Amenorrhea - AUD lecture

Question 1

What is Amenorrhea
what does primary vs secondary mean

Answer 1

Amenorrhea is defined as the absence of a menstrual cycle. Most are often asymptomatic and can be accompanied by weight loss or weight gain
often a symptom rather than a condition itself:
- want to check lab values (pregnancy test, FSH/LH levels, TSH, Prolactin, estrogen) to see if they are normal
- PCOS, low BMI, eating disorders, excessive exercise
- Medications

Primary - no menses by age 15
Secondary - no menses for 3 months in women who have previously had their period

Question 2

Pathophysiology

Answer 2

Uterus - anatomic abnormalities
Ovaries- anatomic abnormalities
Pituitary gland - Disruption to GnRH, LH, FSH, and prolactin hormones
Hypothalamus - Anorexia nervosa,Bulimia, intense exercise, stress

Question 3

Pathophysiology for drug-induced amenorrhea

Answer 3

First-generation antipsychotics - Prochlorperazine, chlorpromazine, Haloperidol
Second-generation antipsychotics - risperidone
Antihypertensives - verapamil
GI promotility agent- Metoclopramide

Question 4

First line therapy

Answer 4

Rule out pregnancy
Determine underlying cause
If anorexia - cognitive behavioral therapy, weight gain
if excess exercise - reduction in exercise quantity and intensity
if medications - may consider alternative agents that do not inhibit dopamine receptors or increase prolactin levels OR initiate dopamine agonist

Question 5

Pharmacologic treatment for amenorrhea

Answer 5

If caused by hypoestrogenic
- conjugated equine estrogen (premarin, cenestin, enjuvia)
- estradiol (patch) (climara, vivelle-Dot)

if caused by medications that increase prolactin levels
-Bromocriptine - multiple dosing
- Cabergoline - Weekly or twice weekly
-Contraindications - breastfeeding, uncontrolled HTN
Mild side effects- nausea, diarrhea, orthostatic hypotension, fatigue

Question 6

Monitoring and follow up

Answer 6

Average time to resolution of menses is 6-8 weeks
if no resolution seen with one agent try the other