Amenorrhea Flashcards
Workflow algorithm for amenorrhea
- H&P, pregnancy test
- prolactin and TSH
- progestin challenge: yes bleeding = PCOS, no bleeding = move on
- estradiol (or given estradiol and progestin): nl estradiol = outflow tract problem, low estradiol = move on
- FSH/LH: high = ovarian failure, low = hypothalamic or pituitary disorder
Asherman syndrome prognosis
best to worst: endometrial adhesions > myometrial adhesions > atrophic and sclerotic endometrium w/o adhesions (post radiation/TB)
Asherman syndrome RF
least likely to cause Asherman to most likely: curettage after incomplete abortion or molar pregnancy < curettage after missed abortion < postpartum curettage combined w/ hypoestrogen states (breast feeding, hypogonadotropic hypogonadism)
Causes of secondary amenorrhea hypothalamic - pituitary - ovarian - outflow -
hypothalamic: stress, hypothyroidism (-> high TRH -> high PRL -> low GnRH), hyperprolactinemia
pituitary: Sheehan, irradiation, pituitary surgery
Ovarian: PCOS, premature ovarian failure
Outflow: intrauterine adhesions, cervical stenosis
Workup for PCOS
TSH, prolactin (pituitary cause of secondary amenorrhea)
17-OH (congenital cause)
testosterone-ovarian and DHEA-adrenal (androgen-secreting tumor)
lipid, glucose (PCOS)
endometrial biopsy (assess for malignancies 2/2 unopposed estrogen)