Lecture 4 - Menstrual Probs Flashcards
Amenorrhea
absence of menses
this is a symptom, not a dz
What are the stages of puberty?
Thelarche (breast development)
Pubarche (axillary and pubic hair growth)
Accelerated Growth
Menarche (first menses)
Primary Amenorrhea
absence of menarche by age 16 in presence of normal pubertal development
OR
absence of menarche by age 14 years in absence of normal pubertal development
OR
absence of menarche 2 years after completion of sexual maturation
When does typical menarche start?
11-13 years old
estrogen dependent
How much blood is loss during menstruation?
<80mL
What 3 three questions are you aiming to answer when examining a pt with primary amenorrhea?
1) Do they have secondary sexual characteristics?
2) Are all reproductive organs present?
3) Is there an obstruction to menstrual flow?
What history is important to ask about in regards to primary amenorrhea?
Childhood chemotherapy or radiation exposure
pubertal development
sexual activity
contraceptive use
athletic training
weight change
family hx - when family members started their menarche
autoimmune dz
Which labs should you run for pts with primary amenorrhea?
B-hCG FSH (high indicates ovarian failure, low indicates hypothalamus/pituitary disorders) Prolactin TSH Karyotype
What is the most important step in evaluation of amenorrhea?
determine by PE or US if uterus is present
Poll everywhere questions
go back and panopto
What can cause ovarian failure?
Gonadal dysgenesis
Turner’s syndrome
What is the MC cause of primary amenorrhea?
Gonadal dysgenesis
decrease in estrogen
increase in LH and FSH
Gonadal Dysgenesis
MC cause of primary amenorrhea decrease in estrogen increase in LH and FSH underdeveloped ovaries normal internal and external female genitalia
Congenital - Turner’s Syndrome (45 XO)
Acquired - chemo/radiation
Turner’s Syndrome
45XO
partial/complete absence of X chromosome
no ovaries-fibrous band of tissues “gonadal streak”
Poor breast development
Primary amenorrhea
short stature, webbed neck, infertility, hear defects (coart of aorta), learning disabilities
dx: karyotype
management: estrogen replacement
cyclic progesterone to induce menses
How do you dx Turner’s syndrome?
Karyotype
How do you manage Turner’s syndrome?
estrogen replacement
cyclic progesterone to induce menses
Mullerian Ageneiss
Congenital malformation of genital tract normal XX karyotype no uterus shortened vagina ovulation occurs normal hormone levels
management: surgical reconstruction of vagina
AIS
androgen insensitivity syndrome
genetically male
testosterone is secreted - target cells lack receptors - no masculizing effects occur
46XY - X linked recessive
lack of androgen receptors
primary amenorrhea with normal breast development
absent uterus, short vagina, +testes present
complete (female external genitalia) vs partial
increase testosterone (to male levels)
tx: remove testes after puberty
estrogen replacement after puberty
gender assignment