Dunn: Amenorrhea, etc. Flashcards
hematocolpos
imperforate hymen
–> retained menstruation in a female who has reached puberty
Thelarche
is the onset of female breast development.
Pubarche
is the appearance of sexual hair.
Adrenarche
is the onset of androgen-dependent body changes such as growth of axillary and pubic hair, body odor, and acne.
Menarche
is the onset of menstruation.
Tanner stage - Breast
Stage 1: Prepubertal
Stage 2: Breast bud stage with elevation of breast and papilla; enlargement of areola
Stage 3: Further enlargement of breast and areola; no separation of their contour
Stage 4: Areola and papilla form a secondary mound above level of breast
Stage 5:Mature stage: projection of papilla only, related to recession of areola
Tanner stage-Pubic Hair
Stage 1: Prepubertal (can see velus hair similar to abdominal wall)
Stage 2: Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or along labia
Stage 3: Darker, coarser and more curled hair, spreading sparsely over junction of pubes
Stage 4: Hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs
Stage 5: Adult in type and quantity, with horizontal distribution (“feminine”)
Primary amenorrhoea
Failure to menstruate by age 16
Secondary amenorrhoea
Absence of menstruation for >6 months
Primary Amenorrhea – Common Causes
Constitutional delay Chromosomal e.g. 45XO, 46XY Pituitary tumour e.g craniopharyngioma Congenital adrenal hyperplasia Genital tract anomaly (Plus all the causes of secondary amenorrhoea)
Primary Amenorrhoea – Clues to diagnosis
Constitutional delay
Chromosomal e.g. 45XO, 46XY Pituitary tumour e.g craniopharyngioma Congenital adrenal hyperplasia Genital tract anomaly Secondary sexual characteristics slow Stigmata of Turners S
Visual field defect
Virilisation
Imperforate hymen
Primary amenorrhoea – Diagnostic steps
Height, weight and BP Evaluate secondary sexual characteristics Look for signs of androgen excess Do visual fields Chromosomes FSH, LH and E2 Maybe HydroxyPROG, Androgens, PRL, TSH Maybe CT pituitary
Secondary amenorrhoea – Common causes
Hypothalamic
- “Stress”
- Weight loss/gain (Anorexia)
- Post Pill and Depo Provera
PCO Syndrome (1:20 women)
Premature Menopause
- Idiopathic
- Iatrogenic
- Resistant ovary syndrome
Hyperprolactinaemia
- Physiological
- Pituitary adenoma
- Drug-induced
Remember also pregnancy & progestins!
Secondary amenorrhoea – Uncommon causes
Kallman’s Syndrome Sheehan’s Syndrome Cushing’s Syndrome Other Pituitary Tumors Post encephalitis/trauma Thyroid disease Androgen-producing Tumors Asherman’s Syndrome (infection/ miscarriage/ termination of pregnancy/ post-partum hemorrhage curettage too aggressive --> endometrium collapses on itself)- give high doses of estrogen, put in IUD
Cervical stenosis
Secondary amenorrhoea – Clinical evaluation
History: Life events Weight/Exercise history Pregnancy Drugs Galactorrhoea Hot flushes (premature ovarian failure) Headaches/Vision
Examination: Height/Weight BP 2ary Sexual characteristics Hirsutism/Virilisation Visual fields Galactorrhoea Genital tract oestrogenisation Cervical stenosis
Secondary amenorrhoea - primary tests
FSH LH E2 TSH PRL Androgens Ultrasound pelvis Visual fields Progesterone challenge test
Secondary Tests: CT Pituitary Other pituitary hormones Dexamethasone suppression HydroxyPROG Hysteroscopy or HSG Laparoscopy & ovarian biopsy
