Amenorrhea and Menopause

Question 1

3 Main causes of primary amenorrhea?

Answer 1

1. Gonadal probs
2. Mullerian probs
3. Androgen insenstiivity

Question 2

What happens to Swyer’s Syndrome’s Gonads?

Answer 2

SNIP SNIP

Question 3

What is the genotype and genital presentation of a Swyer’s Syndrome patient?

Answer 3

• 46 XY
• Uterus

Question 4

Name the 2 main types of anomalies MRKH (Vaginal Agenesis) patients have

Answer 4

1. Renal
2. Skeletal

Question 5

____-____-____-____ (____ _____) has breasts present, but uterus absent due to Mullerian duct lack of development

Answer 5

• Mayer-Rokitanksy-Kuster-Hauser (Vaginal Agenesis)

AKA MRKH

Question 6

____ Syndrome is the #1 Post-Partum problem resulting in failure to lactate

Answer 6

Sheehan’s

(hormone loss from necrosis/blood loss)

Question 7

-Mayer-Rokitanksy-Kuster-Hauser (MRKH) patients have what genotype and present with what kind of genitalia?

Answer 7

• 46XX
• No uterus

Question 8

Menopause is the cessation of menses for one year with FSH levels usually greater than ____, however a diagnosis can be made with just clinical information

Answer 8

25 IU/L

Question 9

3 Types of congenital Vaginal Outflow tract obstructions

Answer 9

1. Absence
2. Imperforate Hymen
3. Transverse Vaginal Septum

Question 10

If a patient has breasts absent and uterus absent, then the most likely deficiency is ________ase

Answer 10

17-OH

Question 11

3 differences of Imperforate Hymen vs Transverse Vaginal Septum

Answer 11

• Imperforate has a Bulge and easily treated
• Transverse has a complex treatment
• Transverse doesn’t have cervix present

Question 12

_____ syndrome results in gonadal dysgenesis with a mutation in the ____ gene. A uterus will be present.

Answer 12

• Swyer’s
• SRY

“Sorry swyer”

Question 13

How does PCOS respond to the progestin challenge?

Answer 13

Expected vaginal bleeding

Question 14

Utero-Vaginal obstruction, Ovarian Failure, and Hypothal Dsfxn are 3 causes of secondary amenorrhea that have what in common?

Answer 14

Fail the Progestin challenge

Question 15

Even though neither have a Uterus developed, what’s the Key differences between MRKH and 17-OHase deficiency (name one for each disorder)?

Answer 15

• MRKH HAS BREASTS
• 17 OHase deficiency has HTN

Question 16

After a progestin challenge you expect bleeding, if there’s appropriate bleeding then you would suspect ____ ____ causing SECONDARY amenorrhea

Answer 16

Anovulation PCOS

Question 17

_____ Syndrome, Cervical Stenosis, and Pelvic radiation are the main causes of Acquired Uterovaginal Obstruction

Answer 17

Asherman’s

“Sticky Asherman”

Question 18

When assessing for secondary amenorrhea, if they fail the Progestin challenge, what are the next two steps?

Answer 18

• Estrogen First
• Estrogen and Progesterone Second

Question 19

3 Main SECONDARY amenorrhea disorders that fail the progestin bleed challenge?

Answer 19

1. Utero-Vaginal Obstruction
2. Ovarian Failure
3. Hypothal Dysfxn

Question 20

Aside from the karyotype, what’s a key difference between Mullerian Agenesis (MRKH) and Androgen insensitivity?

Answer 20

MRKH has many renal and skeletal anomalies