Secondary Amenorrhea Flashcards
Definition of 2ndary Amenorrhea
Any repro age person w 2ndary menorrhea, suspect
Test for pregnancy with
Intrauterine adhesions aka
lining of uterus adheres together, preventing
Absence of periods for 6m+
Pregnancy
UPT, Beta HCG
Ashermans Syndrome
Shedding of endometrial lining
MCC of IUA is ___ assc w
Or evacuation of live/dead ___ by mech means
also w post partu,/post abortal
also occurs after ___ or (D/C) of non pregnant women
Rare cause is
endometrial curretage, preg
fetus
curettage
C section, dilation/curettage
severe infection
Dx IUA ___ via __
TX ___ to transect scar tissue
Follow w ___ x 7 days
____ to stimulate endometrial growth
direct visualization, hysteroscopy
hysteroscopy
IU Pediatric foley
High dose Estrogen
Brain lesions that alter ___ can cause 2ndary amenorrhea
Lesion + dec GnRH sec, pt has dec
If brain lesion expected, dx modality of choice is
Tx
GnRH release
estrogen levels
imaging
depends on lesion
Meds that alter ___ can result in amenorrhea
Prolactin alters ____, leading to abnormal ___ release
Pt presents to amenorrhea, make sure to take a detailed hx of
Stressful situations can inhibit ___ leading to ___
Situations include ____ in enviro, ____, extreme ___
prolactin levels
GnRH sec, FSH/LH
medication
GnRH prod, hypothalamic amenorrhea
sudden change, excess exercise, wl
Hypothalamic amenorrhea occurs when ____ stops producing GnRH
leads to dec ___ which stops periods
Tx starts w
If hypoestrogenic, tx w
thalamus
FSH/LH
reverse cause
estrogen replacement
Leadomg cause of infertility/metabolic disorders in women
Clinical/laboratory evidence of ___
10 or more ___ seen on ultrasound
Presents w ___ or ___
Most characteristic feature is
inc ___ acts on theca cells of ovary to inc prod of
Inc androgens inhibit steroid ___ on the hypothalamus, leading to inc ___ via inc/shorter GnRH sec
PCOS
elevated androgens
peripheral follicles
oligomenorrhea, anovulation
hyperandrogenism
LH sec, androgens
NF, LH pulsility
Shorter GnRH preferentially promotess production of ___ and dec in ___
Results in an ___ LH/FSH ratio
Inc androgens leads to __, ___, _____
all 3 contribute to
Hyperandro/Hyperinsulin/Obesity dec __, inc amount of circulating
continues to __ the cycle
LH, FSH
inc
obesity, visceral fat deposition, dyslipidemia
insulin resistance
sex hormone binding globulin, testo
exacerbate
Polycystic ovaries are ___ and not __
Cysts are ___ arrested in development
Inc androgen affects the ovary to inc ___ and ___ by making the ovary more responsive to
Oligo/anovulation can promote ___ in GnRH via a reduction in circ ____
Progesterone is released from ___ during ovulation
Progesteron acte to slow ___
in PCOS, a dec in ovulatory events causes dec in circ __
common, dx
antral follicles
follicle number/size, FSH
rapid pulsations, Progesterone
CL
GnRH pulsation
progesterone
Work PCOS rule out
Rule out hormonal causes w __, ___. ____
T__, D___, 17__ for hyperandrogenism
T____ to look for polycystic ovaries
TX preventative care w
Menstrual reg- preffered method uses ___ to dec
such as
if contraceptive needed, use
___ for endometrial suppression
other causes
TSH, A1c, prolactin
Testo, DHEAS, 17OHP
Transvaginal ultrasound
Diet/exercise
combined OC, SHBG
OCP, vaginal ring, patches
progesterone IUD
progesterone
Fxnal hypothalamic amenorrhea includes some indiv w ____ but do not ingest ____, do not have __, or ___
Hyperprolactinemia caused by M/M H R H Neuro stim such as M
2ndary amenorrhea, drugs/stress/anomalies
Micro/Macroadenoma HypoT Renal failure Hepatic failure chest wall injury, nipple massage Meds
High prolactin inhibits ___ prod in hypothalamus
thus, labs show ____, causing anovulation/amenorrhea
If asx adenoma, get yearly ___ and __ level to monitor
DA ag such as __ and ___ (assc w ___)
Tx for those not tolerating/responding to meds
GnRH
low GnRH/FSH/LH
MRI, prolactin
Bromocriptine, Cabergoline (cardiac valvuloplasty)
Transsphenoidal surgery/radiation
Menopause is the absence of a period for > __ in absence of other causes
Avg age
On lab eval, pt has inc __ and low __
Tx consists of tx ___ and ____
1 yr
51
FSH, estrogen
hot flashes, night sweats
POF has ___ develop of amenorhea
__ high, ___ low
Karyotype if age less than __ to rule out genetic cause
Tx w __ and ___ prev
Can be fertile w ____ w or wo donor egg
Spontaneous
FSH, LH
30
HRT, osteoporosis
IVF
HypoT- low T3/T4 allows for release of
High prolactin inhibits ___ and ___ ___ leading to amenorrhea
Tx
TRH, TSH, prolactin
GnRH, LH/FSH
levothyroxine
