Amenorrhea

Question 1

how to define primary amenorrhea?

Answer 1

no menarche by age 16, or no menarche by 4 years after thelarche

Question 2

how to define secondary amenorrhea?

Answer 2

absence of menses for 6 mos in women who have had previously normal menses, or absense of menses for 3 cycles.

Question 3

what are some causes of primary amenorrhea?

Answer 3

imperforate hymen
transverse vaginal septum
vaginal agenesis
Turner syndrome
17-alpha-hydroxylase def'y
primary ovarian failure
AIS
Kallman syndrome
pituitary or hthal'c tumors

Question 4

tx for primary amenorrhea:

Answer 4

tx underlying cause, ususally surgery or ES replacement

Question 5

what should you think of if a pt is phtc’lly female but lacks breasts and uterus?

Answer 5

46 XY gnt

Question 6

what if a pt has no uterus or breasts, and karyotype shows 46 XX?

Answer 6

mullerian agenesis

Question 7

what if a pt has no uterus or breasts, and karyotype shows 46 XY?

Answer 7

AIS
Swyer syndrome (congenital absence of testes)

Question 8

what is the most common cause of secondary amenorrhea?

Answer 8

pregnancy

Question 9

what are some causes of secondary amenorrhea?

Answer 9

Asherman syndrome
cervical stenosis
PCOS
hyperPrl
premature ovarian failure
anorexia/exercise-induced hypogonadotropic hypogonadism
Sheehan syndrome
hemosiderosis (Fe deposition in pituitary, seen in thalassemias)

Question 10

another name for PCOS?

Answer 10

Stein-Leventhal syndrome

Question 11

what is the constellation of s&s for PCOS?

Answer 11

anovulation
oligo or amenorrhea
hirsutism
ob
enlarged, polycystic ovaries

Question 12

hrm’l changes that occur w/PCOS?

Answer 12

anovulation => increased levels of ES and androgens. Periph conversion of androgens to ES => propagation of cycle.
LH:FSH ratio increased
IR occurs

Question 13

tx of PCOS?

Answer 13

if fertility is desired, use clomid
weight loss
metformin
if not interested in fertiity, OCPs or Depo-Provera, or mini-pill

Question 14

increased risk of what cancer in PCOS?

Answer 14

endometrial - due to elevated levels of unopposed ES

Question 15

hrm’l regulation of Prl secretion?

Answer 15

Prl rel is inh’d by DA, stim’d by 5HT and TRH

Question 16

causes of hyperprolactinemia

Answer 16

primary hypothyroidism
DA blockers (psych drugs)
TCAs, MAO-I's
prolactinoma
pregnancy, lactation

Question 17

approach to Dx of secondary amenorrhea?

Answer 17

b-hCG to r/o pregnancy
TSH
Prl
medication hx
if Prl is normal, progesterone challenge test

Question 18

what is a progesterone challenge test?

Answer 18

give progesterone for a week to mimic PG withdrawal.
if a withdrawal bleed occurs, cause is likely anovulation.
if no withdrawal bleed, need to admin ES and PG. If still no bleed, consider Asherman or cervical stenosis. If bleed does occur, consider hthal/pit disorder (measure FSH and LH levels)