Amenorrhea Flashcards
3 criteria for clinical Amenorrhea
- no mens at 14yo + no secondary sex char.
- no mens at 16yo + w/ or w/o secondary sex char.
- has mens in the past but currently 6 mos w/o mens
Clinical demonstration of menstrual fxn
visible external menstrual discharge
mens depends on what structures?
patent outflow tract, endometrium, ovaries, ant. pituitary gland, hypothalamus
hormone produced by hypothalamus for reproductive cycle
GnRH
hormone produced by Ant. Pituitary gland for reproductive cycle
LH and FSH
What happens in Turner Syndrome
normal germ cell migration and mitosis; oogonia dont undergo meiosis –> rapid loss of oocyes –> gonads w/o follicles by birth –> appears as fibrous streak
Hormones produced by Ovary for reproductive cycle
estrogen and progesterone
What are the 4 compartments?
Compartment I - outflow tract and uterus
Compartment II - ovary
Compartment III - Ant pituitary gland
Compartment IV - CNS and hypothalamus
What the use of the 4 compartmets
used in diagnosis. any disorder could be classified using the 4 compartments
Info needed to evaluate amenorrhea
Psychological state Genetic anomalies Nutritional status Growth and Devt Anatomy of Reproductive tract Any CNS disease
An important clinical sign. A term used for nonpuerperal breast secretion
Galactorrhea
1st step in evaluating a patient with amenorrhea
Check for pregnancy
After checking for pregnancy, what are the succeeding steps in the workup for amenorrhea
TSH measurement
Prolactin levels
Progestational challenge
Initial step in patient presenting with galactorrhea
TSH and prolactin measurements + imaging of sella turcica
effect of Hypothyroidism on galactorrhea
dec in hypothalamic content of dopamine –> unopposed TRH efect on pituitary cells –> cells secrete prolactin
Constant stimulation by TRH to the ant pituitary gland due to hypothyroidism results in?
hypertrophy/hyperplasia of pituitary –> tumor like presentation on radiography
2 hormonal factors resulting in amenorrhea
hypothyroidism and hyperprolactinemia
remember that breastfeeding is contraceptive
What is the purpose of the progestational challenge?
assess the level of endogenous estrogen and patency of outflow tract
How do you interpret the results of the progestational challenge
after 2-7 days:
(+) withdrawal response or bleeding –> diagnosis of anovulation, fxnal outflow tract, fxnal endometrium –> minimal fxn of ovary, pituitary and CNS is established
What does blood spots mean in progestational challenge
marginally positive response; need to be monitored; may be recategorized after some time
What does a negative withdrawal response in the progestational challenge mean if endogenous estrogen is within normal levels?
means that the endometrium is decidualized (will not shed)
2 causes for this: due to high androgen levels and due to adrenal enzyme deficiency (leading to high androgen levels)
