Amenorrhea Flashcards
Menstruation
amenorrhea
absence of menstruation
primary amenorrhea
NO period by 16 w/normal secondary sex characteristics OR by 14 w/no secondary sex characteristics
secondary amenorrhea
the absence of menstruation after a period of normal menses (>3 mo if regular or >6 mo if not)
etiologies of primary amenorrhea (+ dx and tx)
+ breast/+uterus
outflow obstruction (transverse vaginal septum, imperforate hymen)
dx: PE tx: surgery
Turner’s Syndrome
45XO
primary amenorrhea
PE: short webbed neck and NO breasts
tx: OCs
etiologies of primary amenorrhea
- breast/+ uterus –> FSH/LH elevated
indicates ovarian cause
premature ovarian failure or gonadal dysgenesis
etiologies of primary amenorrhea
- breast/ + uterus –> FSH/LH normal or decreased
hypothalamus - pituitary failure (tx with OCP) or puberty delay
etiologies of primary amenorrhea
Mullerian Agenesis (46XX) or Androgen Insensitivity (46XY)
Mullerian Agenesis (46XX) or Androgen Insensitivity (46XY)
Androgen Insensitivity Syndrome (AIS)
definition and labs
no response to androgens = genetic male, phenotypically female
elevated testosterone levels
tx of AIS
start estrogen and remove testes
etiologies of primary amenorrhea
- breast/-uterus
rare
defect in testosterone synthesis causes.an immature girl with testes
MC cause of secondary amenorrhea
pregnancy!
Causes of secondary amenorrhea (5)
- Pregnancy
- hypothalamus dysfunction
- pituitary dysfunction
- ovarian d/o
- uterine d/o
hypothalamus dysfunction and secondary amenorrhea
abnormal GnRH secretion causes decreased LH/FSH
hypothalamus dysfunction etiologies
hypothalamic d/o
anorexia
exervise
stress nutritional deficiency
how is hypothalamus dysfunction diagnosed ?
normal to decreased FSH/LH with low estradiol and low/normal prolactin
hypothalamus dysfunction treatment
stimulate GnRH secretion
clomiphene OR menotropin
pituitary dysfunction and secondary amenorrhea
labs +tx
low FSH/LH with increased prolactin
must get MRI of pituitary sella (prolactin = decreased GnRH)
tx= transphenoidal removal of tumor
ovarian d/o and secondary amenorrhea etiologies
PCOS
premature ovarian failure
premature ovarian failure
onset of spontaneous menopause before the age of 40
no response to FSH/LH
dx of ovarian disorder in secondary amenorrhea
ncreased FSH/LH with decreased estradiol or progesterone challenge test with withdrawal bleeding
Asherman syndrome
scarring of the uterine cavity due to pp hemorrhage, D&C or endometrial infection
Dx Asherman’s syndrome
u/s with no uterine stripe or hysteroscopy
what is diagnostic and therapeutic for asherman’s syndrome?
hysteroscopy
progesterone challenge test
what do you take to start it?
10 mg medroxyprogesterone x 10 days
progesterone challenge test
+ withdrawal bleeding
OVARIAN cause
enough estrogen present to stimulate release of lining
progesterone challenge test
- w/d bleeding means?
hypoesterogenic or uterine abnormalitiy is cause of amenorrhea
why do we care if you have a period?
women who don’t menstruate but have estrogen stimulation are at increased risk of endometrial cancer
amenorrhea s/s might clue you in to the etiology
- drug use
- stress
3 significant weight change
- excessive exercise
estrogen irregularity possible amenorrhea causes
PCOS
CNS tumor
hyperprolactinemia
Sheehan syndrome
sheehan syndrome
pituitary failure from ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth
galactorrhea is present, what cause of secondary amenorrhea?
prolactinemia MC
first line testing amenorrhea
B-Hcg, TSH and prolactin
second line lab work
FSH, estrogen, LH and testosterone
may also need MRI or CT, or genetic testing
