Chapter 21 Amenorrhea

Question 1

Amenorrhea definition:

Answer 1

absence of menses.

Question 2

primary amenorrhea

Answer 2

absence of menses by age 16 or no menses by 4 years after thelarche (onset of breast development)

Question 3

secondary amenorrhea

Answer 3

absence of menses for 3 menstrual cycles or total of 6 months in women who have previously had normal menstruation.

Question 4

primary amenorrheacauses:

Answer 4

congenital and chromosomal abnormalities
hormonal aberrations
hypothalamic-pituitary disorders

divided into 3 categories:

1. outflow tract obstruction
2. end-organ disorders
3. central regulatory disorders

Question 5

Outflow tract anomalies:

Answer 5

imperforate hymen. after time, pts present with pelvic or abdominal pain from accumulation and subsequent dilation of the vaginal vault and uterus by menses. treatment of imperforate hymen is surgical.

Question 6

End organ disorders

Primary ovarian failure results in low levels of estradiol but elevated levels of gonadotropins . This is termed

Answer 6

Hypergonadotropic hypogonadism

Question 7

Savage syndrome

Answer 7

Failure of ovaries to respond to follicle stimulating hormone fsh and lute ionizing hormone lh secondary to a receptor defect

Question 8

Turner syndrome 45 xo ovaries undergo

Answer 8

Rapid atresia that by puberty there are usually no primordial oocytes

Question 9

Hypothalamic disorders
Pituitary will not release fsh and lh if hypothalamus is unable to produce gonadotropin- releasing hormone. Anovulation will result from this hypo gonadotropin hypogonadism.

Answer 9

Kallmann syndrome

Question 10

Pituitary disorders usually secondary to hypothalamic dysfunction. May be causes by tumors, infiltration of pituitary gland, or infarcts of the pituitary

Answer 10

True

Question 11

Secondary amenorrhea absence of menses for more than 6 months or for the equivalent if three menstrual cycles

Answer 11

Ovarian failure may result from ovarian torsion, surgery, infection, radiation, or chemotherapy. Any time woman has menopause before age 40. PTs with either idiopathic pof or a known cause of early ovarian failure are generally treated with supplemental estrogen to decrease risk of cardiovascular disease and osteoporosis

Question 12

Polycystic ovary syndrome aka

Answer 12

Stein leventhal syndrome

Question 13

Diagnosis of pcos

Answer 13

Oligo or anovulation, clinical or laboratory evidence of hyperandrogenism may include excessive hair growth (hirsutism) and male pattern hair loss as well as acne

Question 14

Hyperprolactinemia associated amenorrhea . Excess prolactin leads to amenorrhea and galactorrhea.

Answer 14

True

Question 15

Hyperprolactinemia has several rtiologies.

Answer 15

Primary hypothyroidism that leads to elevated tsh and try can lead to hyperprolactinemia.

Medications - half ok, reglan, phenothiazine , tricyclics antidepressants, estrogen, mono amine oxidase inhibitors, and opiates.

Prolactin she creating pituitary adenoma leads to elevated prolactin levels

Pregnancy

Breastfeeding

Question 16

Any pt with hyperprolactinemia should have imaging studies done to rule out prolactinemia

Answer 16

True

Question 17

Disruption of the hypothalamic pituitary axis common causes include

Answer 17

Stress, exercise, anorexia nervosa, weight poss

Question 18

Dx of secondary amenorrhea

Answer 18

R/o pregnancy
Tsh and prolactin should be checked to rule out hypothyroidism and hyperprolactinemia, both which can cause amenorrhea.
MRI can rule out hypothalamic or pituitary lesion.