Amenorrhea Flashcards
Three types of PCOS
Frank
Ovulatory
Nonpolycystic ovary
What is Frank PCOS
oligomenorrhea
hyperandrogenism
polycystic ovaries
What is Ovulatory
hyperandrogenism
polycystic ovaries
regular menstrual cycles
What is non polycystic ovary
Oligomenorrhea
hyperandrogenism
normal ovaries
PCOS treatment
For those that are obese:
weight loss
lifestyle changes
Goal, improving insulin sensitivity
Significant weight loss can result in normal ovulatory pattern.
(less adipose tissue cranking out estrogen!)
USE of metformin!!!
Screen for depression
COC’s if not trying to get pregnant
-suppresses the ovary
-protects against unopposed estrogen and -endometrial hyperplasia and endometrial -cancer
GnRH agonists
Antiandrogens
spironalactone (Aldactone)- diuretic
-helps with hirsutism
Clomipene citrate (Clomid)
to induce ovulation in those that want to conceive
collaborate with OB or refer to fertility specialist depending on your training with this.
Causes of Amenorrhea
PCOS
Functional hypothalamic Amenorrhea
Hyperprolactinemia
Primary ovarian insufficiency
Elevated FSH
ovaries are not producing enough estradiol,
Effects of TSH on HPO axis
elevated TSH suppresses GNrH release
Effects of prolactin on HPO axis
Elevated prolactin levels inhibits GNrH (negative feedback)
PCOS hormonal state
Normal to high estrogen
In patients with PCOS, excessive amounts of androgens can interfere with granulosa cell function, which is normally responsible for converting androgens to estrogen. This excess of androgens stimulates an abnormally large number of follicles to grow while also prematurely maturing them, leading to suppression of ovulation.
Anorexia hormonal state
low estrogen
chronic disease hormonal state
low estrogen
excess adipose (fatty) tissue hormonal state
normal to high estrogen
Prolactinoma hormonal state
low estrogen
Menopause hormonal state
High FSH/LH but low Estrogen
