Amenorrhea/Menopause

Question 1

PRIMARY AMENORRHEA

Answer 1

No menses by age 14 combined with absence of secondary sex characteristics
OR
No menses by age 16 regardless of development of sex characteristics

Question 2

SECONDARY AMENORRHEA

Answer 2

Absence of menses for 6 months or 3 cycle intervals in a woman who has previously menstruated

Question 3

Asherman’s Syndrome

Answer 3

Most Common Secondary

Endometrial destruction/scarring from infection or D&C

Question 4

Mullerian Anomalies

Answer 4

Most cases of outflow obstruction result from congenital abnormalities in development of the mullerian ducts
Most Common Primary:
Imperforate Hymen
Absence of cervix, uterus, or endometrium, obliteration of vaginal orifice

Question 5

Androgen Insensitivity

Answer 5

Genetic male with lack of functioning testosterone receptors

Question 6

Premature ovarian failure

Answer 6

Primary vs. secondary amenorrhea with absence of, partial, or full sexual development
Dx-FSH level, autoimmune investigation

Question 7

Polycystic ovarian syndrome

Answer 7

Glucose intolerance
Hyperinsulinemia
Hyperandrogenism
Anovulation causes amenorrhea, oligomenorrhea, or DUB

Question 8

Sheehan’s Syndrome

Answer 8

Postpartum pituitary necrosis
Due to obstetrical hemorrhage and shock
Failure of lactation and loss of body hair

Question 9

Initial workup of amenorrhea

Answer 9

TSH level
elevated=hypothyroidism
Prolactin level
elevated=pituitary adenoma
Progestational challenge
withdrawal bleed= anovulation
No bleed=hypoestrogenic or anatomic abnl (asherman’s or outflow obstruction)
E/P cycle
FSH

Question 10

Age at menopause

Answer 10

Average age 51.5 years

Range of 48-55 years

Question 11

vaginal changes from menopause

Answer 11

Decreased lubrication
loss of ruggae and elasticity
thinning of epithelium
dyspareunia
post-coital bleeding

Question 12

menopause treatment

Answer 12

Correct calcium and vitamin D deficiency
weight-bearing exercise
alendronate and calcitonin
hormone replacement therapy
selective estrogen receptor modulators (SERMs)

Question 13

Osteoporosis treatment

Answer 13

in addition to prevention measures: 
	Zoledronic acid (Reclast) IV annually
Bisphosphonates 
Alendronate (Fosamax) 
Risedronate (Actonel) 
Ibandronate (Boniva) 
Calcium 1200 mg/daily and Vitamin D 400-800 IU/daily
Selective estrogen receptor modulators

Question 14

Selective Estrogen Receptor Modulators

Answer 14

Raloxifene (Evista), Tamoxifen 
No increased risk of uterine cancer
Decreased risk of breast cancer
no adverse effect of bleeding
won’t alleviate menopausal symptoms
May cause hot flushes
Increases risk of stroke
Helps prevent osteoporosis