amenorrhea + AUB Flashcards
Primary amenorrhea
no menses by 15 or no menses by age 13 & no secondary sex characteristics
secondary amenorrhea
no menses for 3 months after normal menstruation
no menses for 6 months after irregular menstruation
amenorrhea workup
FSH levels
<5: hypogonadal, issue at brain
>20: hypergonadal, issue at ovary
Normal: 5-20, issue somewhere else
post-menopausal, ovarian failure: FSH > 40
oligomenorrhea
cycle length >35 days
polymenorrhea
cycle length < 24 days
heavy menstrual bleeding
regular, normal intervals; excessive volume and duration of flow
intermenstrual bleeding
irregular intervals with normal or reduced volume and duration of flow
irregular menstrual bleeding (AUB)
irregular intervals, excessive volume and duration of flow
ovulatory causes of infertility
PCOS, advanced age, hyperprolactinemia (can be pituitary adenoma or hypothryoidism), hypothalamic amenorrhea
tubal causes of infertility
PID, tubal ligation, pelvic adhesions, endometriosis
uterine causes of infertility
fibroids, polyps, asherman, endometrosis
cervical causes of infertility
Immune (antisperm), trauma (conization, cryotherapy), DES exposure, cervical anomalies (insufficient mucus production)
semen analysis
collect semen after 2-7 days ejaculatory abstinence
analyze semen volume (> 2mL), sperm count (15 million/mL and >40 million/ejaculate), and motility + morphology (>40% sperm motility, 4% with head, neck, and tail)
Most common cause of infertility
Sperm count abnormalities: oligospermia (<15 mil/mL) - azoospermia (absence of sperm)
what is a day 21 serum progesterone
during the luteal phase, corpus luteum secretes progesterone
if measure and <3ng/mL –> anovulation
most common cause of female infertility
PCOS: anovulation + androgen excess
hyperandrogenism, oligomenorrhea, polycystic ovaries + increased LH (more androgens, insulin resistance)
how to treat infertility caused by PCOS
weight loss, exercise
metformin
clomiphene - blocks estrogen receptor on brain –> prevents negative feedback –> increase FSH output
aromatase inhibitors: letrozole (blocks aromatase)
primary ovarian failure
FSH > 25, low estrogen, low AMH
atresia and depletion before menopause
