Sept5 A2-Oligomenorrhea_Amenorrhea Flashcards
primary amenorrhea def
no prior menses
secondary amenorrhea def
menses stopped
oligomenorrhea def
<9 menstrual cycles per year
causes of oligo, ameno
- H
- P
- O not responding to HP
- uterus not responding to P and E
- distal problem (vagina). like imperforate hymen
some causes of primary amenorrhea
- 45,X and variants (Turner)
- Mullerian agenesis
- Eating disorders, stress, excess exercise
some causes of secondary ameno
- PCOS (chronic anovulation)
- Sheehan syndrome
- high prolactin level
top ddx causes of primary amenorrhea
- primary POF (hypergonadotropic hypogonadism)
- HH (hypogonadotropic hypogonadism)
- PCOS
- hyperPRLemia
- weight related
top ddx causes of secondary amenorrhea
- PCOS
- POF
- hyperPRLemia
- weight
- HH
- exercise induced
top ddx causes of anovulatory infertility
- PCOS
2. POF
POF sx
- amenorrh, oligomeno
- hot flushes
- vaginal dryness
- infertility
POF labs
- high FSH (bc no estradiol and inhibin B)and LH
- low AMH
- low antral follicular count (AFC)
AFC in POF vs PCOS
POF = low PCOS = high
(imp) most common cause of POF caused by gonadal dysgenesis
Turner syndrome
(imp) Turner nuances
- pure turner
- some cells X, some XX
- some cells X, some cells XY
- all females*
(imp) most common PE featurs of Turner
- webbed neck
- low stature
- brown spots nevi
- folds of skin in the neck
how Turner dx
karyotype
Turner problems long term
no P and E made so increased risk of CVD and osteoporosis
turner tx
HRT
mullerian agenesis (MRKH syndrome) def
uterus, cervix and upper part of vagina are absent
PCOS def
increased AFC, lot of follicles, big swollen ovaries, follicles pockets
NO CYSTS
clinical pres of PCOS
- obesity
- insulin resistance (diabetes and acanthosis nigricans)
- hirsuitism
- acne
- oligo, amenor
- lean PCOS (not all sx, still periods, normal weight)
criteria of PCOS dx
2 of the following 3:
- > 12 follicles on one ovary on US
- ameno, oligorrhea
- hyperandrogenism (clinical evidence lab evidence)
main factor in PCOS to act on and why
- reduce obesity
- bc main pathophgy is obesity causing insulin resistance leading to anovulation via diff steps. this anovulation is also caused by high androgen activity
consequences of PCOS
- infertility
- chronic anovulation (unopposed E on endometrium = endometrial hyperplasia, ca)
- long term (metabolic syndrome, glucose intolerance, CVD, obesity, dyslipidemia, OSA, FLD)
