Amenorrhea Flashcards
Key history in amenorrhea
Primary vs. secondary, duration, possible pregnancy, associated symptoms (headache, decreased peripheral
vision, galactorrhea, hirsutism, virilization, hot flashes, vaginal dryness, symptoms of thyroid disease);
history of anorexia nervosa, excessive dieting, vigorous exercise, pregnancies, D&Cs, uterine infections;
drug use; medications
Key physical exam in amenorrhea
Vital signs; breast exam; complete pelvic exam
40 yo F with amenorrhea, morning nausea, vomiting, fatigue and polyuria
+ LMP was six weeks ago
+ breast fullness and tenderness
+ uses rhythm method for contraception
Pregnancy Anovulatory cycle Hyperprolactinemia UTI Hypothyroidism
Pelvic exam Urine hCG U/S—abdomen/pelvis CBC UA, urine culture Prolactin, TSH Baseline Pap smear, cervical cultures, rubella antibody, HIV antibody, hepatitis B surface antigen and VDRL/RPR
23 yo obese F with amenorrhea over last six months, facial hair and infertility over last three years
Polycystic ovary syndrome Thyroid disease Hyperprolactinemia Pregnancy Ovarian or adrenal malignancy Premature ovarian failure
Pelvic exam
Urine hCG
LH/FSH, TSH, prolactin
Testosterone, DHEAS
35 yo F with amenorrhea, galactorrhea, visual field defects and HAs over last six months
Amenorrhea secondary to prolactinoma Pregnancy Thyroid disease Premature ovarian failure Pituitary tumor
Pelvic and breast exam
Urine hCG
LH/FSH, TSH, prolactin
MRI—brain
48 yo F with amenorrhea over last six months with hot flashes, night sweats, emotional lability and dyspareunia
Menopause
Pregnancy
Pituitary tumor
Thyroid disease
Pelvic exam Urine hCG LH/FSH, TSH, prolactin, testosterone, DHEAS CBC MRI—brain
35 yo F with amenorrhea, cold intolerance, coarse hair, weight loss and fatigue
+ Hx of placental abruption followed by hypovolemic shock and failure to lactate two years ago
Sheehan’s syndrome Premature ovarian failure Pituitary tumor Thyroid disease Asherman’s syndrome
Pelvic exam Urine hCG CBC LH/FSH, prolactin TSH, FT4 ACTH MRI—brain Hysteroscopy
18 yo F with amenorrhea over last four months
+ 5’6” and weighs 90 pounds
+ Hx of vigorous exercise
+ cold intolerance
Anorexia nervosa
Pregnancy
Hyperthyroidism
Urine hCG
CBC
TSH, FT4
LH/FSH
29 yo F with amenorrhea over last six months
+ occasional palpitations and dizziness
+ lost fiance in car accident in which she was a passenger
Anxiety-induced amenorrhea
PTSD
Depression
Hyperthyroidism
CBC TSH, FT4 Urine cortisol level Progesterone challenge test LH/FSH, estradiol levels
