Menstrual disorders Flashcards
What is primary amenorrhea?
No menarche by 15y/o w/ signs of puberty
OR
No menarche and no signs of puberty by 13y/o
What is the MC genetic cause of primary amenorrhea?
Turner’s syndrome
What is the 1st and 2nd MC causes of primary amenorrhea?
1- Chromosomal abnormalities causing gonadal dysgenesis (Turners)
2- Hypothalmic hypogonadism
If you have a patient with primary amenorrhea and low body weight what are you thinking is the cause
hypothalmic dysfunction
The following are possible causes of what?
- Chrom abnormalities causing gonadal dysgenesis
- Hypothalmic hypogonadism (functional/hypothalmic amenorrhea, tumors, hyperprolactinemia, hypothyroid)
- Mullerian agenesis
- Transverse vag septum
- Imperforate hymen
- Pituitary dz
- Androgen insensitivity syndrome
Primary amenorrhea
If you have a patient with primary amenorrhea with cyclic pelvic pain and a perirectal mass, what are you thinking is the cause?
imperforate hymen
Primary amenorrhea:
What is functional/hypothalmic amenorrhea associated with?
eating disorders, times of extreme stress, excessive exercise, etc
What 5 labs should be ordered to evaluate for the cause of primary amenorrhea?
- HCG!!!!!
- Serum FSH/LH
- Serum prolactin and TSH
- Serum testosterone
- +/- Karyotype
What does an elevated FSH in a person with primary amenorrhea indicate?
Gonadal dysgenesis
What does an decreased or normal FSH in a person with primary amenorrhea indicate?
Hypogonadotropic hypogonadism
What are the 2 possible causes of a person with primary amenorrhea and normal puberty?
- Outflow tract obstruction
- H-P-O axis dysfunction
What are the 4 possible causes of primary amenorrhea w/ delayed puberty?
- Gonadal dysgenesis
- Mullerian agenesis
- Physiologic delay of puberty
- Genetic abnormality
What is secondary amenorrhea?
No menses x3 mo if previously regular cycles
OR
No menses x6mo if previously irregular cycles
What is the MCC of secondary amenorrhea?
Pregnancy!!
Then PCOS
If you have a patient with secondary amenorrhea and they have a history of uterine surgical procedure or infection, what shoudl you be thinking is the cause?
Asherman’s syndrome
If you have a patient with secondary amenorrhea along with worsening acne, weight gain and hirsutism, what shoudl you be thinking is the cause
PCOS
Hypothyroidism
If you have a patient with secondary amenorrhea along with HA, visual changes and nipple discharge what should you be thinking?
Pituitary disease/tumor
Sheehan Syndrome