OBGYN- Amenorrhea Flashcards
Define Amenorhea
Amenorrhea is the absence or cessation of menstruation
types of amenorhea
Primary
secondary
Define Primary Amenorrhea
Primary amenorrhea is defined as no menses by age 14 years associated with the absence of the development of secondary sexual characteristics,
or no menses by age 16 years even in the presence of normal secondary sexual characteristics
Define secondary amenorrhea
Secondary amenorrhea is defined as the absence of menses for a period of three cycles, or 6 months in a woman with previously normal menstruation
Cause of primary amenorrhea?
Primary amenorrhea is often caused by chromosomal irregularities that lead to ovarian insufficiency (e.g., Turner syndrome) or anatomic abnormalities (e.g., Müllerian agenesis).
Disorders arising from the hypothalamus, anterior pituitary, ovary, and genital tract make up the pathological causes of amenorrhea.
extreme weight loss or gain
why amenorhea during lactation ?
In the case of lactation, milk production r_elies on a rise in prolactin_, which inhibits GnRH release thereby preventing normal ovarian stimulation.
impairement of the GnRH pulsatile secretion occurs form ———————————————————-
reversible condition such as weight loss related amenorrhea, exercise related amenorhea. This cause functional hypothalamic amenrhea
What is functional hypothalamic amenorhea?
low /normal level of FSH and LH; and low estrogen
normal prolactin level
normal imaging of the pituitary foss
Mensturation is regulated by
healthy level of fat- healthy body
Who are mostly impacted by
Calorie restricted diet
athlete ( strenous activities
Athlete women are risk for———————-
disordered eating
amenorhea
osteoporosis
Most common pathological cause of secondary amenorhea
result of PCOS
hypothalamic amenorhea
hyperprolactinemia
primary ovarian insufficiency
PITUITARY DISODER- High leve of prolacti level in pituitary cause
secondary amenoreah
tumors in anterior pituitary gland cause high prolactin level and —————————————
galactorreha
medication that increase prolactin level are——————————
antihistamine
phenothiazide
methyl dopa
metoclopromide
cimetidine
Sheehan’s syndrome
necrosis of anterior pituitary gland
OVARIAN DISORDER- Premature ovarian failure is defined as?
cessation of ovarian function before the age of 40 years
Characterstics of POF are
amenorhea
increased gonadotropin level
Polycystic ovary syndrome - Ultrasound
enlarged ovaries with fluid filled
what are elevated and decreased in PCOS?
Elevated- ——- LH, Testosterone, androstetenedione and dehydroepiasndrosterone, prolactine level
normal—————— Estrogen and FSH are normal
Hallmark of PCOS
Androgen biosynthesis
insulin resistance
How PCOS is diagnosed?
Should have 2/3 criteria
- light or irregular menses
- Evidence of hyperandrogenism
- cysctic appearing in US examination
Asherman’s syndrome
Post partum hemorrhage leading to curatage/ dialattion that cause scaring to endometrium. This leads to amenorhea
Hidden menstruation
Cervical stenosis that blocks the menstrual flow.
cause of cervical stenosis
- infection
- Imperate hymen
- transverse vaginal septum
Headache with galactorhea and visual disturbance is —————-
pituitary tumor
Cyclic abdominal pain without menstruation can be diagnosed as - —-
imperforate hymen
Amenorehea with Truncal obesity ( abdominal fat) and Increased BMI is diagnosed
Cushing syndrome
PCOS
hirsutism, acanthosis nigricans, acne
- Purple strae
- webbed neck, widely spaced nipple or short stature
PCOS
- Cushing syndrome
- Turner syndrome
Wowen physical examination indicate hyperadrogenic state, what labs should you order
Orderfree and total testosterone and DHEA concentration
diagnostic test for amenorhea
- Progestational challenge test
why progestational challenge test
- To evaluate the endogenous estrogen present
- to assess outflow tract abnormalities
How progesterone challenge test is done?
The progesterone challenge test is done by giving oral medroxyprogesterone acetate (Provera) 10 mg daily for 5-10 days or one intramuscular injection of 100-200 mg of progesterone in oil. A positive response is any bleeding more than light spotting that occurs within 2 weeks after the progestin is given.
If there is no bleeding after progesterone test, what it is?
outlflow problem and inadequate estrogen production
Step 2 diagnostic wok up
administering second round of estorgen/progestin challenge tets.
what is estrogen/progestin challeneg test
Adminitering estrogen/progestin— if bleed what is that?
problem with either HPO axis or ovary
what is estrogen/progestin challeneg test
Adminitering estrogen/progestin— if does not what is that?
Problem with HPO axis or Ovary
STEP 3- What diagnostic test is done?
The gonadotropin assay ( FSH and LH ) is drawn and sent fro laboratory analyiss
