OnlineMedEd: Gynecology - "Secondary Amenorrhea"

Question 1

What are the most common causes of secondary amenorrhea?

Answer 1

1) Pregnancy
2) Hypothyroidism
3) Prolactinemia
4) Drugs
5) HPO axis defects

Question 2

By what mechanism does hypothyroidism lead to amenorrhea?

Answer 2

Low T4 leads to high TRH. TRH stimulates the release of prolactin.

Question 3

List the things that can disrupt the hypothalamus.

Answer 3

• Stress
• Anorexia
• Exercise

Question 4

List the things that can disrupt the anterior pituitary.

Answer 4

• Sheehan’s
• Apoplexy
• Prolactinoma

Question 5

List the things that can disrupt the ovary.

Answer 5

• Premature ovarian failure
• Menopause
• Savage syndrome

Question 6

List the things that can disrupt the endometrium.

Answer 6

• Asherman syndrome (D&C, deliberate procedures)

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Question 7

How do you workup secondary amenorrhea?

Answer 7

Start from the “bottom” up:

1) Progesterone challenge – this tells you if she has proliferated endometrium but no progesterone (i.e., PCOS)
2) Combined endometrium and progesterone challenge – this tells you if they have basement endometrium to work with (i.e., that they don’t have Asherman)
3) Test LH, FSH, and TSH
4) Brain MRI

Question 8

__________ syndrome presents with folicles in the ovary in a woman who does not bleed with progesterone withdrawal.

Answer 8

Savage

It’s like menopause but with follicles. Treat with HRT.