Menstrual Irregularities

Question 1

What is the Absence of menstrual bleeding?

1) What are the primary parameters?
2) What are the secondary parameters?

Answer 1

Amenorrhea

1) Primary - No menses 1a) by age 16 in the presence of normal secondary sexual characteristics
1b) by age 13 in absence of secondary sexual characteristics
1c) within 2 years of thelarche

2) Secondary: Absence of menses for at least 6 months in women who were previously menstruating

Question 2

What are the times what woman lack of menses? (Pathological symptom, not a Dx)

Answer 2

Pre-pubertal
Gravid
Lactating
Post-menopausal

Question 3

What generally causes Primary Amenorrhea?

What is the leading cause?

What are other causes?

Answer 3

Usually d/t genetic or anatomic abnormality
50% chromosomal abnormalities (gonadal failure) like Turner Syndrome (45,X)
20% hypothalamic hypogonadism incl functional
15% absence of uterus,cx a/o vagina, muller.agen
5% transverse vag septum/imperf. hymen
5% pituitary disease
Remaining 5% combination of disorders (PCOS, CAH, AIS)

Question 4

What causes Functional (non-pathologic)Amenorrhea?

What can contribute to this cause?

Answer 4

Abnormal GnRH secretion - Low gonadotropin levels, absent surges, etc, ie non-ovulatory.

FSH usually in low/normal range

Contributing factors - Stress, eating disorders, excessive exercise, Wt loss or wt

Can also be source of secondary amenorrhea.

Question 5

What is the female athletic triad?

Answer 5

Female athlete triad is a syndrome in which eating disorders (or low energy availability), amenorrhoea/oligomenorrhoea, and decreased bone mineral density (osteoporosis and osteopenia) are present.