Amenorrhea Flashcards
What is the definition of primary Amenorrhea?
- No menses by the age of 15 yrs in the presence of normal secondary sexual characteristics
- No menses within 5 years of breast development if occurs before age 10
- No menses or development of secondary sexual characteristics by age 13
What is the definition of secondary Amenorrhea?
No menses for a total of at least 3 previous cycles, 3 months
What are the 4 main causes of Amenorrhea
PCOS, Hypothalamic amenorrhea, Hyperprolactinoma, ovarian failure
Mullerian Agenesis is also known as ____.
Mayer-Rokitansky-Kuster-Hauser syndrome
On physical exam what finding will indicate mullerian agenesis rather than Androgen Insensitivity?
Presence of pubic hair
How do you prescribe a progesterone for a withdrawl bleed?
Medroxyprogesterone 10 mg PO for 5-10 days
What does a positive withdrawl bleed indicate?
Functional outflow tract and presence of responsive endometrium
Why might a progesterone whithdrawl bleed not occur in a patient with PCOS?
endometrium may be decidualized by high circulating androgen levels
What does obtaining an estradiol level help achieve?
Whether the patient is eugonadal or hypogonadal
What level of estrogen suggests ovarian follicular activity?
> 40 pg/mL
What level of FSH suggests ovarian failure?
> 20 IU/L
What level of FSH indicates hypogonadotropic hypogonadism?
< 5 IU/L
Low FSH in the setting of low estradiol suggests what type of dysfunction?
Hypothalamic
What labs should be obtained when evaluating a patient with amenorrhea?
HCG, TSH, Prolactin, FSH, Estradiol
Hypergonadotropic Hypogonadism refers to ____
premature ovarian failure
Hypogonadotropic Hypogonadism refers to_____
hypothalamic amenorrhea, pituitary or CNS tumor
If both FSH and Estradiol are in the normal range are the two possible causes of amenorrhea?
Annovulation, Anatomic Defect
What are the three main syndromes associated with Hypergonadotropic Hypogonadism?
Gonadal Dysgenesis, Primary ovarian insufficiency, Menopause
What is the definition of primary ovarian insufficiency?
depletion of ovarian follicles and cessation of menses before the age of 40
What percent of women does primary ovarian insufficiency affect?
1 %
What genetic syndrome is associated with primary ovarian insufficiency?
Fragile X (FMR1 gene)
What specific sex chromosomal abnormalities are associated with primary ovarian insufficiency?
X and Y chromosome mosaicism
True or false: If Y chromosome present in a genetic analysis for a patient who has ammenorhea and POI, then gonads should be removed due to malignant potentia?
True
In a patient with Primary ovarian Insufficiency, what Autoimmune diseases should you test for?
21 hydroxylase antibodies, Antithyroid antibodies
primary ovarian insufficiency is strongly associated with what Autoimmune syndrome?
Adrenal Insufficiency
Following radiation, how long does it take for menses to resume?
6 - 18 months
True or false: prior radiation therapy can cause birth defects?
false
Which chemotherapy agents result in highest rate of premature ovarian insufficiency?
Alkylating agents
How does chemotherapy affect fertility?
causes depletion of primordial follicles
What percentage of patients with premature ovarian insufficiency may conceive spontaneously?
5 - 10%
What should be prescribed for patients with premature ovarian insufficiency?
HRT with low dose estrogen
What must be added to HRT for those patients who still have a uterus?
Progesterone
What is the most common disorder of the pituitary that causes amenorrhea?
Pituitary Adenoma
What disorder of the hypothalamus is associated with Amenorrhea?
Kallman Syndrome
What are common causes of hypothalamic amenorrhea?
Eating disorder, excessive exercise, excessive weight loss
In a patient with hypothalamic amenorrhea, what agents must be used to achieve pregnancy?
Gonadotropin ovulation induction agents
What is Kallman syndrome?
Congenital GnRH deficiency associated with anosmia
What causes Kallman Syndrome?
failure of GnRH neurons to migrate to the hypothalamus during embryogenesis
True or false: adrenarche is not compromised in a patient with Kallman syndrome, therefore patients will still have pubic hair
True
