Amenorrhea

Question 1

What are the types/classifications of amenorrhea?

Answer 1

Hypogonadotropic

Hypergonadotropic

Normogonadotropic

Question 2

Causes of primary amenorrhea

Answer 2

Gonadal dysgenesis, Turner syndrome

Mullerian Agenesis

Adrogen insensitivity syndrome

Kallman syndrome

Obstruction, cryptomenorrhea

Imperforate hymen

Uterine agenesis.

Question 3

Causes of amenorrhea.

Answer 3

Important causes of amenorrhea for step 1

• Anorexia nervosa
• Prolactinoma
• Polycystic ovarian syndrome
• Sheehan syndrome
• Pregnancy
• Menopause
• Cushing’s
• Hyperthyroidism
• Hypothyroidism
• Severe stress
• Hormonal contraceptives, progesterone only contraceptives.
• Asherman’s syndrome, intrauterine adhesions, fibrosis, from past PID.
• Polycystic Ovarian Syndrome
• Complete androgen insensitivity syndrome - XY genetic males born with total non-responsiveness to androgens. Have a totally female body and genitals, with subsequent atrophy of the uterus and ovaries.
• Turner syndrome - gonadal dygenesis XO syndrome or X- syndrome.

Causes of amenorrhea that may not be so important for step 1

• Müllerian agenesis
• Sertoli-Leydig cell tumor of the ovary, hormone secretory sex cord stromal tumor.
• cervical stenosis
• vaginal septum
• imperforate hymen
• asherman’s syndrome
• ovarian insufficiency, including menopause
• drugs causing hyperprolactinemia
• hypothyroidism
• pregnancy, and post pregnancy during lactation.
• Kallman’s syndrome
• pituitary causes, other than sheehan (such as radiation)
• sarcoidosis
• autoimmune (such as oophoritis)
• infectious (such as TB)
• female atheletes - associated with significant loss of fat, such as ballet, gymnastics, and long-distance running
• Aromatase enzyme deficiency