Amenorrhea - Lunenfeld

Question 1

What is the definition of amenorrhea? Of Oligomenorrhea?

Answer 1

Primary Amenorrhea
No period by age 14 in the absence of growth or development of secondary sexual characteristics
No period by age 16 regardless
Incidence: 2.5%

Secondary Amenorrhea
In a woman who has been menstruating, absence of periods (3 cycles) or 6 months
Incidence-variable
Oligomenorrhea
Menses occurring at an interval longer than 35 days

Question 2

What are the 4 compartments where amenorrhea can originate?

Answer 2

Compartment 1:
Disorders of the uterus/outlet
-7% of all secondary amenorrhea cases
-Ex: Asherman’s syndrome, imperforate hymen, vaginal transverse septum, Mullerian agenesis

Compartment 2:
Disorders of the ovary
-PCOS is a sort of chronic anovulation, the most common type of anovulation
-Gonadal failure is 30-40% of primary and 10% of secondary
-Diagnosed by elevated FSH
-Hypergonadotropic hypogonadism
-No secondary sex characteristics unless given outside hormones
-Ex: Turner syndrome (abnormal karyotype), Premature ovarian failure (normal karyotype, menopause

Compartment 3:
Disorders of the anterior pituitary
-No LH or FSH production
-Ex: Sheehan’s syndrome
-Hypogonadotropic hypogonadism

Compartment 4:
Disorders of hypothalamic factors
-No GnRH so no stimulation of FSH and LH release
-No secondary sex characteristics
-Hypogonadotropic Hypogonadism
-Ex: Kallman’s syndrome