Amenorrhea/Bleeding Flashcards
46XX w/primary amenorrhea
Mullerian agenesis
= no Müllerian ducts = no uterus or upper vag
+ boobs, pubes, ovaries but -uterus = primary amenorrhea
46XY w/primary amenorrhea
Androgen insensitivity
=no androgen receptor! Balls present and making testosterone but due to lack of receptor wolf degrades, MIF degrades mullerian.
+testes +breast -pubes -uterus =primary amenorrhea
45X w/primary amenorrhea
Turners!
No ovaries and no estrogen!
Streak ovaries, short stature, webbed neck, infertility, amenorrhea, broad chest, urinary track abnormalities, bicuspid aortic, aortic core Tatian, dysgerminomas risk, normal intelligence
- ovaries,breast,pubes but + uterus = primary amenorrhea
Amenorrhea and can’t smell
Kallman syndrome = no GnRH = no LH & FSH = no E&P
-boobs +uterus
+ boobs, pubes, ovaries but -uterus = primary amenorrhea
Mullerian agenesis 46XX
+testes +breast -pubes -uterus =primary amenorrhea
Androgen insensitivity 46XY
Causes of primary amenorrhea
Kallman syndrome Mullerian agen(46XX) Androgen insensitivity(46XY) Turners (45X) Swyer Syndrome(46XY)
What is important to do for ppl with androgen insensitivity that you don’t do for mullerian agenesis?
Remove testes once developed to prevent cancer and then start hormone therapy.
Kallmann syndrome tx
Replace hormones appropriate for sex
what might need to be done for women with mullerian agenesis & androgen insensitivity?
elevate the vagina to increase its length to increase satifaction with sex
all girls should develop menarche by —- and begin to develop secondary sex char by —-.
15, 13
testosterone in mullerian agen vs androgen insens?
normal in mullerian but elevated in androgen insen.
what does a negative progesterone challenge test tell you?
absence of withdrawal bleeding is caused by either inadequat estrogen priming of the endometrium or outflow tract obstruction(imperforate hymen).
what does a positive Progesterone challenge test tell you?
diagnostic of anovulation! = need to give cyclic progesterone to prevent endometrial hyperplasia. give Clomiphene if pregnancy is desired.
What does a negative estrogen-progest challenge test tell you?
diagnostic of outflow obstruction or endometrial scarring(Asherman Syndrome) = do hysterosalpingogram(HSG) to ID
What does a positive estrogen-progest challenge test tell you?
bleeding = there just wasnt enough estrogen in the first place. look at FSH to ID etiology.
- elevated FSH = ovarian failure
- low FSH = need to r/o brain tumor.
what is asherman syndrome?
scarring of the uterus due to extensive uterine curettage and infection-producting adhesions.
define primary amenorrhea
girl who has never had a period
define secondary amenorrhea
women of reproductive age who has stopped having periods for >6 months.
^nobody waits that long to investigate though lol
causes of secondary amenorrhea
- Pregnancy
- Hypothyroidism
- Prolactinoma
- Meds
- Menopause
- Savage Syndrome/Resistant ovarian Syndrome
- Asherman’s Syndrome
- Hypothalamus
- Primary Ovarian Insufficiency
how does hypothyroid cause secondary amenorrhea? how do you treat?
hypothyroid = increased TSH = increases prolactin production = inhibits GnRH causing amenorrhea.
*will also see dec FSH & LH(duh) just like wiht a prolactinoma.
tx: levothyroxine
work up and tx of prolacintoma
suspect if galactorrhea or amenorhea. get prolactin level then MRI.
tx: Pramixpaxole < cabergoline
what drugs will cause secondary amenorrhea?
DA antagoinist like atypical antipsychotics.
hormone levels in menopause…
elevated FSH and LH
