
cushings disease

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5
Q

functional causes of hypothalamic-pituitary dysfx

A

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

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6
Q

name two neoplastic causes of hypothalamic-pituitary dysfx

A

craniopharyngioma
hypothalamic hamartoma

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7
Q

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

A

thyroid-ism
PCOS
head injury

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8
Q

5 conditions of ovarian dysfx that can cause amenorrhea

A

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

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9
Q

define savage syndrome

A

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

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10
Q

define blizzard syndrome

A

autoimmune multisystem ovarian failure

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11
Q

list three outflow obstructions that can cause amenorrhea

A

imperforate hymen
asherman syndrome
other structural abnormalities – abnormal vaginal openings

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12
Q

what is Asherman syndrome

A

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

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13
Q

PE workup for amenorrhea

A

BMI
thyroid exam
pelvic exam
breast exam
tanner staging

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14
Q

what is tanner staging

A

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

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15
Q

what are labs to get if considering amenorrhea?

A

pregnancy test
FSH, TSH
prolactin
imaging– US
LH

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16
Q

how is US used in amenorrhea workup?

A

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

17
Q

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

A

to r/o ashermans syndrome

18
Q

why check LH if its not a first line test?

A

can help to see if it is hypothalamic amenorrhea or PCOS

19
Q

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

A

PCOS– LH is higher than FSH

20
Q

expected lab levels if cause if hypo-pit dysfx?

A

high prolactin
abnormal TSH
low/normal FSH

21
Q

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

A

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

22
Q

what is the progesterone challenge

A

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

23
Q

anovulatory vs oligoovulatory

A

anovulation is no ovulation
oligoovulation is condition causing irregular ovulation

24
Q

is amenorrhea always bad?

A

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

25
how to treat hypothalamic-dysfx induced amenorrhea?
treat underlying cause of the dysfunction
26
how to treat ovulatory dysfx induced amenorrhea?
contraceptives
27
how to treat outflow alteration induced amenorrhea?
refer for surgery!
28
What happens if they have primary but no secondary sex development?
Think genetics & check FSH levels
29
What happens if they have primary WITH secondary sex development?
think structural cause!!