amenorrhea Flashcards
What is amenorrhea?
Absence or abnormal cessation of menses.
How is amenorrhea classified?
It can be classified based on timing (before or after menarche) or etiology (physiological, pathological, or based on which part of the HPO axis is affected).
What is primary amenorrhea?
Absence of menses by age 14 with no secondary sexual characteristics, or by age 16 with secondary sexual characteristics.
What is secondary amenorrhea?
Abnormal cessation of menses for 6 months or for 3 cycle lengths in a previously irregular menstruating woman.
What is the prevalence of amenorrhea among women of reproductive age?
Ranges from 5% to 20%.
What is the prevalence of amenorrhea not due to physiological states?
Approximately 3-5%.
Which is more common, primary or secondary amenorrhea?
Secondary amenorrhea is more common than primary amenorrhea.
In what groups of people is amenorrhea more prevalent?
Athletes, adolescents, perimenopausal women, and HIV-positive women.
How is physiological amenorrhea divided?
Primary: Prepubertal.
Secondary: Adolescence, pregnancy, lactation, perimenopause, and menopause.
How is pathological amenorrhea divided?
Primary and secondary, based on whether it occurs before or after menarche.
What are the causes of primary pathological amenorrhea?
Hypothalamic (Kallman’s syndrome, craniopharyngioma, psychological disturbance), Pituitary (Prolactinoma, hemochromatosis), Ovarian (Turner’s syndrome, chemotherapy), Uterovaginal tract (Mullerian dysgenesis, imperforate hymen), Hormonal/metabolic (Congenital adrenal hyperplasia, hypothyroidism).
What are the causes of secondary pathological amenorrhea?
Hypothalamic (psychological disturbances, tuberculosis, sarcoidosis), Pituitary (Sheehan’s syndrome, prolactinoma), Ovarian (premature ovarian failure, chemotherapy), Uterovaginal tract (Asherman’s syndrome), Drugs (antipsychotics, antihypertensives).
What history should be asked for primary amenorrhea?
Prepubertal changes, family history, height relative to family, signs of virilization, stress levels, galactorrhea, medications.
What history should be asked for secondary amenorrhea?
History of postpartum hemorrhage, dilation and curettage, stress, virilization signs, chronic illness, estrogen deficiency symptoms, galactorrhea.
What should be examined in cases of amenorrhea?
General: Pubertal features, Turner’s syndrome signs, thyroid enlargement, galactorrhea, virilization.
Pelvic: Clitoral size, hymen perforations, vaginal septum, uterus, and ovaries.
What is the progestin challenge test used for?
Determines if the ovary is producing estrogen. If bleeding occurs, estrogen production is intact.
What is the estrogen/progesterone challenge test used for?
Helps determine if estrogen is deficient due to ovarian or hypothalamic pathology.
What is the purpose of an FSH assay?
Distinguishes between primary ovarian dysfunction (high FSH, low estradiol) and hypothalamic dysfunction (low FSH, low estradiol).
How is primary amenorrhea evaluated?
Includes history, physical examination, hormone assays, imaging, and genetic testing.
How is secondary amenorrhea evaluated?
Includes history, physical examination, pregnancy test, hormone assays, imaging, and endometrial biopsy.
What are the treatment options for amenorrhea?
Treatment depends on the cause: Hormone replacement therapy for ovarian insufficiency, surgery for anatomical lesions, dopamine agonists for hyperprolactinemia, increased calorie intake for functional hypothalamic amenorrhea, OCPs or GnRH therapy for pituitary dysfunction, surgery for CNS tumors, metformin for PCOS, hysteroscopic surgery for Asherman’s syndrome.
