Gynae Amenorrhea

Question 1

Define primary amenorrhea vs secondary amenorrhea

Answer 1

Primary: Definition: the absence of menarche at 15 years of age despite normal development of secondary sexual characteristics, or absence of menses at 13 years of age in female individuals with no secondary sexual characteristics

Secondary: Definition: the absence of menses for more than 3 months in individuals with previously regular cycles, or 6 months in individuals with previously irregular cycles

Question 2

What are hypothalamic causes of primary amenorrhea

Answer 2

Syndromes due to hypogonadism which causes decreased fsh and lh

• congenital gnrh deficiency which may be isolated or associated with conditions such as prader willi and LAURENCE-MOON-BIEDL OR KALLMANNS SYNDROME (gnrh def. +anosmia)
• severe stress
• idiopathic delay of puberty
• hypothalamic failure due to disease of hypothalamus for eg infection(encephalitis) or tumour
• weight loss

Question 3

Pituitary causes of primary amenorrhea

Answer 3

Hyperprolactinemia- prolactin suppress gnrh synthesis.. seen in pituitary Adenomas or prolactinoma

Pituitary failure due to destruction or compression for eg due to tumour of pituitary itself (craniopharyngioma) or nearby growth (internal carotid artery neoplasm)

Question 4

What is the most common cause of primary amenorrhea

Answer 4

Turner syndrome (gonadal dysgenesis)

Question 5

Describe utero vaginal agenesis as a cause of amenorrhea

Answer 5

Causes primary amenorrhea

This is due to problems with genital tract/Müllerian duct.

Utero vaginal agenesis- the function of the HPO axis is normal and development of secondary sexual characteristics is normal but NO uterus so no menstruation

Question 6

Describe androgen insensitivity syndrome as a cause of amenrrhea

Answer 6

46XY
Patient genetically male but phenotypically female
Absence of androgen receptors so they do not respond to normal conc. of testosterone