Amenorrhea & Ovulation Flashcards
Primary vs. Secondary Amenorrhea?
Primary:
No menses in a women who has never menstruated by
- 13 w/out secondary sexual characteristics or
- 15 w/ normal secondary sexual characteristics
Secondary:
Absence of menses after establishment of menstruation for reasons other than pregnancy, lactation or menopause.
- must be absent for at least 3 of previous menstrual intervals or 6 months
3 common, “normal causes” of Amenorrhea?
1) Pregnancy
2) Normal Menopause
3) Lactation
Compartment I - causes of Amenorrhea?
Asherman’s Syndrome (7%)
Compartment = Uterus → Menses
Compartment II - causes of Amenorrhea?
Primary:
- Gonadal dysgenesis (0.5%)
- Ovarian failure/destruction (10%)
- – (Premature Ovarian Failure)
Secondary: Related to multiple karyotype abnormalities
Compartment = Ovary (E & P)
Compartment III - causes of Amenorrhea?
Prolactinoma (7.5%)
- also: Sheehan’s syndrome, Empty Sella syndrome, Hemochromatosis, & Sarcoidosis
Compartment = Ant. Pituitary (LH, FSH, TH)
Compartment IV - causes of Amenorrhea?
- Anovulation (28%)
- Anorexia (10%)
- Chronic Stress (10%)
When to think Amenorrhea is caused by Compartment IV issue?
– Normal Pituitary (Prolactin, TH)
– Low to normal gonadatropins
– Failure to demonstrate withdrawal bleed
(Dx of exclusion)
How to Anorexia & Stress cause Anovulation?
↑ CRH & ↑ Endorphins → ↓GnRH, ↑Cortisol, ↓TSH
How does a Prolactinoma cause Amenorrhea?
Increased prolactin causes increased dopamine which suppresses GnRH
Empty Sella Syndrome - what is it?
Congenital incompleteness of the diagphram of the sella turcica
Definition of “Premature Ovarian Failure”?
Amenorrhea with persistent elevated FSH levels and hypoestrogenism prior to the age of 40.
This affects 1% of women.
Compartment II- Iatrogenic causes?
Chemotherapy or radiation therapy
(w/ chemo, Alkylating agents, specifically)
- Karyotype should be done in women <30 yrs b/c likely chromosomal issue w/ them
(Turners, Mosaicism, etc.)
Premature Ovarian Failure - Tx?
Counselling is critical. Women lose their natural fertility. Will need oocyte donors or surogates.
Hormone replacement is critical for bone protection
GnRH, LH, FSH, E,P all being produced in a regular, orderly fashion, yet still no menses…
Where is the problem?
Compartment I - Uterus
can be absent, abnormal, or have blocked outflow
Asherman’s Syndrome - Tx?
Surgery – may need multiple procedures to produce desired menses and allow for future pregnancies
Asherman’s Syndrome - how is Dx made?
Hysterosalpingogram or saline u/s
What is Asherman’s Syndrome?
Presence of intrauterine adhesions, typically caused by surgery (iatrogenic)
What is Mayer-Rokitansky- Kuster-Hauser syndrome?
Complete vaginal agenesis
- also in 95% of these cases the uterus is also absent
- Ovaries typically normal
Mayer-Rokitansky- Kuster-Hauser syndrome — Dx?
Physical exam or Ultrasound
MRI if ultrasound not available
Most common obstructive condition of the female reproductive tract?
Imperforate Hymen
Imperforate Hymen - pathology?
Inferior aspect of the vaginal plate fails to open – causing this defect
Imperforate Hymen - Dx?
Dx typically made at birth
- infants will have mucocopos
- if not @ birth, will be diagnosed at puberty with hematocolpos (pt will have pain and will see a bulging blue mass on vaginal exam)
Female patient presents @ puberty w/ pain & a bulging blue mass on vaginal exam (hematocolpos). What is likely Dx?
Imperforate Hymen
though this is typically diagnosed @ birth
Imperforate Hymen - Tx?
Surgery
