Puberty and Menstrual Disorders 2 Flashcards
secondary amenorrhea- definition
-absence of menstruation for 6 months
causes of menstrual irregularity
- pregnancy
- endocrine causes
- acquired conditions
- tumors
Secondary amenorrhea- labs
- urine HCG
- TSH
- PRL
- FSH
Secondary amenorrhea- check what?
- TSH and PRL
- abnormal TSH- thyroid dz
- if normal- progesterone challenge test
Secondary amenorrhea- normal PRL, abnormal TSH
mild hypothyroidism
- assoc with oligomenorrhea
- tx should restore menses
Secondary amenorrhea- abnormal PRL
- hyperprolactinemia- most common sx is galactorrhea
- PRL > 100- prolactinoma (head MRI- pit adenoma, empty sella syndrome)
- PRL < 100- other causes- ectopic production
Secondary amenorrhea- PRL > 100
- microadenoma (<10 mm)- MRI- dopamine agonist
- macroadenoma (>10 mm)- dopamine agonist
Secondary amenorrhea- normal PRL and TSH- do what?
progesterone challenge test
- blood- normogonadotropic hypogonadism
- no blood:
- do estrogen/progesterone challenge test:
- blood- inc FSH and LH (hypogonadotropic hypogonadism); dec FSH and LH (hypogonadotropic hypogonadism)
- no blood- outflow obstruction
Secondary amenorrhea- progesterone challenge test
- blood- normogonadotropic hypogonadism- PCOS
- neg blood- estrogen/progesterone challenge test:
- if neg- outflow obstruction
- if positive- inc FSH and LH (hypogonadotropic hypogonadism); dec FSH and LH (hypogonadotropic hypogonadism)
Anatomic causes of secondary amenorrhea
- asherman syndrome
- cervical stenosis
Secondary amenorrhea- TSH and PRL normal- blood on progesterone challenge test
Normogonadotropic hypogonadism
- adrenal disorders- CAH, cushing’s, adrenal androgen secreting tumor
- ovarian- PCOS, sertoli-leydig cell tumor
- exogenous androgens
PCOS
- 10% of women of reprod age
- leading cause of female anovulatory infertility
- insulin sensitivity
- inc in T!!
- dx- 2 of 3: oligomenorrhea or amenorrhea; hyperandrogenism (LH to FSH 2:1); mult small cysts on US
PCOS- mech
- inc estrogen
- inc LH, dec FSH
- dec follicular maturation- chronic anovulation
- stim of stroma and theca- inc ovarian androgen- androgen excess
PCOS- sx’s, signs
- anovulation
- hyperandrogenism
- LH hypersecretion
- elevated T
- hirsutism, acne, menstrual dysfxn
- acanthosis nigricans
- chronic anovulation- inc risk of endometrial cancer!!
PCOS- tx
- weight loss
- oral contraceptives- suppress FSH and LH
- clomiphene citrate- induce ovulation
- spironolactone- competes for T binding sites
- insulin-sensitizing agents
Secondary amenorrhea- PCT neg- estrogen (PCT) positive- check what??
FSH and LH levels
- inc FSH and LH- hypogonadotropic hypogonadism- postmenopausal ovarian failure, premature ovarian failure
- dec FSH and LH- hypogonadotropic hypogonadism- check MRI (pit tumor)- anorexia, chronic illness, radiation, excessive exercise, malnutrition)
evaluation of pts with hyperandrogenism
- PCOS and late onset CAH- progress slowly
- neoplastic disorders- rapid virilization
- inc 17-hydroxyprogesterone- CAH
- cortisol- cushing syndrome
- prolactin and TSH- hyperprolactinemia and thyroid dysfxn
- glucose, lipid levels
- T and DHEA-S
primary amenorrhea
-no menstruation by 13 W/O secondary characteristics
OR
-age 15 WITH secondary characteristics
secondary amenorrhea
absence of menses for > 6 months
polymenorrhea
freq menses < 21 days
menorrhagia
excessive and/or prolonged bleeding (>80 mL and > 7 days) occurring at normal intervals
metrorrhagia
-irregular episodes of uterine bleeding
menometrorrhagia
heavy and irregular uterine bleeding
intermenstrual bleeding
scant bleeding at ovulation for 1-2 days
oligomenorrhea
-menstrual cycles occurring > 35 days, but less than 6 months
DUB (dysfxnal uterine bleeding)- structural causes?
PALM
- polyp
- adenomyosis
- leiomyoma
- malignancy and hyperplasia
DUB (dysfxnal uterine bleeding)- nonstructural causes?
COEIN
- coagulopathy
- ovulatory dysfxn
- endometrial
- iatrogenic
- not yet classified
DUB- dx evaluation
- office endometrial bx
- hysteroscopy directed endometrial sampling
