Amenorrhea Flashcards
Ovarian, Uterine, Pituitarism, Hypothalamical
Define amenorrhea.
absence of menses
Mention types of amenorrhea. (2)
- Primary
- Secondary
Explain primary amenorrhea.
a) no menses after 16 yrs of age with secondary sexual characteristics= DELAYES PUBERTY
b) no menses after 14 yrs of age without secondary sexual characteristics
Explain secondary amenorrhea.
a) absence of menses for >3 months with previous normal menstruation
b) absence of menses for >6 months with previous oligomenorrhea
Mention causes of primary amenorrhea acc to anatomical structure. (4)
- Ovarian
- Uterine
- Pituitary
- Hypothalamic
What will happen to FSH and Estrogen levels in 4 causes of primary amenorrhea?
- Ovarian= increases FSH, decreased Estrogen
- Uterine= Normal
- Pituitary= both decreased
- Hypothalamic= both decreased
Name ovarian causes of primary amenorrhea. (4)
- Gonadal dysgenesis
- PCOD
- Premature ovarian follicle
- Savage syndrome
What is gonadal dysgenesis?
Atypical development of gonads -Turner’s syndrome
(In short) PCOD causes (2 main), which hormones increase (2), main 3 c/f.
CAUSES= genetic, lifestyle
HORMONES= androgens, insulin
C/F= anovulation, hirsutism, acne
What is premature ovarian follicle?
loss of ovarian function before 40 yrs age
What is savage syndrome?
ovarian resistance d/t FSH receptor dysfunction
What are uterine causes of primary amenorrhea? (4)
- Mullerian agenesis
- Imperforate hymen
- Transvaginal septum
- Cervical stenosis
What is mullerian agenesis?
absence of uterus & vagina (MRKH syndrome)
What are pituitary causes of primary amenorrhea? (4)
- Neoplasms= prolactinomas
- Hyperprolactinemia
- Empty sella turcica (pituitary gland shrinks)
- Pituitarism
What are hypothalamic causes of primary amenorrhea? (5)
- Kallmann syndrome (decreased/absent GnRH)
- Vigorous exercise, stress, weight loss, anorexia nervosa
- Functional hypothalamic GnRH secretion decreased pulsatile GnRH secretions= anovulation
- Hyperprolactinemia {inhibit GnRH}
- Delayed puberty= delayed adrenarche & gonadarche
What Dx used for primary amenorrhea?
- History
- If secondary sexual characteristics present or absent?
- FSH & LH levels
- USG of uterus
- MRI
What will be your next step if secondary sexual characters are absent or present?
Absent= measure FSH and LH
Present= USG uterus
What does high levels of FSH and LH tells you?
-high levels= hypergonadotropic
-hypogonadism= Turner’s syndrome, Savage syndrome
What pathologies if uterus is absent? What will be Tx?
Absent= Mullerian agenesis
Tx= Vaginoplasty
What will you do next if uterus is present?
check for obstruction
What pathologies if obstruction absent or present? What Tx if obstruction present?
Absent= secondary amenorrhea
Present= Imperforate hymen, Transverse vaginal septum
Tx= Surgery
What is the treatment of primary amenorrhea? (2)
- GnRH
- OCPs= induce menstruation
What are the causes of secondary amenorrhea based on anatomy? (4)
- ovarian
- uterine
- pituitary
- hypothalamic
What are the ovarian causes of secondary amenorrhea? (6)
- premature ovarian failure
- premature menopause
- pregnancy
- PCOD
- surgical removal of ovaries
- masculising ovarian tumors
What are the uterine causes of secondary amenorrhea? (5)
{acquired scarring of endometrium}
1. infections
2. TB
3. instrumentation (asherman’s syndrome)
{obstruction of cervical canal}
4. chemical burns
5. CIN
What are the pituitary causes of secondary amenorrhea? (4)
- Hyperprolactinemia
- Sheehan syndrome
- Pituitary tumors
- empty sella turcica
What are the hypothalamic causes of secondary amenorrhea? (4)
- GnRH deficiency
- Brain tumors
- Pituitary stalk compression
- Functional= eating disorders, weight loss, stress
Dx of secondary amenorrhea? (6)
- pregnancy test
- FSH levels
- Progesterone challenge test
- Symptoms of estrogen deficiency= hot flushes, dyspareunia, dryness of vagina, loss of breast mass
- Serum prolactin levels
- MRI= to check tumors
What to do next if FSH normals are low?
- GnRH test unresponsive= pituitary causes
- GnRH test responsive= hypothalamic causes
- Measure TSH, T3, T4= to exclude panhypopituitarism
What pathology if FSH N/increased?
N= PCOD
Increased= Premature ovarian failure
What if progesterone challenge test is positive or negative?
+ve= PCOD
-ve= Hypothalamic causes
Tx of secondary amenorrhea. (4)
- Estrogen replacement therapy
- Bromocriptine
- Surgery
- HRT
